Emergency medicine clinics of North America
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The latest cancer agents, collectively known as cancer immunotherapy, have tremendously increased the armamentarium against cancer. Their targeted mechanisms seem ideal, but they do come with complications. As these therapies become more widespread, emergency physicians everywhere must be aware of the immune-related adverse events that can occur, and be ready to identify and coordinate treatment. This article provides the emergency physician with a brief introduction and overview of immunotherapy drugs and their complications.
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Pediatric patients with cancer, although rarely, do present to emergency departments for first-time diagnosis, as well as for complications of treatment. The presenting symptoms can be vague, so emergency physicians must maintain a high index of suspicion and be aware of guidelines to help direct appropriate care after an initial diagnosis. It is also necessary to know the complications of treatment. Although these patients often seek care in the institution where they receive treatment, many live far from these locations and may present to any emergency department in extremis.
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Superior vena cava syndrome occurs from obstruction of the superior vena cava. The most common cause is malignancy. Small cell lung cancer and non-Hodgkin lymphoma are the most frequent culprits. ⋯ Treatment in the emergency department is mostly supportive, with head elevation, oxygen, and steroids. Rarely, emergent airway issues and cerebral edema must be addressed. Definitive treatment includes radiotherapy, chemotherapy, and stenting.
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Emerg. Med. Clin. North Am. · Aug 2018
ReviewEmergency Medicine Evaluation and Management of Anemia.
Anemia is a common condition and is diagnosed on laboratory assessment. It is defined by abnormally low hemoglobin concentration or decreased red blood cells. Several classification systems exist. ⋯ Iron is an alternative treatment for patients with microcytic anemia owing to iron deficiency. Hyperbaric oxygen is an option for alternative rescue therapy. Most patients with chronic anemia may be discharged with follow-up if hemodynamically stable.