Emergency medicine clinics of North America
-
Emerg. Med. Clin. North Am. · Aug 2009
Management of pediatric tumor lysis syndrome in the emergency department.
Tumor lysis syndrome is most often seen after the treatment of blood and solid malignancies. The resultant hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia can lead to life threatening complications. Expeditious evaluation and therapy are paramount in preventing the most serious sequelae of acute renal failure and fatal dysrhythmias.
-
Neutropenic enterocolitis, also known as typhlitis or ileocecal syndrome, is a rare but important complication of neutropenia associated with malignancy. It occurs as a result of chemotherapeutic damage to the intestinal mucosa in the context of an absolute neutropenia, and can rapidly progress to intestinal perforation, multisystem organ failure, and sepsis. Presenting signs and symptoms may include fever, abdominal pain, nausea, vomiting, and diarrhea. Rapid identification by emergency physicians and timely, aggressive medical and/or surgical intervention are the cornerstones of survival for these patients.
-
Patients and families struggling with cancer fear pain more than any other physical symptom. There are also significant barriers to optimal pain management in the emergency setting, including lack of knowledge, inexperienced clinicians, myths about addiction, and fears of complications after discharge. In this article, we review the assessment and management options for cancer-related pain based on the World Health Organization (WHO) 3-step approach.
-
Emerg. Med. Clin. North Am. · May 2009
ReviewEmergent management of malignancy-related acute airway obstruction.
Acute obstruction of the airway in the emergent situation results from a wide variety of malignant and benign disease processes. Acute management involves establishing a secure and patent route for adequate gas exchange. This requires rapid determination of the location of the obstruction and nature of the obstruction followed by a thoughtful management approach based on findings. ⋯ For both the patient and the clinician, the presentation can be frightening, and advanced interventional pulmonary/endobronchial techniques are required to achieve prompt relief of symptoms. The alleviation of central airway obstruction by tumor is most often palliative, with improvement of quality of life the primary goal rather than cure. This review will cover covers an approach to the patient with airway obstruction that results from malignancy involving the trachea or proximal bronchial tree and affecting gas exchange.
-
Emerg. Med. Clin. North Am. · May 2009
Treating cancer patients who are near the end of life in the emergency department.
Cancer-related visits to the emergency department (ED) can be expected to increase in the next decade as the population ages. Some of the these patients and their caregivers will come to the ED without prior end-of-life care planning, and others will require modification of prior plans based on disease progression. In this article, we discuss some of these end-of-life issues related to and including those of legal documents, transmission of patient wishes, limiting factors in implementing those wishes, and the new horizon of palliative care in the ED.