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CHAPTER 98 ■ ONCOLOGIC EMERGENCIES
ALISA McQUEEN, ANDREW E. PLACE

GOALS OF EMERGENCY THERAPY
Every year in the United States, approximately 12,000 children and adolescents are
diagnosed with cancer and 2,300 children die of their disease or from side effects of
treatment. This chapter is organized into two major sections. The first section
reviews common presenting symptoms and emergency care considerations for a
child who presents to the emergency department (ED) with either a new cancer
diagnosis or recurrence of disease. This section is organized by diagnosis and by
location of malignancy. The second section addresses the management of
complications associated with common pediatric malignancies and their treatment.
The general approach to the pediatric oncology patient in the ED is outlined in
Table 98.1 . When taking a history from a pediatric oncology patient, exploring the
perspective of the patient and parents about the potential cause of the problem and
how the patient is doing is a crucial step in the evaluative process. A detailed
medication history is critical as patients are likely to be receiving multiple
medications (e.g., chemotherapy, antibiotics, antiemetics) with side effects which
may be contributing to their presenting symptoms. One last introductory principle is
to remember the extreme psychosocial stress that a pediatric cancer diagnosis places
on a family. The care of these patients requires the highest level of compassion and
professionalism.
KEY POINTS
The differential diagnosis of many common childhood complaints should
include malignant processes.
Prompt recognition of oncologic emergencies has been proven to have a
positive effect on outcomes.
Early consultation with a pediatric oncologist is highly recommended.
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