Pediatric emergency medicine trisk 2661 2661

SECTION I: INITIAL CARE OF THE CHILD WITH NEW OR
RECURRENT CANCER
Childhood cancer can present with nonspecific signs and symptoms that can overlap
with those of many childhood illnesses ( Table 98.2 ). Even when the chief
complaint is a localized symptom, disseminated disease may be present. Once the
diagnosis of cancer is suspected, the child should be referred to a center skilled in
the management of childhood malignancies. However, supportive care for lifethreatening complications may need to be initiated prior to referral. After
stabilization, the specific workup, including obtaining tissue for diagnosis, should be
carried out under the direction of a pediatric oncologist so that optimal information
can be obtained. No patient should be discharged from the ED without a specific
plan for definitive diagnosis and management.
The possibility of a cancer diagnosis usually causes fear and distress and requires
empathic care and support from the health care team in the ED. The emergency
clinician should describe the findings and concern about possible cancer to the
patient and family. It is appropriate to reassure them that most childhood cancer is
curable. Specific details about diagnosis, treatment, and prognosis are best deferred
to the pediatric oncologist once definitive information is available.

LEUKEMIA
Goals of Treatment
The primary goal of emergency management of these patients is rapid assessment
and correction of hematologic, metabolic, infectious, and cardiorespiratory
complications. After a patient has been stabilized, further diagnostic evaluations can
be performed.