Pediatric emergency medicine trisk 2669 2669

unless critical level with
high risk of cardiac
arrhythmia
Hyperphosphatemia

Aluminum hydroxide

Hypocalcemia

No calcium replacement
unless symptomatic

Hyperleukocytosis

Leukostasis

Mediastinal mass

Fever

WBC count >100,000/mL

Ensure IV fluids are being
given at maximum
tolerated volume
Limit transfusion of packed
red blood cells, which can
increase viscosity
Monitor for leukostasis
Prevent and monitor TLS
Urgent leukopheresis

Clinical symptoms of
respiratory distress or
change in neurologic status
Chest x-ray findings may be Proceed with caution if PT or
present
PTT elevated
Chest x-ray and/or chest CT Establish diagnosis as soon
scan
as possible
Echocardiogram
Mass will likely shrink
quickly in response to
chemotherapy
Assessment of respiratory
Support respiratory
status while upright and
mechanics, though
supine
intubation unlikely to offer
benefit
Peak flow
No sedation/anesthesia
Blood culture (from CVL, if All patients should be
present)
assumed neutropenic, even
if ANC >500
Additional culture from any Empiric broad-spectrum
site with localizing
antibiotics (see Fig. 98.4 )

symptoms
Avoid lumbar puncture
Tylenol, no NSAIDs