Pediatric emergency medicine trisk 2689 2689

to a course of steroids but has now recurred is consistent with partial treatment of
lymphoblastic leukemia or lymphoma. Many lymphomas present with nonspecific
systemic symptoms such as weight loss, fatigue, unexplained fevers, night sweats,
and malaise. Itching can be a paraneoplastic phenomenon associated with Hodgkin
lymphoma. Examination should include assessment of all nodal groups (including
axilla and supraclavicular) to both aid in the differential diagnosis and establish a
site for possible biopsy. Of note, almost all pediatric lymphomas are high grade and
have an acute to subacute course.
The initial focus should include a thorough assessment of airway, breathing, and
circulation, all of which may be compromised by an AMM. When an AMM
compresses the airway below the level of the carina, intubation will not be effective
in managing respiratory failure. Management must focus on prevention of
respiratory failure through such strategies as oxygen therapy and maximizing
respiratory mechanics. Do not place the patient with respiratory distress in the
supine position. Do not sedate or anesthetize the patient as this can lead to airway
obstruction or cardiovascular collapse. Do not start empiric steroids without a
discussion with an oncologist to ensure that steroids will not interfere with ability to
establish the diagnosis. If there is evidence of SVC syndrome (plethora, facial
edema, and jugular venous distention), ensure adequate intravascular volume to
support systemic return.