Pediatric emergency medicine trisk 2747 2747
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Influenza
signs or symptoms elicited
through history and
Parainfluenza
physical examination
Respiratory syncytial virus
Bacterial and fungal cultures
Adenovirus
as well as viral studies of
Fungal
blood, urine, sputum
Disseminated candidemia
Spinal tap not required
Invasive aspergillosis
Thrombotic
Acute form displays classic
thrombocytopenic
pentad
purpura
Fever
Hemolytic anemia
Thrombocytopenia
Renal failure
Neurologic symptoms
Rarely can evolve into
chronic hemolytic uremic
syndrome–like picture
Manage as TTP would be
managed outside of the
stem cell transplant setting
Central to the mission of the emergency clinician approaching a child with
advanced cancer should be establishing the current goals of care. This can occur in
two major ways:
The preferences of the patient and/or family members may already be documented
in the medical record. Often, these preferences have been explored during previous
hospitalizations or clinic appointments with the patient’s primary oncology team.
In many cases, the outcome of such discussions may now be written in the form of
a Do-Not-Resuscitate (DNR) order or an outpatient/home form or order meant to
establish limits for resuscitation. Insight into the patient’s and family’s goals of
care may be gained by direct communication with the oncologist who knows the
patient best.
During the visit to the ED, the clinician should ask the patient/family open-ended
questions to allow for an open expression of preferences. During this conversation,
if the patient has documented preferences already expressed in the medical record,
the clinician should inquire whether there have been any recent changes to these
preferences. Changes sometimes occur and medical staff unacquainted with the
patient often feel uncomfortable embarking upon these discussions, even though
patients and family members usually welcome the opportunity to communicate in
this way.
