Emerg Med Clin North Am
· 2025 Nov · PMID 41106868
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Care of the injured pediatric patient requires a holistic understanding of pain and distress. This article provides a multifactorial approach using both pharmacologic and nonpharmacologic methodologies to manage pediatri...Care of the injured pediatric patient requires a holistic understanding of pain and distress. This article provides a multifactorial approach using both pharmacologic and nonpharmacologic methodologies to manage pediatric pain related to injury. It further describes cognitive, social, and pharmacologic interventions to minimize distress and anxiety employing patient and family-centered care within a multidisciplinary team.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610068
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Mechanical obstructions are potentially life-threatening complications that frequently arise in oncologic and hematologic settings. These obstructions may occur due to tumors, lymphadenopathy, or treatment-induced adhesi...Mechanical obstructions are potentially life-threatening complications that frequently arise in oncologic and hematologic settings. These obstructions may occur due to tumors, lymphadenopathy, or treatment-induced adhesions, and they require immediate recognition and tailored management. This article discusses the epidemiology, pathophysiology, clinical presentation, and management strategies for mechanical obstructions, emphasizing evidence-based care and highlighting future developments in this field.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610067
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Bleeding is a common presentation in patients with cancer. Hemorrhage may result from ongoing low-volume oozing, episodic major bleeding, or acute catastrophic bleeding. Resuscitating critically ill patients involves air...Bleeding is a common presentation in patients with cancer. Hemorrhage may result from ongoing low-volume oozing, episodic major bleeding, or acute catastrophic bleeding. Resuscitating critically ill patients involves airway management and volume resuscitation with blood products. Bleeding should be immediately controlled with pressure, packing, and local hemostatic agents. Endoscopic or surgical interventions may be required to control persistent bleeding. Emergency medicine providers should prioritize the patient's care goals when making clinical management decisions.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610066
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Chimeric antigen receptor T-cell therapy is a modern approach in our treatment of cancer. However, it is not without potential side effects. While cytokine release syndrome and immune effector cell-associated neurotoxici...Chimeric antigen receptor T-cell therapy is a modern approach in our treatment of cancer. However, it is not without potential side effects. While cytokine release syndrome and immune effector cell-associated neurotoxicity syndrome are some of the more well-known toxicities, other potential complications include B- and T-cell aplasia/hypogammoglobulinemia, opportunistic infections, various coagulopathies, graft versus host syndrome, immune effector cell-associated hemophagocytic lymphohistiocytosis-like syndrome, and on-target off-tumor toxicities. Having a high index of suspicion is important when encountering patients with these conditions.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610065
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Immunotherapy is rapidly expanding to include a growing list of immune checkpoint inhibitors (ICIs) and indications for their use in the growing population of patients with cancer. Immune-related adverse events (irAEs) a...Immunotherapy is rapidly expanding to include a growing list of immune checkpoint inhibitors (ICIs) and indications for their use in the growing population of patients with cancer. Immune-related adverse events (irAEs) are common in patients receiving ICI therapy and greatly varied, affecting most organ systems. This diversity of symptoms that often mimic other disease processes and variable timeline of onset poses a particular challenge to emergency physicians in the acute care setting. This article presents a detailed overview of irAEs evaluation and management by organ system.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610064
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Chemotherapy is a cornerstone of cancer treatment. It routinely targets rapidly proliferating cancer cells, but can also affect healthy cells leading to various complications. This article explores different classes of c...Chemotherapy is a cornerstone of cancer treatment. It routinely targets rapidly proliferating cancer cells, but can also affect healthy cells leading to various complications. This article explores different classes of chemotherapy medications and their most common side effects or complications. It also explores the most common effects on the body while undergoing chemotherapy treatment in general. This article emphasizes the complications of chemotherapy are numerous, range widely in severity, and are impacted by patient's underlying medical history.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610063
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Hypercalcemia and multiple myeloma are major disease processes with at times similar presentations, especially in situations where multiple myeloma causes acute hypercalcemia. Hypercalcemia, in the acute presentation, ca...Hypercalcemia and multiple myeloma are major disease processes with at times similar presentations, especially in situations where multiple myeloma causes acute hypercalcemia. Hypercalcemia, in the acute presentation, can represent a life-threatening condition with a varied and often non-specific presentation. Having a high-index of suspicion and being able to quickly associate the illness with critical findings of electrocardiogram changes, acute kidney injury, and elevated calcium levels are critical. Multiple myeloma can similarly present as a critically-ill patient with infection, severe metabolic derangements, acute kidney injury, and spinal cord compression. Rapid stabilization of both processes is critical to patient outcomes.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610062
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Tumor lysis syndrome (TLS) is an oncologic emergency that occurs due to the massive lysis of tumor cells resulting in hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia. Patients are at significant risk for...Tumor lysis syndrome (TLS) is an oncologic emergency that occurs due to the massive lysis of tumor cells resulting in hyperkalemia, hyperuricemia, hyperphosphatemia, and hypocalcemia. Patients are at significant risk for acute kidney injury, arrhythmia, seizures, and sudden death as sequelae of this condition. Management is dependent on severity but often includes acute stabilization, aggressive hydration, correction of electrolyte abnormalities, and uric acid-lowering medications, such as rasburicase and allopurinol. TLS carries high morbidity and mortality risk making prevention through intravenous hydration and prophylactic medications the best management strategy.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610061
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Hyperviscosity syndrome (HVS) is considered an oncologic emergency. In this review, we describe the pathophysiology, clinical presentation, diagnosis, and treatment of this life-threatening condition. The most common eti...Hyperviscosity syndrome (HVS) is considered an oncologic emergency. In this review, we describe the pathophysiology, clinical presentation, diagnosis, and treatment of this life-threatening condition. The most common etiology of HVS is hypergammaglobulinemia, such as Waldenström macroglobulinemia. Other causes include bone marrow hyperproliferative states, autoimmune diseases, and human immunodeficiency virus infection. The presence of mucosal and specifically bilateral nasal bleeding, along with neurologic and ophthalmologic symptoms, should raise suspicion for HVS, but the condition can affect principally all organ systems. Fundoscopic examination is important when evaluating patients with HVS. The mainstays of treatment of HVS are supportive care, plasmapheresis, and chemotherapy.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610060
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Neutropenic fever is a life-threatening condition commonly associated with chemotherapy-induced neutropenia, requiring rapid diagnosis and immediate treatment. Risk stratification tools, such as the MASCC and CISNE score...Neutropenic fever is a life-threatening condition commonly associated with chemotherapy-induced neutropenia, requiring rapid diagnosis and immediate treatment. Risk stratification tools, such as the MASCC and CISNE scores, help clinicians identify high-risk patients and tailor management strategies. Future efforts should focus on integrating technological advancements, enhancing patient-centered care, and developing novel therapies to reduce recurrence and improve outcomes.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610059
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For many patients, the emergency department (ED) serves as the sole access to health care. Therefore, providers must evaluate patients thoroughly and with a holistic approach regardless of presenting concerns. Recognizin...For many patients, the emergency department (ED) serves as the sole access to health care. Therefore, providers must evaluate patients thoroughly and with a holistic approach regardless of presenting concerns. Recognizing that acute leukemia can present with non-specific systemic symptoms can aid in early diagnosis and timely referral. Treatment with chemotherapy and the disease process itself can leave leukemia patients vulnerable to a number of conditions that require emergent management. Maintaining clinical suspicion for these conditions and being aware of treatment mainstays is crucial for ED providers in properly treating patients with leukemia.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610058
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Thrombotic microangiopathies (TMAs) are rare diseases characterized by endothelial injury and microvascular clots. TMAs often lead to microangiopathic hemolytic anemia, thrombocytopenia, and end organ damage. Common TMA...Thrombotic microangiopathies (TMAs) are rare diseases characterized by endothelial injury and microvascular clots. TMAs often lead to microangiopathic hemolytic anemia, thrombocytopenia, and end organ damage. Common TMA types include thrombotic thrombocytopenic purpura (TTP), infection-associated hemolytic uremic syndrome, and complement-mediated TMAs. Diagnosing TMAs in the emergency setting is challenging. Laboratory tests, such as complete blood count and peripheral smear are useful in the diagnosis. TTP, marked by severe thrombocytopenia, hemolytic anemia, and normal coagulation factors, has high mortality without treatment. Early recognition and thorough evaluation are crucial for appropriate management and improved patient outcomes.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610057
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Despite advances in outpatient treatment options, early mortality, chronic pain, and limitations in quality-of-life indices remain substantial for those living with SCD. It is imperative for emergency providers (EPs) to...Despite advances in outpatient treatment options, early mortality, chronic pain, and limitations in quality-of-life indices remain substantial for those living with SCD. It is imperative for emergency providers (EPs) to understand their challenging and dual obligation when treating a patient with SCD. First, the EP must aggressively manage the acute pain episode in an objective manner. Secondly, it is equally important to consider concurrent pathology that cannot be missed, such as AChS, pulmonary embolism, sepsis, and splenic sequestration. Finally, the EP should prioritize compassionate care that avoids reinforcing any stigma associated with SCD with subsequent detriment to the patient.
Emerg Med Clin North Am
· 2025 Aug · PMID 40610056
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Patients with traumatic and medical emergencies that require the transfusion of blood products are frequent visitors to the Emergency Department. Emergency clinicians must have a robust understanding of the options avail...Patients with traumatic and medical emergencies that require the transfusion of blood products are frequent visitors to the Emergency Department. Emergency clinicians must have a robust understanding of the options available to replace various blood components. The ever-increasing number of patients on antithrombotic agents demands facility with approaches to reversing their effects. These topics merge in the care of the patient taking an antithrombotic agent who experiences a hemorrhagic emergency requiring urgent hemostasis and transfusion of components to replace those lost.
Emerg Med Clin North Am
· 2025 May · PMID 40210352
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Multidisciplinary care for older adults in the emergency department (ED) is endorsed by multiple national and international guidelines. There are numerous disciplines to consider including, each with different strengths...Multidisciplinary care for older adults in the emergency department (ED) is endorsed by multiple national and international guidelines. There are numerous disciplines to consider including, each with different strengths and contributions, including social workers, case managers, pharmacists, physical, occupational, and speech therapists, hospice and palliative medicine teams, and the emergency deaprtment physicians and nurses themselves. The care team also extends beyond the ED walls and should include community services and the patient's family members and caregivers. There are many advantages to multidisciplinary care, including improved ED metrics, reduced length of hospitalization, and a reduction in repeat ED visits.
Emerg Med Clin North Am
· 2025 May · PMID 40210351
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Emergency department (ED) boarding, which refers to holding patients in the ED for prolonged periods while awaiting an inpatient bed, is linked to patient harm and is associated with worsening ED crowding. Evidence sugge...Emergency department (ED) boarding, which refers to holding patients in the ED for prolonged periods while awaiting an inpatient bed, is linked to patient harm and is associated with worsening ED crowding. Evidence suggests that older patients are at increased risk of complications from boarding, including the development of delirium. By prioritizing the admission of at-risk older patients to inpatient beds, ED may improve the both the quality of care for these patients and reduce inpatient lengths of stay. Older patients who must board in the ED may benefit from targeted interventions to help mitigate risks from ED boarding.