Pediatric Hematologic And Oncologic Emergencies

2018 ◽  
Author(s):  
Rebecca Milligan ◽  
Jenny Mendelson
Keyword(s):  
Emergency Medicine ◽  
Children And Adolescents ◽  
Pediatric Patients ◽  
Emergency Physicians ◽  
Oncologic Emergencies ◽  
Life Threatening

Hematologic and oncologic emergencies that afflict children and adolescents are important for emergency medicine physicians to recognize. Pediatric patients can present with a previous formal diagnosis and have a complication related to their disease or with new symptoms that suggest a hematologic or oncologic process. Oncologic treatments can also lead to life-threatening complications. Recognizing these emergencies is very important for emergency physicians to prevent further morbidity. This review covers common patient presentations, diagnosis, and treatments for hematologic and oncologic emergencies.  This review contains 6 figures, 6 tables and 57 references

Pediatric Hematologic And Oncologic Emergencies

2018 ◽  
Author(s):  
Rebecca Milligan ◽  
Jenny Mendelson
Keyword(s):  
Emergency Medicine ◽  
Children And Adolescents ◽  
Pediatric Patients ◽  
Emergency Physicians ◽  
Oncologic Emergencies ◽  
Life Threatening

Hematologic and oncologic emergencies that afflict children and adolescents are important for emergency medicine physicians to recognize. Pediatric patients can present with a previous formal diagnosis and have a complication related to their disease or with new symptoms that suggest a hematologic or oncologic process. Oncologic treatments can also lead to life-threatening complications. Recognizing these emergencies is very important for emergency physicians to prevent further morbidity. This review covers common patient presentations, diagnosis, and treatments for hematologic and oncologic emergencies.  This review contains 6 figures, 6 tables and 57 references

Pediatric Hematologic And Oncologic Emergencies

2018 ◽  
Author(s):  
Rebecca Milligan ◽  
Jenny Mendelson
Keyword(s):  
Emergency Medicine ◽  
Immune Thrombocytopenia ◽  
Pediatric Patients ◽  
Tumor Lysis Syndrome ◽  
Von Willebrand Disease ◽  
Emergency Physicians ◽  
Tumor Lysis ◽  
Oncologic Emergencies ◽  
Life Threatening ◽  
Von Willebrand

Hematologic and oncologic emergencies that afflict children and adolescents are important for emergency medicine physicians to recognize. Pediatric patients can present with a previous formal diagnosis and have a complication related to their disease or with new symptoms that suggest a hematologic or oncologic process. Oncologic treatments can also lead to life-threatening complications. Recognizing these emergencies is very important for emergency physicians to prevent further morbidity. This review covers common patient presentations, diagnosis, and treatments for hematologic and oncologic emergencies.  This review contains 6 figures, 7 tables and 48 references Key words: hematology, hemophilia, immune thrombocytopenia, neutropenic fever, oncology, pediatric, sickle cell anemia, tumor lysis syndrome, von Willebrand disease

Pediatric Hematologic And Oncologic Emergencies

2018 ◽  
Author(s):  
Rebecca Milligan ◽  
Jenny Mendelson
Keyword(s):  
Emergency Medicine ◽  
Immune Thrombocytopenia ◽  
Pediatric Patients ◽  
Tumor Lysis Syndrome ◽  
Von Willebrand Disease ◽  
Emergency Physicians ◽  
Tumor Lysis ◽  
Oncologic Emergencies ◽  
Life Threatening ◽  
Von Willebrand

Hematologic and oncologic emergencies that afflict children and adolescents are important for emergency medicine physicians to recognize. Pediatric patients can present with a previous formal diagnosis and have a complication related to their disease or with new symptoms that suggest a hematologic or oncologic process. Oncologic treatments can also lead to life-threatening complications. Recognizing these emergencies is very important for emergency physicians to prevent further morbidity. This review covers common patient presentations, diagnosis, and treatments for hematologic and oncologic emergencies.  This review contains 6 figures, 7 tables and 48 references Key words: hematology, hemophilia, immune thrombocytopenia, neutropenic fever, oncology, pediatric, sickle cell anemia, tumor lysis syndrome, von Willebrand disease

Efficacy and Safety of Eculizumab in Children and Adolescents with Paroxysmal Nocturnal Hemoglobinuria

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1034-1034
Author(s):  
Ulrike M. Reiss ◽  
Jeffrey Schwartz ◽  
Kathleen M Sakamoto ◽  
Geetha Puthenveetil ◽  
Masayo Ogawa ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Research Funding ◽  
Paroxysmal Nocturnal Hemoglobinuria ◽  
Pediatric Patients ◽  
Phase Iii ◽  
Intravascular Hemolysis ◽  
Short Term ◽  
Clone Size ◽  
Sustained Reduction ◽  
Life Threatening

Abstract Abstract 1034 Background: Paroxysmal nocturnal hemoglobinuria (PNH) is a progressive, life-threatening disease characterized by chronic intravascular hemolysis caused by uncontrolled complement activation. The cellular abnormality in PNH originates from a somatic mutation in the PIG-A gene resulting in a deficiency of the glycosylphosphatidyl-inositol (GPI) anchored complement regulatory proteins, CD55 and CD59. Featuring a complex pathophysiology, PNH is associated with hemolysis, cytopenia, thromboembolism (TE), multi-organ damage, bone marrow failure, and death. Patients with PNH also experience a range of debilitating symptoms including fatigue, shortness of breath, erectile dysfunction, and abdominal pain that significantly reduce quality of life (QoL). The terminal complement inhibitor eculizumab has been shown to provide a rapid and sustained reduction in intravascular hemolysis, leading to significant reductions in TE events, pulmonary hypertension and improvements in renal disease, QoL and anemia. In a single center study of long term eculizumab treatment (up to 8 years), eculizumab was shown to normalize the survival of adult PNH patients compared to age and sex-matched controls. In contrast, systematic research focused on pediatric PNH patients has been limited, largely due to small patient numbers. However, pediatric PNH patients experience many of the same clinical features and life-threatening complications as adult patients. The current study assessed the safety, pharmacokinetics, and efficacy of short-term eculizumab treatment in children and adolescents with PNH. Methods: The study began in May 2009, and is no longer recruiting as the enrollment targets have been met. In this 12-week, open-label, multicenter study, children and adolescents (aged 2 to 17 years) were eligible with a diagnosis of PNH, ≥5% GPI-deficient red blood cells (RBC) or granulocytes, and serum lactate dehydrogenase (LDH) levels > upper limit of normal (ULN) or those who had received ≥1 transfusion during the previous 2 years for anemia or anemia-related symptoms. Eculizumab was administered using weight-based dosing (300–900 mg IV) at pre-determined regular 7–14 day intervals throughout the treatment period. In addition to pharmacokinetic (PK) and pharmacodynamic (PD) parameters, safety and efficacy parameters included adverse events (AEs), LDH and hemoglobin levels, platelet counts, and granulocyte and RBC type III clone size. Results: Seven pediatric patients with PNH ranging in age from 11 to 17 years participated in this study (4 females, 3 males). One patient also had aplastic anemia at study enrollment. At baseline, patients had elevated LDH (normal range 100–275 U/L), thrombocytopenia and anemia, and a median PNH granulocyte clone size of 79%. Eculizumab was well-tolerated; common AE's included headache, fever, and nasal congestion, all mild to moderate in severity. All 7 patients completed the 12-week trial and are currently alive; the safety and AE profile of eculizumab was consistent with that previously reported in adults participating in Phase III PNH clinical trials. Eculizumab treatment led to a rapid and sustained reduction in LDH levels, from a mean of 1,020 U/L at baseline to 256 U/L at 12 weeks (Table 1). PK-PD analysis is ongoing. Conclusions: Consistent with results in adults, pediatric patients with PNH tolerate short-term eculizumab infusions well and have reduced intravascular hemolysis. These results highlight the potential of eculizumab for the treatment of children and adolescents with PNH. Disclosures: Sakamoto: Abbott: Research Funding; Genentech: Research Funding. Puthenveetil:Novartis Pharmaceuticals Corporation: Honoraria, Speakers Bureau; Alexion: Honoraria, Speakers Bureau. Ogawa:Alexion Pharmaceuticals, Inc.: Employment, Equity Ownership.

Anglo-American vs. Franco-German Emergency Medical Services System

2003 ◽  
Vol 18 (1) ◽  
pp. 29-37 ◽  
Author(s):  
Wolfgang F. Dick
Keyword(s):  
Emergency Medicine ◽  
Emergency Medical Services ◽  
The United States ◽  
Medical Services ◽  
Care Providers ◽  
Emergency Physicians ◽  
Emergency Patients ◽  
Emergency Medical ◽  
Life Threatening ◽  
Anglo American

AbstractIt has been stated that the Franco-German Emergency Medical Services System (FGS) has considerable drawbacks compared to the Anglo-American Emergency Medical Services System (AAS):1. The key differences between the AAS and the FGS are that in the AAS, the patients is brought to the doctor, while in the FGS, the doctor is brought to the patient.2. In the FGS, patients with urgent conditions usually are evaluated and treated by general practitioners in their offices or at the patient`s home; initially, very few approach an emergency department.3. Emergency patients with life-threatening trauma or disease are treated by emergency physicians at the scene and during transport. Paramedics often are first to arrive at the scene, and until the emergency physician arrives at the scene, are allowed to defibrillate, to intubate endotracheal-ly, and to administer life-saving drugs (epinephrine endotracheally, glucose intravenously, etc.).4. Prehospital emergency physicians treat patients at the scene and during transport.5. Emergency patients are guaranteed to be reached by an appropriate emergency vehicle and a respective crew within 10 minutes in 80% of the responses and within 15 minutes in 95% of cases.6. The FGS deploys qualified emergency physicians assisted by qualified paramedics as prehospital intensive care providers; extended immediate care is standard. Total Prehospital Times (TPT) and scene times only are minimally longer than in the AAS.7. Emergency Medicine is recognized as a supra-specialty to the base specialties. Specific training programs exist for emergency physicians, medical directors of emergency medical services systems (EMSS), and chief emergency physicians (CEP).8. Resuscitation attempts are carried out not only by anesthesiologists, but also by internists, surgeons, pediatricians, etc. Emergency medicine encompasses cardiopulmonary resuscitation (CPR) and shock cases, and patients with an acute myocardial infarction, stroke, poly-trauma, status asthmaticus, etc. Emergency patients are admitted directly to emergency departments of the hospitals, which, depending upon the size of the hospital.9. The incidence of life-threatening trauma victims has decreased to <10% in the FGS. Of a total of 830,000 deaths/year, fatal trauma cases ranked the lowest at 4%.10. Survival figures on cardiac arrest (asystole, ventricular fibrillation/ventricular tachycardia (VF/VT), pulseless electrical activity (PEA), etc.) reported in the German EMSS correspond to those in Europe and the United States.11. Paramedic training is characterized by a two-year program followed by a theoretical and a practical examination.12. Paramedics and emergency physicians-in-training are supervised at the scene and during transport. Quality assurance (Q/A) constitutes an integral and legally compulsory part of the EMSS.13. In the majority of cases, the emergency patients are evaluated and treated by the respective specialties without delays caused by patient transfer to other hospitals.14. The FGS does not require a greater number of ambulances and/or personnel than does the AAS.15. The German healthcare system creates less expenses/ capita than the does the U.S. system at a similar level of quality of care.16. Emergency procedures are carried out by anesthesiologists, emergency physicians, surgeons, internists, and other specialists.

scholarly journals Assessing the effectiveness of pediatric emergency medicine education in emergency medicine residency training: A national survey

2020 ◽  
pp. 102490792092631
Author(s):  
Wei-Chen Chen ◽  
Chung-Hsien Chaou ◽  
Chip-Jin Ng ◽  
Yueh-Ping Liu ◽  
Yu-Che Chang
Keyword(s):  
Emergency Medicine ◽  
Residency Training ◽  
Clinical Supervision ◽  
Pediatric Patients ◽  
Training Programs ◽  
Demographic Data ◽  
Pediatric Emergency ◽  
Point Of Care Ultrasound ◽  
Pediatric Emergency Medicine ◽  
Emergency Physicians

Background: Evaluating the effectiveness of pediatric emergency medicine training is essential to ensure that emergency physicians and emergency medicine residents have sufficient knowledge, skill, and confidence in optimizing care for acute pediatric visits. Although the field of pediatric emergency medicine has experienced phenomenal growth in past decades, it still faces challenges in how to best implement the curriculums in emergency medicine residency training programs. Objectives: Exploring emergency physicians’ and emergency residents’ perspectives on pediatric emergency medicine training in emergency residency training programs in Taiwan through a nationwide survey. Methods: The survey was distributed to 1281 emergency physicians and emergency medicine residents in 43 teaching hospitals. The survey inquired about demographic data, hospital type, rank of proctored trainers and assessors, and the setting of pediatric emergency medicine training. Participants’ confidence in managing acute pediatric visits and their satisfaction and reflections of their pediatric emergency medicine training were explored. Results: In all, 258 responses were received from 117 residents and 141 emergency physicians. Seventy-seven percent reported working in medical centers. Clinical supervision was primarily performed by pediatric attending physicians and emergency physicians. Fifty-eight percent of participants felt satisfied with their pediatric emergency medicine training. However, only 52.3% felt confident managing acute pediatric visits, which was attributed to inadequate exposure to pediatric patients. Residents noted lack of confidence in managing newborns, infants, and clinical procedures. Therefore, simulation training and point-of-care ultrasound learning were considered advantageous. Conclusion: The pediatric emergency medicine training in emergency medicine residency programs is diverse in intensive care training, supervisors, and assessors. Surveys demonstrate that learning experience in pediatric wards and emergency department rotations is associated with overall satisfaction with pediatric emergency medicine training; inadequate exposure to pediatric patients contributed to learners having less confidence. Emergency medicine residency program reform might focus on adequate hands-on pediatric patient care.

scholarly journals Stroke Education in Canadian Emergency Medicine Residency Programs

CJEM ◽  
2015 ◽  
Vol 18 (4) ◽  
pp. 283-287 ◽  
Author(s):  
Devin R. Harris ◽  
Philip Teal ◽  
Matthew Turton ◽  
Brian Lahiffe ◽  
Simon Pulfrey
Keyword(s):  
Emergency Medicine ◽  
Emergency Physicians ◽  
Team Leaders ◽  
Residency Programs ◽  
Stroke Team ◽  
Life Threatening ◽  
English Speaking ◽  
Ischemic Attack ◽  
Training Opportunities ◽  
Lecture Time

AbstractObjectivesStroke and transient ischemic attack (TIA) are common disorders treated by Canadian emergency physicians. The diagnosis and management of these conditions is time-sensitive and complex, requiring that emergency physicians have adequate training. This study sought to determine the extent of stroke and TIA training in Canadian emergency medicine residency programs.MethodsA two-page survey was emailed to directors of all English-speaking emergency medicine residency programs in Canada. This included both the Fellow of the Royal College of Physicians of Canada (FRCPC) and the College of Family Physicians Enhanced Training [CCFP(EM)] residency programs. The number of mandatory and elective rotations, lectures, and examinations relevant to stroke and TIA were assessed.ResultsNine FRCPC programs responded (of 11; RR=82%) and 11 CCFP(EM) programs responded (of 18; RR=61%), representing 20 of 29 programs in Canada (RR: 20/29=69%). Mandatory general neurology (3/9) and stroke neurology (2/9) rotations were offered in a minority of FRCPC programs and not at all in CCFP(EM) programs (0/11). Neuroradiology rotations were mandatory in 1/9 FRCPC programs and no CCFP(EM) programs (0/11). Acute ischemic stroke was allocated 3 hours of lecture time per year in all residency programs, regardless of route of training. Despite the fact that 100% of respondents train residents in facilities that administer thrombolysis for stroke, only 1/11 (9%) CCFP(EM) programs and 0/9 FRCPC programs have residents act as stroke team leaders.ConclusionsFormal training in stroke and TIA is limited in Canadian emergency medicine residency programs. Enhanced training opportunities should be developed as this disease is sudden, life-threatening, and can have disabling or fatal consequences, and therapeutic options are time sensitive.

scholarly journals Oncologic Emergencies

2014 ◽  
Vol 31 (3) ◽  
pp. 150-155
Author(s):  
MM Hossen ◽  
R Rabbani ◽  
M Hasan
Keyword(s):  
Emergency Medicine ◽  
Early Detection ◽  
Disease Progression ◽  
Cancer Patients ◽  
Permanent Damage ◽  
Oncologic Emergencies ◽  
Life Threatening ◽  
Life Threatening Event ◽  
Specific Management

Oncologic emergencies are complications resulting from cancer itself or from treatment of cancer requiring immediate attention & reversal. It is an acute life threatening event, may be the first sign of disease or may indicate disease progression. Cancer patients presenting with oncologic emergencies should be approached in a similar way to those without cancer. The care of cancer patients with oncologic emergencies is a challenge not only to oncologists but also to clinicians involved in emergency medicine. It requires rapid intervention to avoid death or severe permanent damage. The overall goal is to prevent, reverse or minimize life threatening complications through prophylaxis, early detection and specific management. DOI: http://dx.doi.org/10.3329/jbcps.v31i3.20982 J Bangladesh Coll Phys Surg 2013; 31: 150-155

Successful Control of Massive Vaginal Bleeding with Resuscitative Endovascular Balloon Occlusion of the Aorta and Pelvic Packing

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Emre Özlüer ◽  
Çagaç Yetis ◽  
Evrim Sayin ◽  
Mücahit Avcil
Keyword(s):  
Vaginal Bleeding ◽  
Balloon Occlusion ◽  
Emergency Physicians ◽  
Pelvic Packing ◽  
Gynecological Malignancies ◽  
Life Threatening ◽  
Successful Control ◽  
Endovascular Balloon Occlusion

Gynecological malignancies may present as life-threatening vaginal bleeding. Pelvic packing and Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may be useful along with conventional vaginal packing when in terms of control of the hemorrhage. Emergency physicians should be able to perform these interventions promptly in order to save their patients from exsanguination.

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