CHAPTER 98 ■ ONCOLOGIC EMERGENCIES ALISA McQUEEN, ANDREW E PLACE GOALS OF EMERGENCY THERAPY Every year in the United States, approximately 12,000 children and adolescents are diagnosed with cancer and 2,300 children die of their disease or from side effects of treatment This chapter is organized into two major sections The first section reviews common presenting symptoms and emergency care considerations for a child who presents to the emergency department (ED) with either a new cancer diagnosis or recurrence of disease This section is organized by diagnosis and by location of malignancy The second section addresses the management of complications associated with common pediatric malignancies and their treatment The general approach to the pediatric oncology patient in the ED is outlined in Table 98.1 When taking a history from a pediatric oncology patient, exploring the perspective of the patient and parents about the potential cause of the problem and how the patient is doing is a crucial step in the evaluative process A detailed medication history is critical as patients are likely to be receiving multiple medications (e.g., chemotherapy, antibiotics, antiemetics) with side effects which may be contributing to their presenting symptoms One last introductory principle is to remember the extreme psychosocial stress that a pediatric cancer diagnosis places on a family The care of these patients requires the highest level of compassion and professionalism KEY POINTS The differential diagnosis of many common childhood complaints should include malignant processes Prompt recognition of oncologic emergencies has been proven to have a positive effect on outcomes Early consultation with a pediatric oncologist is highly recommended RELATED CHAPTERS