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