Pediatric emergency medicine trisk 2669 2669

unless critical level with high risk of cardiac arrhythmia Hyperphosphatemia Aluminum hydroxide Hypocalcemia No calcium replacement unless symptomatic Hyperleukocytosis Leukostasis Mediastinal mass Fever WBC count >100,000/mL Ensure IV fluids are being given at maximum tolerated volume Limit transfusion of packed red blood cells, which can increase viscosity Monitor for leukostasis Prevent and monitor TLS Urgent leukopheresis Clinical symptoms of respiratory distress or change in neurologic status Chest x-ray findings may be Proceed with caution if PT or present PTT elevated Chest x-ray and/or chest CT Establish diagnosis as soon scan as possible Echocardiogram Mass will likely shrink quickly in response to chemotherapy Assessment of respiratory Support respiratory status while upright and mechanics, though supine intubation unlikely to offer benefit Peak flow No sedation/anesthesia Blood culture (from CVL, if All patients should be present) assumed neutropenic, even if ANC >500 Additional culture from any Empiric broad-spectrum site with localizing antibiotics (see Fig 98.4 ) symptoms Avoid lumbar puncture Tylenol, no NSAIDs