The recognition and nursing management of common oncological emergencies in children

2022 ◽  
Vol 31 (1) ◽  
pp. 20-27
Author(s):  
Olivia Sherwen ◽  
Madeleine Kate Baron ◽  
Natalie Strachan Murray ◽  
Paul Anthony Heaton ◽  
Jane Gamble ◽  
...  
Keyword(s):  
Cancer Progression ◽  
Health Professionals ◽  
Brain Tumours ◽  
Nursing Management ◽  
Initial Management ◽  
Oncological Emergency ◽  
Neutropenic Sepsis ◽  
Life Threatening ◽  
Current Guidance ◽  
Time Critical

An oncological emergency may be the initial presentation of a cancer, a sign of cancer progression, or a complication of cancer treatment. The most frequently encountered paediatric oncological emergencies include neutropenic sepsis, hyperleukocytosis, brain tumours presenting with raised intracranial pressure, tumour lysis syndrome and superior mediastinal syndrome. These are all life-threatening conditions that require urgent recognition and management. Health professionals working in an emergency department (ED) are likely to be involved in managing these children. This article brings together the current guidance and recommendations for these specific emergencies. It also includes two case studies that demonstrate the challenges health professionals can face while managing these situations. It is important that health professionals have an acute awareness of oncological emergencies. Confidence in recognising the presentations, diagnoses and initial management are essential because these conditions may be life-threatening and time critical.

scholarly journals Organophosphorus Poisoning

2008 ◽  
Vol 47 (172) ◽  
Author(s):  
Buddhi Prasad Paudyal
Keyword(s):  
Signs And Symptoms ◽  
Clinical Problem ◽  
Acute Poisoning ◽  
The Body ◽  
Organophosphorus Insecticides ◽  
Basic Principles ◽  
Initial Management ◽  
Organophosphorus Poisoning ◽  
Life Threatening ◽  
History Of

Acute poisoning by organophosphorus (OP) compounds is a major global clinical problem, withthousands of deaths occurring every year. Most of these pesticide poisoning and subsequentdeaths occur in developing countries following a deliberate self ingestion of the poison. Metacid(Methyl parathion) and Nuvan (Dichlorovos) are commonly ingested OP pesticides; Dimethoate,Profenofos, and Chlorpyrifos are other less frequently ingested compounds in Nepal. The toxicityof these OP pesticides is due to the irreversible inhibition of acetylcholinesterase (AChE) enzymeleading to accumulation of acetylcholine and subsequent over-activation of cholinergic receptorsin various parts of the body. Acutely, these patients present with cholinergic crisis; intermediatesyndrome and delayed polyneuropathy are other sequel of this form of poisoning. The diagnosisdepends on the history of exposure to these pesticides, characteristic manifestations of toxicityand improvements of the signs and symptoms after administration of atropine. The supportivetreatment of OP poisoning includes the same basic principles of management of any acutelypoisoned patient i.e., rapid initial management of airways, breathing, and circulation. Gastriclavage and activated charcoal are routinely used decontamination procedures, but their valuehas not been conclusively proven in this poisoning. Atropine is the mainstay of therapy, andcan reverse the life threatening features of this acute poisoning. However, there are no clearcut guidelines on the dose and duration of atropine therapy in OP poisoning. Cholinesterasereactivators, by regenerating AChE, can reverse both the nicotinic and muscarinic effects;however, this benefit has not been translated well in clinical trials. All these facts highlight thatthere are many unanswered questions and controversies in the management of OP poisoningand there is an urgent need for research on this aspect of this common and deadly poisoning.Key Words: poisoning, organophosphorus insecticides, decontamination, antidotes

Work challenges negatively affecting the job satisfaction of early career community mental health professionals working in rural Australia: findings from a qualitative study

2018 ◽  
Vol 13 (3) ◽  
pp. 173-186 ◽  
Author(s):  
Catherine Cosgrave ◽  
Myfanwy Maple ◽  
Rafat Hussain
Keyword(s):  
Mental Health ◽  
Job Satisfaction ◽  
Public Sector ◽  
Community Mental Health ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Physical Geography ◽  
Early Career ◽  
Content Type ◽  
Time Critical

Purpose Some of Australia’s most severe and protracted workforce shortages are in public sector community mental health (CMH) services. Research identifying the factors affecting staff turnover of this workforce has been limited. The purpose of this paper is to identify work factors negatively affecting the job satisfaction of early career health professionals working in rural Australia’s public sector CMH services. Design/methodology/approach In total, 25 health professionals working in rural and remote CMH services in New South Wales (NSW), Australia, for NSW Health participated in in-depth, semi-structured interviews. Findings The study identified five work-related challenges negatively affecting job satisfaction: developing a profession-specific identity; providing quality multidisciplinary care; working in a resource-constrained service environment; working with a demanding client group; and managing personal and professional boundaries. Practical implications These findings highlight the need to provide time-critical supports to address the challenges facing rural-based CMH professionals in their early career years in order to maximise job satisfaction and reduce avoidable turnover. Originality/value Overall, the study found that the factors negatively affecting the job satisfaction of early career rural-based CMH professionals affects all professionals working in rural CMH, and these negative effects increase with service remoteness. For those in early career, having to simultaneously deal with significant rural health and sector-specific constraints and professional challenges has a negative multiplier effect on their job satisfaction. It is this phenomenon that likely explains the high levels of job dissatisfaction and turnover found among Australia’s rural-based early career CMH professionals. By understanding these multiple and simultaneous pressures on rural-based early career CMH professionals, public health services and governments involved in addressing rural mental health workforce issues will be better able to identify and implement time-critical supports for this cohort of workers. These findings and proposed strategies potentially have relevance beyond Australia’s rural CMH workforce to Australia’s broader early career nursing and allied health rural workforce as well as internationally for other countries that have a similar physical geography and health system.

Indigenous Language Media and Communication for Health Purposes in the Digital Age

2022 ◽  
pp. 33-49
Author(s):  
Toyosi Olugbenga Samson Owolabi ◽  
Nahimah Ajikanle Nurudeen
Keyword(s):  
Decision Making ◽  
Health Information ◽  
Health Professionals ◽  
Indigenous Language ◽  
Digital Era ◽  
The People ◽  
The World ◽  
Life Threatening ◽  
Potential Channels ◽  
Media And Communication

All over the world, the issues of health and ill health have generated heightened attention among health professionals and communication experts. This is expected in view of the prevalence of increasingly life-threatening ailments. It is therefore not surprising that matters bordering on health have been elevated to the front burner of policy and decision making both at the national and multinational levels. This chapter, therefore, observes that the reason most health information doesn't get to the intended audiences and produce the desired effect is because they are not communicated in the most intelligible language to the people. Indigenous language media are potential channels through which health information could reach the grassroots where more than 70 percent of the nation's populations are resident. It also perceived that health communication could be made to produce more effect in this digital era as more citizen journalists could be raised to communicate in the indigenous language.

scholarly journals Risks associated with oral deferiprone in the treatment of infratentorial superficial siderosis

2019 ◽  
Vol 267 (1) ◽  
pp. 239-243 ◽  
Author(s):  
Y. Sammaraiee ◽  
G. Banerjee ◽  
S. Farmer ◽  
B. Hylton ◽  
P. Cowley ◽  
...  
Keyword(s):  
Side Effects ◽  
Case Series ◽  
Iron Chelator ◽  
Superficial Siderosis ◽  
Neutropenic Sepsis ◽  
Favourable Safety ◽  
Favourable Safety Profile ◽  
Life Threatening ◽  
The Mean ◽  
Mean Time

Abstract Objective Deferiprone is an iron chelator that has recently been used to treat patients with infratentorial superficial siderosis (iSS). It is considered to have a generally favourable safety profile but concerns have been raised due to the risk of agranulocytosis. We aimed to evaluate the safety and tolerability of oral deferiprone as a treatment for patients with iSS. Methods We present a case series of 10 consecutive patients presenting with classical iSS treated with deferiprone. Results Ten patients were followed up for a mean period of 2.3 years (range 0.5–5.5 years). Four patients (40%) were withdrawn from treatment because of treatment-related side effects. The reasons for treatment discontinuation were neutropenic sepsis (n = 3) and fatigue (n = 1). In 2 out of the 3 cases of neutropenic sepsis, patients initially developed neutropenia without sepsis. The mean time to neutropenic sepsis following deferiprone was 1.2 years (range 0.3–2.5) with mean neutrophil count of 0.4 (range 0.3–0.5). Six patients (60%) reported no change in neurological function while on treatment, and four patients (40%) reported that their condition deteriorated. Conclusions Deferiprone was poorly tolerated, with 40% of patients withdrawing from treatment, most commonly due to neutropenic sepsis, after an average of 2 years on treatment. This study increases the number of reported cases of agranulocytosis in patients with iSS treated with deferiprone. Clinicians treating iSS patients with deferiprone should be aware that this drug has a potentially life-threatening side effect of neutropenic sepsis, and should ensure that appropriate haematological monitoring is in place.

scholarly journals A review of informed consent and how it has evolved to protect vulnerable participants in emergency care research

2020 ◽  
Vol 5 (2) ◽  
pp. 73-79
Author(s):  
Rajpal Nandra ◽  
Alan F. Brockie ◽  
Faisal Hussain
Keyword(s):  
Informed Consent ◽  
Emergency Care ◽  
Ethics Committees ◽  
Moral Obligations ◽  
Ethical Considerations ◽  
Vulnerable Patients ◽  
Ethical Approval ◽  
Life Threatening ◽  
Time Critical

A vulnerable participant in research lacks capacity to consent or may be exposed to coercion to participate. Capacity may be temporarily impaired due to loss of consciousness, hypoxia, pain and the consumption of alcohol or elicit substances. To advance emergency care, providing life-threatening measures in life-threatening circumstances, vulnerable patients are recruited into research studies. The urgent need for time-critical treatment conflicts with routine informed consent procedures. This article reviews ethical considerations and moral obligations to safeguard these participants and preserve their autonomy. A particular focus is given to research methodology to waive consent, and the role of ethics committees, research audits, research nurses and community engagement. Research on the acutely unwell patient who lacks capacity is possible with well-designed research trials that are led by investigators who are sufficiently trained, engage the community, gain ethical approval to waive consent and continuously audit practice. Cite this article: EFORT Open Rev 2020;5:73-79. DOI: 10.1302/2058-5241.5.180051

Initial Management of Simulated Life-threatening Emergencies by Nurse Anesthetists and Anesthesiologists.

2007 ◽  
Vol 2 (1) ◽  
pp. 49
Author(s):  
Bernadette Henrichs ◽  
Michael Avidan ◽  
David Murray ◽  
Julie Woodhouse ◽  
Joseph Kras ◽  
...  
Keyword(s):  
Nurse Anesthetists ◽  
Initial Management ◽  
Life Threatening

Management of Acute Contrast Reactions—Understanding Radiologists' Preparedness and the Efficacy of Simulation-Based Training in Canada

2018 ◽  
Vol 69 (4) ◽  
pp. 349-355 ◽  
Author(s):  
Tyler M. Coupal ◽  
Anne R. Buckley ◽  
Sanjiv Bhalla ◽  
Jessica L. Li ◽  
Stephen G.F. Ho ◽  
...  
Keyword(s):  
National Level ◽  
Daily Practice ◽  
Training Model ◽  
Initial Management ◽  
Mandated Training ◽  
Comfort Levels ◽  
Correct Dose ◽  
Simulation Based ◽  
Before And After ◽  
Life Threatening

Purpose Acute radiologic emergencies, primarily severe contrast reactions, are rare but life-threatening events. Given a generalized paucity of formalized or mandated training, studies have shown that radiologists and trainees perform poorly when acutely managing such events. Moreover, skill base, knowledge, and comfort levels precipitously decline over time given the infrequent occurrence of these events during one's daily practice. The primary aim of this study was to assess radiologists' preparedness for managing acute radiologic emergencies and to determine the efficacy of a high-fidelity simulation based training model in an effort to provide a rationale for similar programs to be implemented on a provincial or national level. Methods This was a prospective, observational study of radiology residents and attending radiologists throughout the province who were recruited to attend a full-day simulation-based course presenting various cases of acute radiologic emergencies. Participant demographics were collected at the time of commencement of the workshop. Course materials were disseminated 4 weeks prior to the workshop, and a 17-question knowledge quiz was administered before and after the workshop. Likert-type questionnaires were also distributed to survey comfort levels and equipment familiarity. The knowledge quiz and questionnaire were redistributed at 3- and 6-month intervals for acquisition of follow-up data. Results A total of 14 attending radiologists and 7 residents attended the workshop, with all participants completing the preworkshop questionnaire and 90.5% (19 of 21) completing the post-workshop questionnaire. Participants' principle locations of practice were as follows: academic institutions (50%), community hospitals (36.9%), and private clinics (13.1%). A significant increase in knowledge was demonstrated, with average scores of 10 out of 17 (59%) and 14.5 out of 17 (85%) ( P < .001) before and after the workshop, respectively. A significant increase in participants' comfort levels in recognizing acute anaphylactic reactions (3.5; 4.7, P < .001), commencing initial management for acute radiologic emergencies (3.3; 5.0, P < .001), and administering the correct dose for anaphylactic reactions (2.5; 4.8, P < .001) was also demonstrated. Moreover, participants became increasingly familiar with the contents and equipment found within contrast reaction kits (2.8; 3.8, P < .01). Repeat evaluations at 3 and 6 months found an average knowledge test score of 13.8 out of 17 (81%) and 10.8 out of 17 (64%), respectively. Comfort levels were also reassessed in recognizing acute anaphylactic reactions (4.5; 4.1), commencing initial management (4.0; 3.9) and administering the correct dose of medication (4.0; 3.7) at 3- and 6-month intervals. Conclusions Acute radiologic emergencies are rare but life-threatening events that require rapid diagnosis and treatment to mitigate associated morbidity and mortality. Simulation-based workshops are a highly efficacious training model to increase knowledge, comfort levels, and equipment familiarity for radiologists and trainees alike; however, retraining at regular intervals is required.

Urinary incontinence principles

2017 ◽  
Author(s):  
Christopher R. Chapple ◽  
Nadir I. Osman
Keyword(s):  
Urinary Incontinence ◽  
Neural Control ◽  
Well Being ◽  
Initial Management ◽  
Lost Productivity ◽  
Life Threatening ◽  
The Individual ◽  
Aetiological Spectrum ◽  
Broad Overview

Urinary incontinence (UI) is a highly prevalent and bothersome problem that affects men and women of all ages. The aetiological spectrum of UI is wide, encompassing dysfunctions of the lower urinary tract, its neural control, the pelvic floor as well as other factors such as the side effects of pharmacotherapy. Although not life-threatening, UI frequently impacts upon the quality of life, psychological and emotional well-being of affected individuals. Additionally, UI imposes a tremendous economic burden on both the individual and the wider society in costs of nursing care, treatments, and lost productivity. The purpose of this chapter is to provide a broad overview of the epidemiology, aetiopathophysiology of UI, and to discuss the approach to the assessment, investigation, and initial management of the patient presenting with UI.

scholarly journals Cancer-Associated Cachexia: A Systemic Consequence of Cancer Progression

2020 ◽  
Vol 4 (1) ◽  
pp. 391-411
Author(s):  
Anup K. Biswas ◽  
Swarnali Acharyya
Keyword(s):  
Cancer Patients ◽  
Cancer Progression ◽  
Metastatic Cancer ◽  
Therapeutic Strategies ◽  
Invasive Growth ◽  
Wasting Syndrome ◽  
Life Threatening ◽  
And Function ◽  
Related Mortality

Cancer is a life-threatening disease that has plagued humans for centuries. The vast majority of cancer-related mortality results from metastasis. Indeed, the invasive growth of metastatic cancer cells in vital organs causes fatal organ dysfunction, but metastasis-related deaths also result from cachexia, a debilitating wasting syndrome characterized by an involuntary loss of skeletal muscle mass and function. In fact, about 80% of metastatic cancer patients suffer from cachexia, which often renders them too weak to tolerate standard doses of anticancer therapies and makes them susceptible to death from cardiac and respiratory failure. The goals of this review are to highlight important findings that help explain how cancer-induced systemic changes drive the development of cachexia and to discuss unmet challenges and potential therapeutic strategies targeting cachexia to improve the quality of life and survival of cancer patients.

scholarly journals Fatal Spontaneous Tumor Lysis Syndrome in a Patient with Metastatic Colon Cancer: A Clinical Case of Rare Oncological Emergency

2020 ◽  
Vol 14 (2) ◽  
pp. 255-260
Author(s):  
Inna Shaforostova ◽  
Robert Fiedler ◽  
Martina Zander ◽  
Johannes Pflumm ◽  
Wolfgang Josef März
Keyword(s):  
Colon Cancer ◽  
Case Reports ◽  
Multiorgan Failure ◽  
Tumor Lysis Syndrome ◽  
Metastatic Colon Cancer ◽  
Tumor Lysis ◽  
Oncological Emergency ◽  
Electrolyte Disturbances ◽  
Life Threatening ◽  
Spontaneous Tumor Lysis Syndrome

Tumor lysis syndrome (TLS) is a potentially life-threatening complication of chemotherapy. It usually occurs in rapidly proliferating hematological malignancies. TLS is deemed spontaneous (STLS) when it occurs prior to any cytotoxic or definite treatment. STLS is extremely rare in solid tumors. Here, we report a rare case of fatal STLS in a 47-year-old woman diagnosed with metastatic colon cancer. The patient developed acute renal failure with anuria, electrolyte disturbances, and metabolic acidosis before initiating chemotherapy. Despite appropriate management of TLS, including renal replacement therapy, she died within a few days from multiorgan failure. Only few other case reports of STLS associated with colon cancer have been reported in the literature.

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