UMEM Educational Pearls

Category: Critical Care

Title: Critically Ill Cancer Patient?

Posted: 11/13/2018 by Mike Winters, MD (Updated: 10/23/2020)
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Identifying Critically Ill Cancer Patients in the ED

  • Immunosuppressed patients with malignancy are at high risk of complications and rapid decompensation.
  • Select pearls in identifying ED patients with cancer that are at high risk of critical illness include:
    • Patients with profound neutropenia (< 100/mm3) are at high risk for fungal infections (i.e., aspergillosis)
    • Hypoxemia that requires oxygen is a predictor of later ICU admission.
    • Patients with bilateral infiltrates on CXR are at high risk of decompensation. Consider ICU admission.
    • Patients with promyelocytic leukemias are at high risk of DIC. Patients with this complication should be admitted to the ICU.

References

Peyrony O, Shapiro NI. The 10 signs telling me that my cancer patient in the emergency department is at high risk of becoming critically ill. Intensive Care Med. 2018; epub ahead of print.