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18 Emergencies in Pediatric Oncology

199

 

 

18.9Cardiac Tamponade

18.9.1 General

(a)Low cardiac output syndrome: Left ventricle cannot maintain output, because of external pressure or intrinsic tumor mass. Duration of pressure on left ventricle is important. Slow accumulation of fluids in pericardium makes compensation possible

(b)Right heart congestion

18.9.2 Diagnosis

(a)Symptoms: cough, chest pain, dyspnea, hiccups, possible abdominal pain, cyanosis, and paradoxical pulse. Auscultation: friction rubs, diastolic murmurs, and arrhythmia may be present

– Low blood pressure, tachycardia

(b)Filled veins, tenseness of liver capsule, abdominal pain

Radiology: chest X-ray, echocardiography

ECG

18.9.3 Treatment

According to the cause of cardiac tamponade, for example, ultrasonographyguided pericardiocentesis. Possibly hydration, oxygen therapy. Possibly surgical consultation (consult oncologist before punction, diagnostic work-up)

18.10Hemolysis

18.10.1

General

Not usually an emergency

Causes: autoimmune, alloimmune (transfusion), mechanical (apheresis), acquired,

 

and hereditary disorders

18.10.2

Diagnosis

Symptoms of anemia, splenomegaly, icterus, dark urine

Laboratory analysis: complete blood count with reticulocyte count, red cell morphology, nucleated red cells (normoblasts) visible? Coombs test (direct antiglobulin test)

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