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INTRODUCTION

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Hematological and oncological emergencies are sometimes overlooked in EMS planning and off-line medical direction and may seem less frequent than some trauma and medical conditions. However, these conditions are no less fatal and often seemingly complex when training and education in these areas are neglected. In some cases, the EMS physician stands to have a significant impact on the outcome of the patient with these conditions, and in other cases, may positively impact an important phase in the dying process for terminal patients. In this chapter, we will review likely hematological and oncological emergencies that may be encountered in the field where there is opportunity for the EMS physician to provide treatment in the field and improved medical direction to system providers on the proper management of these sometimes-complicated patient encounters.

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OBJECTIVES

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  • List common causes of anemia in prehospital patients.

  • Describe the initial prehospital evaluation and management of acute blood loss anemia.

  • Describe the initial prehospital evaluation and management of hereditary anemias.

  • Describe the initial prehospital evaluation and management of hereditary bleeding disorders.

  • Describe the initial prehospital evaluation and management of disseminated intravascular coagulation.

  • Discuss prehospital use of blood, blood products, and factors for acute nontraumatic anemia.

  • Describe the initial prehospital evaluation and management of patients on chemotherapy.

  • Briefly discuss care of terminal cancer patients in the prehospital environment.

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ANEMIA

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The focus of this section will be on anemia related to factors other than traumatic anemia which is covered in Chapter 57. The prehospital provider will often encounter symptomatic anemia which may be at the root of activating the 9-1-1 system though not as obvious as a 9-1-1 call for clinical bleeding. The chief complaint with symptomatic anemia is more likely to be related to the ramifications of decreased oxygen-carrying capacity than the knowledge that the RBC volume is compromised. The physical examination findings are well known to the reader as are the general principles of management. The question is what parts of the standard emergency department schema are applicable to the prehospital environment and how much of it is truly needed? We will divide the discussion into three sections. The first two sections will relate to insufficient RBC production or excessive RBC destruction with the third focusing on acute blood loss other than from traumatic causes.

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INSUFFICIENT RBC PRODUCTION

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Whether this reflects nutritional deficiency, bone marrow disorder, or dysregulation, there is little to do in the prehospital environment to diagnose the cause. Though history and physical may yield a working diagnosis this is of little practical importance as therapy will remain supportive with oxygen and maintenance of effective circulating volume. While empiric treatment with folic acid or iron may seem reasonable if the diagnostic impression is strong enough, it is hard to argue that the effect of that treatment will be brisk enough that it is worth the trade ...

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