دانلود کتاب راهنمای اورژانس های شبانه برای هماتولوژی-انکولوژی کودکان

Anyone who has been a pediatric resident or a pediatric hematology-oncology fellow will remember the anxiety of a night on call. In addition to the relatively common patient with chemotherapy-related fever and neutropenia, there is the anticipation of problems you may have read about but may not have actually seen: the adolescent newly presenting with a white blood cell count of 600,000/mm3, the 2-year-old spitting up blood with a platelet count of 2,000/mm3 and a hemoglobin of 5 g/dL, the child who comes to the ER with dif¬ficulty walking and is found to have a paraspinal mass on magnetic resonance imaging.
Most issues can wait until the next day when more senior practitioners are around, but some are true medical emergencies and just can’t. The tempo with which one needs to come up with a plan for evaluation and treatment will vary—if the service is not too busy, you may have time to pick up a textbook, look at UpToDate or do a PubMed search. Other times, there may be another dozen sick kids on the floor who also need your attention, and your time is more limited.
Our contributors come from a range of generations, but all remember that new-admission anxiety the same way. Apart from guzzling more caffeine before looking for the right infor¬mation or awakening your attending, we all remember thinking that it might have been nice to have had a quick resource to go to to bridge the hours between the start of night call and morning rounds. There are other housestaff manuals such as the wonderful Harriet Lane Handbook, and spiral manuals that give overviews of pathogenesis, diagnostic evalu¬ations and long-term treatment, but none that we know of focuses on what needs to be done immediately to avoid hurting a patient (much less, to avoid looking like a dummy the next day). We offer guidelines to get you started. None is written in stone and some may require institution-based modifications.
We want to thank past University of North Carolina PHO fellows whose Survivors Manual we used in constructing this manual. We also look back gratefully at Dr Richard Sills’ model of disease evaluations (Practical Algorithms in Pediatric Hematology and Oncology, S. Karger, 2003) that remains very useful. However, we thought that an update was in order, since his edition published in 2003, and that brief step-by-step suggestions focusing on inpatient emergencies could be a big help. To that end, we have compiled 1-to 2-page bullets and algorithms for more than 30 acute emergencies we remember as being the most likely to cause GI distress and sleeplessness. Feel free to suggest other topics or changes that we can make down the line. For those of you who hate algorithms and think that they diminish the thought process a doctor needs to cultivate, we don’t disagree—except when it comes to what the first-year fellow or resident must do when alone on call.
You may hate our approach more when you note that we compare the steps we came up with to instructions generated by ChatGPT! For some entries, we have changed the order of bullets to better parallel our own sections; however, the content is faithful to ChatGPT. Spoiler alert: For now, AI just isn’t detailed enough, seems geared to the patient rather than the provider, and may already be outdated—although admittedly it does better if you ask it detailed questions. AI may be a better fit in the future, so keep an open mind. We have added a few references for the learner in all of us to go to after some sleep. None of this gets around the need to read definitive texts when time is more flexible!