Initial Assessment- Check the patient from the foot of the bed, if they look sick then immediately get your safety net (IV, O2, monitor) and start resuscitating. Most patients who present won’t be critically ill and you can get your history and physical
History
-What type of cancer does the patient have?
-When was their last chemotherapy?
-Highest risk 5 to 10 days after chemo, recover 5 days after that
-What chemo are they taking? (if known)
-Not important for us in the ED but nice to be able to tell your heme/onc consultant
-Exact temperature recorded at home
-Infectious symptoms?
-Cough, malaise, headache, body aches, nausea, vomiting, abdominal pain,
urinary symptoms
-New rashes or bumps (abscesses)?
-Recent hospitalizations or procedures?
-Important- if pt has a port- when was it put in? Within the past few weeks?
-Swelling or redness over their port?
-History of neutropenic fever in the past?
-Rest of history- past medical problems, allergies, meds, surgeries
Physical exam
-Standard head to toe assessment
-Special attention to skin exam
-These patients can hide perirectal abscesses so do a full skin exam
-Also carefully examine their port for infection (if they have one)
-Abdominal exam (watch out for typhlitis- mentioned later)
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