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Doctor Doctor: When Is an Emergency an Emergency?

Network - Summer 2007


Carmen Gonzalez, M.D.

The medical team in the Emergency Center at M. D. Anderson is equipped to diagnose and treat myriad medical and surgical emergencies that a patient with cancer may experience. However, it often is difficult for patients and caregivers to know what constitutes an emergency and when they should seek care at an emergency center. Carmen E. Gonzalez, M.D., F.A.C.P., an assistant professor in the Department of General Internal Medicine, Ambulatory Care Treatment and Emergency Center, provides guidance.

What are the most common reasons for a patient to be seen at M. D. Anderson’s Emergency Center?

Fever and pain are the most common reasons for patients to seek treatment. Thirty percent of patients present with fever and about one-third of those patients will have “neutropenic fever,” a fever with “no infection-fighting cells” and a true cancer emergency. This occurs because many of the chemotherapy treatments patients receive suppress their immune system and make them more susceptible to infections. These patients must be evaluated and receive antibiotics within a few hours to avoid severe infection or sepsis and possible death.

How high does the fever have to get before a patient needs to be evaluated?

A patient who has a fever greater than 101 degrees Fahrenheit should have a medical evaluation. The evaluation will most likely include an examination by a physician and registered nurse, laboratory and radiographic studies, and treatment with antibiotics.

What about pain?

Another 30% of patients we treat are in pain. Pain syndromes are common with malignancies and may occur because of the cancer, the treatment or a complication of either. Sometimes, it’s a new pain not related to cancer. Abdominal, chest and back pain are the most common pain syndromes seen in the EC. When a patient has a new pain or an old pain worsens and is not resolved with usual analgesics, he/she should seek medical attention.

How does a patient or caregiver know when to come or bring the patient to the Emergency Center?

In addition to fever and pain, other very common reasons or symptoms for patients to come to any emergency department include, but are not limited to:

  • Nausea/vomiting
  • Severe diarrhea
  • Bleeding
  • Shortness of breath
  • Extreme weakness or weakness affecting a part of the body
  • Headache
  • Confusion or change in behavior
  • Rashes or new discoloration in the skin: Is it red and hot (possible infection)? Or pale and cold (possible abnormal arterial blood supply)?
  • A newly swollen leg or arm — may be a blood clot
  • Injury/trauma

If the patient or caregiver notices a concerning change or feels something may be an emergency, it is time to visit the EC. While the patient might want to call his/her oncologist for advice, it is important not to delay coming to the EC when experiencing an emergency.

Remember that patients with cancer are not immune to the conditions that send other people to emergency rooms: heart attacks, pneumonia, diabetes complications, strokes or acute abdominal problems like appendicitis, gallbladder problems and others. The sooner the problem is addressed, the better the chance of obtaining a positive outcome.

The medical staff at M. D. Anderson’s EC is well equipped to care for all of the above conditions, except trauma. If a patient with cancer is in an automobile accident, the city’s trauma emergency centers are best equipped to treat these injuries.

What side effects should a patient watch for that might bring him/her to the EC?

The treatments that patients receive all have side effects that the patient will be educated about prior to the start of treatment. It is important that the patient and caregiver familiarize themselves with those common side effects. If a patient experiences the expected side effects (for example, nausea, vomiting or mucositis, changes in the oral mucosa) and is unable to control them with medications that may have been prescribed by their oncologist, they should seek medical care in the EC.

What if I just need a prescription refilled? Is the EC the place to go?

Prescriptions to refill medications should be obtained from the primary care physician or oncologist during normal clinic hours. The EC is not the place to refill medications.

What if I am not in Houston and am experiencing an emergency?

Patients who are receiving care at M. D. Anderson and experience emergencies outside of Houston should go to their local emergency department for immediate treatment. The physicians at those locations can call M. D. Anderson if they have questions or need for the patient to be transferred here for further treatment.

What types of treatments are available in the Emergency Center versus admission to the hospital? 

The EC physician might recommend that certain patients remain under observation for 23 hours in the EC. This could be for more testing, interventions and to ensure adequacy of treatment response before the patient is discharged. The EC has updated, evidence-based protocols for observation of several conditions like chest pain, pneumonia, abdominal pain and other diagnoses.

With the new EC, what changes in patient care could be expected?

On May 19, the new M. D. Anderson Emergency Center opened its doors with 43 patient rooms located in the Main Building, Floor 1, near The Fountain. The new EC is a state-of-the-art facility and continues to provide high quality patient care. New benefits for patients are a 24-hour pharmacy, an on-site X-ray room and 24-hour nutritional services. The staff looks forward to providing the best service possible to the M. D. Anderson community.


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