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Oncologic emergencies may be seen in any emergency department and will become more frequent as our population ages and more patients receive chemotherapy. Life-saving interventions are available for certain oncologic emergencies if the diagnosis is made in a timely fashion. In this article we will cover neutropenic fever, tumor lysis syndrome, hypercalcemia of malignancy, and hyperviscosity syndrome. After reading this article the reader should be much more confident in the diagnosis, evaluation, and management of these oncologic emergencies.

Introduction: Over 350,000 out-of-hospital cardiac arrests occur annually in the United States, with neurologically intact survival below 10%. Recent literature demonstrates that survival is lower in communities of color and non-English speakers. Social determinants of health, such as healthcare access, language, and literacy, may serve as barriers to receiving cardiopulmonary resuscitation (CPR) education and using the skills learned. Current research is sparse on identifying barriers contributing to the lack of CPR education and use in non-English speaking communities. We hypothesized that barriers to CPR education and use differ between English- and Spanish-speaking learners. This study provides insights into how classes could be tailored to address disparities in CPR education and use. Methods: In this cross-sectional study we used survey-based research to assess the knowledge, comfort, and perceived barriers to activating the 9-1-1 system and performing bystander CPR. Participants were recruited using convenience sampling at community-based events in Roanoke, Virginia. We directly compared responses between language groups using Fisher tests within R, adjusting for various demographic factors. Results: We collected 367 surveys from the 550 participants (estimated 50 attendees each for 11 events) for a response rate of 66.7%. Of the surveys collected, 231 (63%) were in English and 136 (37%) in Spanish. Spanish-speakers were more concerned with immigration status (7% vs 1%), doing something wrong (14% vs 7%), and language barrier (31% vs 1%) compared to English-speakers when asked why they may not call 9-1-1. We found that 72% of English-speakers would have no problem calling 9-1-1, compared to only 16% of Spanish-speakers. Regardless of language, the most prevalent barrier to initiating CPR was the “fear of doing something wrong” with 49% of Spanish-speakers and 28% of English-speakers endorsing this as a barrier. Only 10% of Spanish speakers would have no concerns starting CPR, compared to 54% of English-speakers. Language was reported by 21% of Spanish-speakers vs 2% of English-speakers as a barrier to administering CPR. Conclusion: Results of this pilot study highlight that Spanish-speaking respondents were less comfortable calling 9-1-1 and initiating CPR compared to English-speaking respondents. While there were some shared barriers between the groups, Spanish-speaking respondents were more likely to identify a barrier overall. These results suggest that marginalized communities would benefit from tailored educational models that address their unique challenges. Further research is necessary to better understand how social determinants of health serve as barriers to CPR education/use in specific communities.

Allosauroidea, Ceratosauria, Megalosauroidea, Megaraptora, and Tyrannosauroidea are five clades containing obligate faunivorous megatheropods. These clades included apex predators from the Early Jurassic until the end of the Cretaceous Period. Studying the timeline of median size class change for ceratosaurians, tyrannosauroids, and megaraptorans compared to the extinction of the incumbent apex predator clades, allosauroids and megalosauroids, is important regarding megatheropod guild structure. This study used the median size classes exhibited by these clades throughout the Jurassic and Cretaceous Periods, along with the relationship of the median number of missing size classes under different apex predatory regimes. We calculated size class medians for each clade during six discrete time bins. Statistical tests on the median size class data were run to identify potential significant differences and test if increases in median size class occurred after the Cretaceous Thermal Maximum (KTM). Statistical tests were run on the number of missing size classes for each type of apex predator regime to determine if previously proposed hypotheses may explain potential differences. Statistical differences were found between four pairs of clades and their respective median size classes. Median size class increased after the Cretaceous Thermal Maximum for tyrannosauroids and potentially megaraptorans, but increased before the Cretaceous Thermal Maximum for ceratosaurians and did not change afterwards. The median number of missing size classes was found to be higher in the abelisauroid, abelisauroid/megaraptoran, and tyrannosauroid ecosystems compared to allosauroid/megalosauroid ecosystems. The median number of missing size classes between allosauroid/megalosauroid environments and tyrannosauroid-dominated environments was found to be significantly different, with a higher median number of missing size classes in tyrannosauroid-dominated environments. The analysis provides support for hypotheses, such as intraclade niche partitioning or niche shifting, to explain the differences in the median number of missing size classes between abelisauroid, abelisauroid/megaraptoran, and tyrannosauroid ecosystems and allosauroid/megalosauroid ecosystems. This study implies a complex history regarding the timing of the increase in the median size class for clades that survived the Cretaceous Thermal Maximum, which requires further study.

Creating a sustainable community cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) program that reaches underserved communities poses a challenge for the emergency medical services (EMS) community. Attendance, funding, and resources have all been linked to struggles surrounding community CPR/AED programs. Through our experience in conducting CPR/AED trainings in underserved regions of eastern North Carolina, we propose a method of effectively utilizing existing organizations and institutions of learning to expand and maintain a sustainable community CPR/AED program. Furthermore, we demonstrate 10 cornerstones in developing relationships within the community to increase attendance and participation in diverse communities.

Fever is one of the most common complaints in the emergency department (ED) and is more complex than generally appreciated. The broad differential diagnosis of fever includes numerous infectious and non-infectious etiologies. An essential skill in emergency medicine is recognizing the pitfalls in fever evaluation. This review provides an overview of the complaint of fever in the ED to assist the emergency physician with a structured approach to evaluation. Fever can be due to infectious or non-infectious etiology and results from the body's natural response to a pyrogen. Adjunctive testing including C-reactive protein, erythrocyte sedimentation rate, and procalcitonin has been evaluated in the literature, but these tests do not have the needed sensitivity and specificity to definitively rule in a bacterial cause of fever. Blood cultures should be obtained in septic shock or if the results will change clinical management. Fever may not be always present in true infection, especially in elderly and immunocompromised patients. Oral temperatures suffer from poor sensitivity to diagnose fever, and core temperatures should be utilized if concern for fever is present. Consideration of non-infectious causes of elevated temperature is needed based on the clinical situation. Any fever evaluation must rigorously maintain a broad differential to avoid pitfalls that can have patient care consequences. Fever is complex and due to a variety of etiologies. An understanding of the pathophysiology, causes, and assessment is important for emergency physicians.