1. Cytokine Release Syndrome (CRS) and Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS) represent a spectrum of inflammatory side effects associated with T-cell targeted therapies, such as CAR-T.

2. Patients with CAR-T related CRS and/or ICANS toxicities have favorable prognosis and are expected to recover without persistent side-effects if symptoms are recognized early and managed rapidly. These toxicities are relatively reversible and require prompt collaboration between the ED provider, oncologist, and other specialists.

3. The American Society for Blood and Marrow Transplantation (ASTCT) grading scale is commonly utilized to characterize the severity of CRS and ICANS with management recommendations based on severity grade.

4. IL-6 inhibitors such as tocilizumab do not cross the blood-brain barrier and should not be used for ICANS treatment unless there is concomitant CRS.

5. Consider early transfer for higher level of care, even if patient has a low CRS grade, if IL-6 inhibitors are not available for administration at your hospital.

1. End of life (EOL) discussions are difficult to initiate in any setting, but especially in the Emergency Department. However, new or worsening illness can be a key moment to start conversations.

2. During discussions, be as honest and direct as possible while employing tools such as compassion, listening and silence.

3. When your patient is a child or adolescent, consider their developmental stage and understanding of death, realizing that often children with chronic illnesses have some delay in achieving developmental milestones.

4. Management of EOL symptoms differs from conventional management, so goals regarding a patient’s care should be thoroughly discussed and established prior to discontinuation and/or escalation of the patient’s medications.

5. Consult and utilize appropriate resources, including the palliative and hospice care team, for assistance with difficult conversations and applying appropriate guidelines for symptom management.

1. The risk of acute or delayed chemotherapy-induced nausea and vomiting (CINV) is dependent on the patient’s chemotherapy regimen and its emetogenic potential.

2. It is important to know the patient’s chemotherapeutic regimen, including the patient’s prophylactic regimen for acute CINV, as the agent utilized for breakthrough nausea and vomiting should have a different mechanism of action.

3. If a patient is considered refractory to an antiemetic regimen, an antiemetic with a different mechanism of action should be added to the current antiemetic regimen.

4. There is no difference in efficacy between PO and IV formulations of antiemetic therapy in the treatment of CINV. As a result, PO is preferred if tolerated due to the decreased number of adverse effects, including QT prolongation.

5. Many antiemetics carry some risk of QTc prolongation, which is a predictor of the risk of Torsades de Pointes. Other risk factors include age = 65 years old, female sex, electrolyte disturbances, cardiovascular disease, and concomitant medications. Since many CINV patients have multiple risk factors for QTc prolongation and cardiac dysrhythmias, caution should be utilized, and providers should consider obtaining an ECG in high-risk patients to help determine optimal therapy.

This chapter discusses an innovative program at the Los Angeles County jail that showcases the transformative impact of compassionate care provided by inmate Mental Health Assistants (MHAs) for incarcerated patients with serious mental illness. The MHAs undergo extensive training in trauma-informed care and work to bridge the communication gap between patients and clinical staff. The chapter outlines the philosophy, structure, and goals of the program, emphasizing the need for a restorative environment and meaningful services within the jail. The core framework of the Mental Health Assistant model focuses on advocating for proper care and creating change for marginalized individuals. The program aims to promote healing, reduce recidivism, and uplift everyone involved through a culture of love, unselfishness, integrity, teamwork, and organized effort. The chapter details the impactful role of MHAs, the institutional mental health support program, and a step-by-step guide for implementing a transformative mental health care model within the corrections system.

1. Distinguishing hemoptysis from pseudohemoptysis is crucial for effective management.

2. Hemoptysis in patients with cancer can rapidly progress from mild symptoms such as small streaks of blood in the sputum to life threatening bleeding requiring hemodynamic stabilization depending on tumor type and location

3. CT pulmonary angiography imaging study enables tumor localization and provides a clearer understanding of the appropriate consultant and treatment options.

4. Acquiring a comprehensive history of present and past cancer treatment medications, anticoagulation therapies, and relevant procedures is essential for identifying additional inciting causes for hemoptysis

5. Inhaled TXA is a useful bridging medication that helps to control bleeding while waiting for more definitive management.

In the Netherlands, compulsory care of patients with mental disorders such as schizophrenia is regulated by the Law on Compulsory Mental Healthcare (Wet verplichte geestelijke gezondheidszorg or Wvggz). This law replaces its predecessor, the Law on Special Admissions to Psychiatric Hospitals (Wet bijzondere opnemingen in psychiatrische ziekenhuizen or Bopz). The legislative process for this new law took over a decade. Discussions in parliament, with clinicians and in civil society focused much on the complexity of the relevant legal procedures and on the autonomy and legal position of the patients. In this paper, we discuss the Wvggz, its background and the central procedures for the judicial authorization of compulsory care. We also discuss which forms of compulsory care the Wvggz allows – as the Wvggz provides options for compulsory care in mental health clinics, but also at home and in community settings. While the Wvggz is a complex law with many elements, in this paper we focus on various ways the Wvggz is purportedly aimed at enhancing autonomy of patients with severe mental illness. In conclusion, we show how Dutch regulations aimed at enhancing autonomy also create more complexity and bureaucracy for patients.

1. Superior vena cava (SVC) syndrome should be suspected in patients with shortness of breath and swelling of the head and neck. As symptoms progress, arm swelling may develop and in severe cases, distension of neck and chest veins.

2. Once suspected, immediately raise the head of the patient’s bed to decrease hydrostatic pressure. Monitor the patient’s airway for laryngeal edema – patients may require intubation if they have respiratory compromise.

3. Ultrasound can be used to assess for evidence of thrombus. However, CT chest with contrast or MRI is the preferred modality of imaging.

4. If thrombus is suspected, the patient should be started on anticoagulation, typically heparin.

5. In cases where SVC syndrome is caused by tumor infiltration/compression, endovascular stenting has become the most popular method of alleviating the obstruction. Patients may also require tumor debulking with radiation therapy and/or chemotherapy.

1. Causes of constipation in patients with cancer are multifaceted, but opioid induced constipation is the most common cause.

2. Constipation in cancer patients can lead to serious complications, including fecal impaction, bowel obstruction, and decreased absorption of oral medications, which can impact the effectiveness of cancer treatment.

3. Bulking agents can be used in mild cases of constipation but should be avoided in patients with severe disease, taking anticholinergic drugs or opioids, and those with poor oral intake.

4. Stool softeners can be helpful in patients with anal fissures or hemorrhoids to allow for less painful bowel movements. Polyethylene glycol is recommended as first line due to its low cost, rapid onset, and rare adverse side effects.

5. Peripherally acting mu-opioid receptor antagonists (PAMORA) bind only to opioid receptors in the gut, counteracting constipation side effects without decreasing analgesic effects.

Animal studies demonstrate particular difficulty in conducting bias-free research, investigators rarely synthesize existing research using modern methods, and have the added problem of translating results in one species to another (humans). Recent guidelines are described that attempt to improve the quality of animal research.

1. Hemorrhagic cystitis (HC) is a condition characterized by inflammation and bleeding of the bladder lining.

2. It is important to have a high index of suspicion for HC in patients who complain of urinary changes after starting chemotherapy or who have previously undergone pelvic radiation therapy.

3. Symptoms commonly include blood in the urine, increased urinary frequency and urgency, pain with urination and lower abdominal pain.

4. HC can present as mild non-infectious hematuria, but in more severe cases as gross hematuria with hemorrhage and clots causing acute urinary retention.

5. The best treatment is prevention and supportive care with saline diuresis and mesna.

1. Pharmacologic management of active seizure in cancer patients starts with benzodiazepines, followed by levetiracetam or lacosamide load. For refractory seizures, intubate and start a benzodiazepine infusion.

2. Tailor a differential diagnosis. Determine whether the seizure was focal or generalized. Obtain a history of their treatments, medications and recent changes, preceding symptoms, and determine if there are residual symptoms or deficits.

3. New seizures in any cancer patient should prompt imaging to evaluate for structural lesion, first with non-contrast CT head followed by gadolinium-enhanced MRI. Focal seizures suggest focal causation.

4. Continuous video EEG is preferred, as shorter EEG may fail to capture non-convulsive status epilepticus (NCSE).

5. Metabolic derangements can present with seizures and is common in patients with oncologic processes. Therefore, a high degree of suspicion and low threshold for repletion of electrolytes and correction of acid-base abnormality is imperative.

1. It is important to consider immune-related adverse events in patients coming in with new cutaneous reactions, even in patients who have not recently started a new immunotherapy regimen, as reactions can occur months later.

2. Pruritus and morbilliform rashes tend to be the most common adverse event related to immunotherapy, and often do not require interruption of treatment.

3. Red flags of more severe cutaneous adverse events include mucous membrane involvement, skin sloughing, large body surface area involvement, end organ dysfunction, presence of bullae, and associated fever.

4. Treatment will vary by Grade and includes topical steroids and antipruritic medications, as well as oral antihistamines.

5. Diagnosis may require Dermatology consultation and skin biopsy. Progression of cutaneous toxicities with serial photographs can be helpful in evaluating immune related cutaneous adverse events.