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Febrile Neutropenia Definition Febrile neutropenia (FN) is a medical emergency characterized by the development of fever in a patient with significant neutropenia. It is commonly seen in immunocompromised individuals, particularly those undergoing chemotherapy for malignancies. Diagnostic Criteria Febrile neutropenia is defined by the following criteria: Fever : A single oral temperature ≥ 38.3°C (101°F) or a sustained temperature ≥ 38.0°C (100.4°F) for more than 1 hour. Neutropenia : An absolute neutrophil count (ANC) < 500 cells/μL, or expected to fall below 500 cells/μL within 48 hours. Etiology and Major Causes The primary cause of febrile neutropenia is chemotherapy-induced myelosuppression. Other causes include: Hematological malignancies (e.g., leukemia, lymphoma, myelodysplastic syndromes) Bone marrow suppression due to radiation therapy Aplastic anemia and other bone marrow disorders Infections : Bacterial (Gram-negative and Gram-positive), fungal, and viral infections Dru...

Extra-Corporeal Cardiopulmonary Resuscitation (ECPR) Introduction: What is ECPR? Extracorporeal Cardiopulmonary Resuscitation (ECPR) is an advanced resuscitative technique that utilizes extracorporeal membrane oxygenation (ECMO) to provide circulatory and respiratory support in patients experiencing refractory cardiac arrest. Unlike conventional cardiopulmonary resuscitation (CPR), which relies on chest compressions and ventilation, ECPR involves the rapid establishment of veno-arterial ECMO to maintain perfusion to vital organs while treating the underlying cause of cardiac arrest. ECPR is primarily used in specialized centers with well-trained personnel and appropriate infrastructure, making it a resource-intensive intervention. Background and History of ECPR The concept of extracorporeal circulation has been evolving since the early 1950s, with Dr. John Gibbon’s development of the first successful heart-lung machine. In the 1970s, the use of ECMO for neonates with respiratory failur...

Introduction The Waterfall Trial is a landmark emergency medicine study investigating the optimal fluid resuscitation strategy for acute pancreatitis . Given the longstanding debate over whether aggressive or moderate fluid resuscitation leads to better outcomes, this trial provides essential clinical evidence. The study aims to determine whether a moderate fluid resuscitation approach is as effective as or superior to aggressive fluid administration , particularly in preventing complications such as fluid overload and organ failure . Background and Clinical Question Acute pancreatitis is an inflammatory condition that can range from mild, self-limiting disease to severe, life-threatening illness. Common causes include gallstones, chronic alcohol consumption, hypertriglyceridemia, and certain medications . The cornerstone of early management in emergency departments (EDs) is fluid resuscitation , aimed at maintaining perfusion and preventing complications such as systemic inflammator...