Foreword

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Amal Mattu, MD, FAAEM, FACEP

Anybody who has worked in emergency medicine for more than a few years has undoubtedly noticed a marked increase in the number of patients reporting a past medical history notable for cancer. This change can largely be attributable to three major factors. First, diagnostic testing for cancer has improved dramatically over the past decade, resulting in earlier detection of many neoplasms. Second, advances in therapy have increased the lifespan of many patients with cancer, turning the condition from a rapid killer in many cases into a chronic and often manageable disease. Third, advances in diagnosis and management of the two other major causes of mortality in the developed world, heart disease and stroke, are essentially allowing greater numbers of patients to live long enough to inevitably develop cancer.

The natural consequence of this is a significant increase in the number of patients presenting to our emergency departments (EDs) with either cancer-related emergencies or with other conditions in which cancer represents an important comorbidity that must be accounted for in diagnosing and treating the primary condition. It is therefore imperative that all emergency physicians gain greater familiarity with oncologic conditions and their treatments. This imperative has, in fact, encouraged an increasing number of emergency physicians to develop an academic niche focusing on oncologic emergencies. Continuing medical education conferences and publications routinely include topics related to management of solid organ and hematologic malignancies. An increasing number of research publications in emergency medicine are focusing on the diagnosis and management of oncologic emergencies. Pharmacists and toxicologists also are spending increasing amounts of time teaching about the must-know drug interactions that occur in patients taking chemotherapeutic agents. And specialists in infectious diseases are busy teaching how cancer and chemotherapy influence the evaluation and treatment of otherwise “routine” infections.

Fortunately for the readers of Emergency Medicine Clinics of North America, guest editors Drs. Mohamud Daya, C.R. Thomas, and David Spiro have assembled an outstanding group of authors that address all of these issues in a 2-part series. In this month's issue, they address neurologic emergencies, endocrine emergencies, metabolic and electrolyte complications, cardiovascular emergencies, airway complications, and toxicologic emergencies. They also address the very important issues of pain management and end-of-life care. In the August 2009 issue, they address gastrointestinal and hematologic emergencies, and they also provide several articles focused on issues relevant to pediatric patients.

Overall, the May and August 2009 issues of Emergency Medicine Clinics represent a comprehensive curriculum that covers the full spectrum of emergencies that ED health care providers are likely to encounter in clinical practice. These two issues represent an important contribution to education, and they are certain to improve the care of this ever-growing patient population in the ED. Our thanks go to the guest editors and their dedicated authors for this excellent work.