Oncologic and Hematologic Emergencies

Question 1

Neurological: Cord Compression Imaging

Answer 1

MRI 1st choice unless any metal/pacemaker

2nd: CT [+/- myelogram] of the WHOLE spine

Question 2

Neurological: Brain Metastases

Answer 2

headache, seizures, altered mental status, or focal deficits
Most commonly from lung or breast cancer if no prior known primary
Most common intracranial tumor

Question 3

Decadron

Answer 3

corticosteriod to treat edema in brain metastases, cord compression, SVC syndrome,,

Question 4

Hematologic: Hyperviscosity

Answer 4

Get The patient HYDRATED
Apheresis for IgM, plus chemotherapy.
Phlebotomy for PV: replace units with NS, want Hgb ~ 15
Hydroxyurea and aspirin for ET

Question 5

Cardiopulmonary: SVC Syndrome

Answer 5

Usually from lung cancer
Facial edema, symmetric or asymmetric upper extremity edema common
Shortness of breath common, but not hypoxic
Only a relative emergency, even with CNS symptoms

Question 6

Metabolic: Tumor Lysis Syndrome

Answer 6

Occurs in tumors with high body burden and high chemosensitivity
high-grade lymphomas or leukemias
Usually due to therapy, so you know the diagnosis already
Few clinical symptoms other than being ill with obvious lab abnormalities due to renal failure

Question 7

Metabolic: Tumor Lysis Syndrome Labs

Answer 7

HYPERURICEMIA
HYPERKALEMIA
HYPERPHOSPHATEMIA
HYPOCALCEMIA

Question 8

Metabolic: Hypercalcemia

Answer 8

Breast, lung, multiple myeloma most common causes
Squamous cancers from multiple sites often make PTH-rP
S/S:
Fatigue, N/V, constipation, anorexia, apathy, decreased consciousness most common

Question 9

Metabolic: SIADH

Answer 9

Small cell lung cancer
↓ BUN & serum osmolarity
↑ Urine Osmolarity & Sodium levels
Hyponatremic patient
treat with diuretics: lasix

Question 10

Neurological: Neutropenic Fever

Answer 10

Most patients are neutropenic due to chemotherapy, not malignancy in the marrow
Most neutropenia occurs 10-15 days after chemotherapy is given
Top of the “right now, this minute” list
Tx. with Cefipime, Moxifloxacin, Pip/Gent, Aztreonam