Oncologic Emergency

Question 1

Spinal cord compression

sqs

Answer 1

1) dexamethasone 6mg q 6 hours or 4q4hr plus radiation
Opioids and bowel regimen

Refractory: surgery

Prevent with bisphosphonate q 4 weeks
Denosumab

Question 2

Superior vena cava syndrome

Answer 2

Back flow of blood - Thrombosis
Upper airway obstruction

Supportive care
Diuretics, low salt

Radiation on tumor
Prednisone for lymphoma

Question 3

Anaphylactic Infusion reactions

Pre-DD

Answer 3

Platinum cumulative dose exposure
Taxane (paclitaxel) early dose

Pre-medicate dexamethasone, diphenhydramine

Treat with fluid resuscitation, O2
Diphenhydramine IV, ranitidine IV, methylprednisolone IV

Question 4

Anaphylactoid infusion reaction

Answer 4

More with mouse -omab , chimeric -ximab
Less with humanized -zumab, -umab

Rituximab premedicate APAP, diphenhydramine, steroids

Treat with steroids, antihistamine

Question 5

Hypercalcemia

Answer 5

1) hydration NS to dilute calcium
bisphosphonates
PTH antagonist (calcitonin) DC after 3 days

2nd) furosemide for fluid overload
Gallium nitrate
Dialysis

10.5-12 w/ symptoms or >12 hydration and bisphosphonate
>14 add calcitonin and DC after 72 hours

Question 6

Extravasation

Answer 6

Prevent: CVC port, IV bolus, short infusion

Treat: stop infusion, heat/ice, antidote

Question 7

Anthracycline, DNA binding drug extravasation

Answer 7

Apply ice. Red rubi ice

Antidote of choice: dexrazoxane

Also DMSO for platinums, mitomycin

Question 8

Taxane, vinca alkaloid

Answer 8

Apply warm compress

Antidote: hyaluronidase

Question 9

Sodium thiosulfate

MBC

Answer 9

Antidote for extravasation with

Mechlorethamine
Bendamustine
Cisplatin

Question 10

Corrected calcium

Answer 10

0.8(4-albumin) + serum Ca