Oncologic Emergency Comparison

• ✦Hyperkalemia (>5.5 mEq/L)
• ✦Hyperphosphatemia (>4.5 mg/dL)
• ✦Hyperuricemia (>8 mg/dL)
• ✦Hypocalcemia (<7.0 mg/dL)
• ✦Elevated creatinine (AKI)
• ✦Cardiac arrhythmias (from hyperK)
• ✦Oliguria

Onset 24–72 hrs post-chemo. Elevated K, PO4, uric acid + low Ca on labs. ECG: peaked T waves, widened QRS. Most common with Burkitt lymphoma, ALL.

1. 1.Aggressive IV hydration (200 mL/hr NS)
2. 2.Strict I&O — goal urine output ≥100 mL/hr
3. 3.Cardiac monitoring — ECG
4. 4.Labs q4–6h (K, PO4, Ca, UA, Cr)
5. 5.Administer allopurinol or rasburicase per order
6. 6.No potassium-containing IV solutions
7. 7.Notify provider STAT

• ✦Back pain (most common first symptom)
• ✦Progressive extremity weakness
• ✦Sensory loss below level of compression
• ✦Bowel or bladder dysfunction (late sign)
• ✦Hyperreflexia or hyporeflexia
• ✦Paraplegia (if untreated)

Cancer patient with new or worsening back pain. MRI spine is gold standard. Neurological deficits may worsen rapidly — any bowel/bladder involvement = emergency.

1. 1.Immobilize spine — log-roll for all repositioning
2. 2.Dexamethasone (high-dose) per order STAT
3. 3.MRI spine — accompany patient
4. 4.Fall precautions — assess motor/sensory function
5. 5.Bladder scan for urinary retention
6. 6.Pressure injury prevention
7. 7.Notify oncology and neurosurgery

• ✦Facial swelling and plethora (flushing)
• ✦Neck and arm edema
• ✦Prominent neck and chest veins (collateral)
• ✦Dyspnea, cough
• ✦Dysphagia
• ✦Headache worsened by bending forward
• ✦AMS or seizures if cerebral edema

Symptoms WORSE when supine — classic. CT chest with contrast confirms SVC obstruction. May be first manifestation of lung cancer or lymphoma.

1. 1.Elevate HOB 30–45 degrees — PRIORITY
2. 2.NO IVs or BP cuff on upper extremities
3. 3.Minimize Valsalva maneuvers
4. 4.Neuro checks — monitor for AMS
5. 5.O2 per protocol; monitor SpO2
6. 6.Prepare for corticosteroids per order
7. 7.Radiation oncology/oncology consult

• ✦Ca >10.5 mg/dL (mild); >14 mg/dL (severe)
• ✦Bones: bone pain, pathologic fracture
• ✦Groans: nausea, vomiting, constipation
• ✦Moans: fatigue, confusion, AMS, coma
• ✦Stones: polyuria, polydipsia, renal failure
• ✦QT shortening on ECG
• ✦Hyporeflexia, muscle weakness

Mnemonic: Bones, Groans, Moans, Stones. Most common in breast CA, myeloma, squamous lung CA. Check ionized calcium or corrected calcium (adjusted for albumin).

1. 1.IV hydration with NS — cornerstone of treatment
2. 2.Strict I&O — monitor urine output
3. 3.Cardiac monitoring
4. 4.Neurological assessment — AMS worsening
5. 5.Encourage ambulation (immobility worsens hypercalcemia)
6. 6.Administer bisphosphonate (zoledronic acid) per order
7. 7.Avoid thiazide diuretics

• ✦Fever ≥38°C (100.4°F) + ANC <500
• ✦OR fever ≥38.3°C (101°F) once
• ✦May have NO localizing infection signs
• ✦Hypotension (septic shock if progresses)
• ✦Tachycardia
• ✦No obvious source in 50% of cases

Timing: 7–14 days post-chemotherapy (nadir). Neutropenic patient: infection can overwhelm before classic inflammatory response (may NOT be febrile with very low ANC). Blood cultures BEFORE antibiotics.

1. 1.Blood cultures × 2 BEFORE antibiotics
2. 2.Broad-spectrum IV antibiotics within 60 minutes
3. 3.Access assessment: peripheral + central line cultures
4. 4.Source assessment: lungs, skin, mouth, CVADs
5. 5.NO rectal temperatures or rectal exam
6. 6.Neutropenic precautions reinforcement
7. 7.Notify provider IMMEDIATELY — treat like sepsis