TY - CHAP M1 - Book, Section TI - Oncologic Emergencies A1 - Rajendram, Prabalini A1 - Pastores, Stephen M. A2 - Schmidt, Gregory A. A2 - Kress, John P. A2 - Douglas, Ivor S. PY - 2023 T2 - Hall, Schmidt and Wood’s Principles of Critical Care, 5th Edition AB - KEY POINTSOncologic emergencies can be classified into tumor obstruction or compression, metabolic, cardiopulmonary, and hematologic malignancy-related emergencies.Management of malignant spinal cord compression includes pain control and preservation of neurologic function with glucocorticoids, surgical decompression, and external beam radiation therapy.Treatment priorities for severe superior vena cava syndrome include rapid stabilization of the airway in the setting of laryngeal/vocal cord edema and relief of obstruction with endovenous recanalization (e.g., mechanical or pharmacologic thrombolysis, balloon angioplasty) and SVC stenting.Tumor lysis syndrome (TLS) occurs as a result of breakdown of malignant cells commonly after initiation of cytotoxic chemotherapy and is characterized by hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.Treatment of TLS includes aggressive intravenous hydration with close monitoring of electrolytes, rasburicase, and hemodialysis or continuous veno-venous hemofiltration for severe hyperphosphatemia and renal failure (uremia, volume overload, hyperkalemia, and acidosis).Malignancy-associated hypercalcemia (MAH) can occur in up to 30% of patients with cancer. Treatment includes aggressive IV hydration with 0.9% saline along with the use of bisphosphonates (zoledronic acid favored over pamidronate), denosumab, and corticosteroids.Echocardiography-guided pericardiocentesis is the preferred treatment modality for pericardial tamponade in an unstable patient to restore hemodynamics.Hematologic malignancy-related emergencies include blast crisis, hyperleukocytosis, leukostasis, and hemophagocytic lymphohistiocytosis (HLH).The HLH-2004 diagnostic criteria requires five of the following eight criteria: fever, cytopenia, splenomegaly, hypertriglyceridemia and/or fibrinogenemia, hemophagocytosis in bone marrow, low or absent NK cell activity, hyperferritinemia, and elevated levels of soluble interleukin (IL)-2 receptor. First-line therapy includes the administration of corticosteroids and etoposide. SN - PB - McGraw Hill CY - New York, NY Y2 - 2025/02/12 UR - accesssurgery.mhmedical.com/content.aspx?aid=1201808214 ER -