TY - CHAP M1 - Book, Section TI - Oncologic Emergencies A1 - Gutierrez, Cristina A1 - Pastores, Stephen M. A2 - Oropello, John M. A2 - Pastores, Stephen M. A2 - Kvetan, Vladimir PY - 1 T2 - Critical Care AB - KEY POINTSOncologic emergencies that may necessitate ICU admission include superior vena cava syndrome (SVCS), cardiac tamponade, malignant spinal cord compression, hypercalcemia, tumor lysis syndrome (TLS), and leukostasis.SVCS is primarily caused by lung cancer and lymphoma. Sudden death is observed only when there is airway compromise or cerebral edema. Management is directed toward restoring the patency of flow in the SVC and stabilizing the airway.Pericardial effusions from malignancies accumulate slowly and may result in large effusions. Lung, breast, melanoma, and lymphoma are the most common malignancies associated with pericardial tamponade. Emergent drainage or pericardial window is the treatment of choice for pericardial tamponade.Early recognition of malignant spinal cord compression with physical exam, magnetic resonance imaging, and angiography is vital to restoring neurologic function.Malignancy-associated hypercalcemia occurs in 20% to 30% of patients and is more common in solid tumors such as breast and lung cancer. Volume repletion with isotonic saline is the initial treatment of choice. Bisphosphonates, calcitonin, and corticosteroids are also useful treatments.TLS is characterized by electrolyte and metabolic derangements from the breakdown of malignant cells. TLS can occur spontaneously or after chemotherapy, radiation, and treatment with corticosteroids. Aggressive hydration and correction of electrolyte abnormalities (hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia) are keys to management.Hyperleukostasis (WBC > 50,000-100,000/mm3) is common in patients with acute myelogenous leukemia. Respiratory symptoms include dyspnea, hemoptysis, respiratory distress, and hypoxemia as well as neurologic including dizziness, headache, blurry vision, confusion, and stroke or intracranial hemorrhage. Treatment consists of leukapheresis, hydroxyurea, and chemotherapy. SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accessmedicine.mhmedical.com/content.aspx?aid=1136415836 ER -