Simon is a 72-year-old patient diagnosed with myelodysplastic syndrome and acute myeloid leukemia. He underwent an HLA-identical sibling peripheral blood stem cell transplantation with fludarabine and melphalan as conditioning chemotherapies before the procedure. Simon is now more than 12 days posttransplant but still neutropenic with an absolute neutrophil count of 0. He has no signs of engraftment, is on total parenteral nutrition, and requires multiple blood transfusions and electrolytes through his central line catheter daily.

Tumor lysis syndrome is an oncologic emergency caused by massive tumor cell death with the release of large amounts of potassium, phosphate, and nucleic acids into systemic circulation. Nucleic acids break down to uric acid, leading to hyperuricemia in patients. This, in turn, leads to precipitates in the renal tubules, renal vasoconstriction, decreased renal flow, inflammation, and can potentially cause acute kidney injury. 

Most emergencies can manifest in the blink of an eye. Whether it’s a medical emergency, a car accident, an act of nature, or something else, emergencies are sudden crises that require swift, immediate action. For many patients with cancer, among the most distressing challenges along the treatment journey is the possibility of experiencing an oncologic emergency.

As new therapies come to market, patients with multiple myeloma have more treatment options that are improving outcomes and extending overall survival. However, the most effective options involve multidrug combinations and continuous maintenance therapy, which can result in cumulative toxicities and the potential for oncologic emergencies.

When a severe tornado hit Joplin, MO, on the evening of May 22, 2011, the situation was serious. St. John’s Regional Medical Center in Joplin was hit so hard that it is still unusable. It needed to be evacuated, nearby Freeman hospital became quickly overwhelmed with patients, and the surrounding community prepared for action.

In the early hours of September 13, 2008, Hurricane Ike—a category 2 hurricane—hit Galveston Island, TX, bringing with it sustained winds of up to 110 miles per hour and storm surges reaching as high as 17 feet. By the next day, more than 200 shelters had opened across Texas to house the estimated 40,000 people who had been forced to evacuate from their homes.

I live in Middle Tennessee, an area that’s part of tornado alley, a pathway across central United States that has a higher incidence of tornadoes. We routinely prepare for the storms, listening for the tornado sirens whether at home or work. Although there have been a number of tornado touchdowns in our region in recent years, fortunately none have directly hit our healthcare facilities.