• Patients you'll see

  • Heme: mostly sickle cell, ITP, pulmonary emboli

  • Onc: B cell ALL, T cell ALL, teratoid tumors, medulloblastoma, neuroblastoma, lymphoma, febrile neutropenia

• Sickle Cell Crisis Basics:

  • know pain scale, are the meds relieving the pain? 

  • The patient can go home when pain is adequately controlled with the inpatient medication equivalent to the home meds. 

  • Assess ability to do ADLs. 

  • Know the baseline Hb, and absolute retic count. 

  • Know the conversions from oral morphine to IV (1:3) and how to convert to other opioids. 

    • IV morphine should start working in 20min. 

    • Side effect of opioids: constipation. Generally need Senna and Miralax. 

    • When someone is on a PCA pump, continuous naloxone can be used for itching. 

    • Encourage deep breathing/incentive spirometry and getting out of bed.

Chemotherapy basics:

• Know the cycle, week, day of chemotherapy and what drugs they are receiving

• Steroids (ie dexamethasone) count as chemo and are one of the first things started

• Almost everyone gets an LP and bone marrow biopsy/aspirate for new diagnosis

  • Also: Intrathecal chemotherapy means it is administered into spinal fluids ie during an LP

• Everyone has a roadmap based on their diagnosis and severity of disease. Road maps outline their chemotherapy meds and schedule. They're usually at the nursing station in the front of the unit. Other times you need to ask Julie the NP

• Pharmacy orders the chemotherapy: ask Desiree (pharmacist) or Julie (NP) about schedule for meds if needed

  • Never EVER adjust chemotherapy meds on your own. Those should never be managed by just residents!

Always keep the fellows/attendings in the loop. To be honest, they never want to be kept out of the loop!