Study guide
27.3 Oncologic Emergencies, Hematopoietic Cell Transplant Complications & Cellular Therapy Toxicity
ABIM Critical Care Medicine Study Guide Exam
Track your progress as you read
Finished sections get a check mark.
1 Chapter 1: Exam Orientation: Format, Blueprint & Study Strategy
1.1 ABIM Critical Care Medicine Exam: Format, Blueprint & Study Strategy
2 Chapter 2: Acute Respiratory Failure & ARDS
2.1 ARDS Definition, Pathophysiology & Phenotypes 2.2 Lung-Protective Mechanical Ventilation 2.3 Refractory ARDS: Prone Positioning, Neuromuscular Blockade & VV-ECMO
3 Chapter 3: Obstructive Airways, Pulmonary Vascular & Pleural Emergencies
3.1 Severe Asthma & COPD Exacerbations in the ICU 3.2 Massive & Submassive Pulmonary Embolism 3.3 Pulmonary Hypertension & Right Ventricular Failure in the ICU 3.4 Massive Hemoptysis, Complex Pleural Effusions & Thoracic Drainage
4 Chapter 4: Airway, Parenchymal & Nonthrombotic Pulmonary Emergencies
4.1 Airway Management, Upper-Airway Obstruction & Artificial-Airway Complications 4.2 Diffuse Alveolar Hemorrhage, Interstitial Lung Disease, Pulmonary Vasculitis & Noncardiogenic Edema 4.3 Severe Community-Acquired & Viral Pneumonia 4.4 Nonthrombotic Embolism (Air, Fat, Amniotic Fluid, Tumor, Septic) & Acute Chest Syndrome
5 Chapter 5: Mechanical Ventilation Modes, Dyssynchrony & Liberation
5.1 Mechanical Ventilator Modes & Advanced Breath Delivery 5.2 Patient-Ventilator Dyssynchrony & Waveform Analysis 5.3 Ventilator Liberation, Spontaneous Breathing Trials & Post-Extubation Support
6 Chapter 6: Shock Syndromes & Hemodynamic Principles
6.1 Shock Classification, Cellular Pathophysiology & Biomarkers 6.2 Hemodynamic Monitoring: Arterial Lines, CVP & Pulmonary Artery Catheter 6.3 Dynamic Assessment of Fluid Responsiveness & Resuscitation Targets
7 Chapter 7: Vasoactive Therapies & Mechanical Circulatory Support
7.1 Vasopressors & Inotropes: Pharmacology & Clinical Titration 7.2 Temporary Mechanical Circulatory Support: IABP, Impella & TandemHeart 7.3 Venoarterial ECMO (VA-ECMO) & Differential Hypoxemia 7.4 Post-Cardiac Arrest Care, Targeted Temperature Management & Neuroprognostication
8 Chapter 8: Acute Kidney Injury & Renal Replacement Therapy
8.1 KDIGO AKI Classification, Etiologies & Diagnostic Evaluation 8.2 Continuous Renal Replacement Therapy (CRRT) vs Intermittent Hemodialysis 8.3 Indications & Timing for RRT in Critical Illness: AKIKI & STARRT-AKI
9 Chapter 9: Electrolyte, Acid-Base & Endocrine Emergencies
9.1 Severe Dysnatremias: Hyponatremia, Hypernatremia & Osmotic Demyelination 9.2 Potassium, Calcium, Magnesium & Phosphate Disorders 9.3 Complex & Mixed Acid-Base Disorders: Boston vs Copenhagen vs Stewart 9.4 Endocrine Crises: DKA, HHS, Thyroid Storm, Myxedema Coma & Adrenal Crisis
10 Chapter 10: Glycemic Control, Hyperammonemia, Pituitary & Adrenal Disorders
10.1 ICU Glycemic Control & Severe Hypoglycemia 10.2 Non-Hepatic Hyperammonemia & Metabolic Encephalopathy 10.3 Pituitary Emergencies, Adrenal Excess & Critical Illness-Related Corticosteroid Insufficiency
11 Chapter 11: Acute Coronary Syndromes & Cardiac Arrhythmias
11.1 Acute Coronary Syndromes & Mechanical Complications of Myocardial Infarction 11.2 Critical Tachyarrhythmias: Atrial Fibrillation with RVR, VT & VF 11.3 Critical Bradyarrhythmias, Conduction Blocks & Temporary Cardiac Pacing
12 Chapter 12: Acute Heart Failure, Valvular & Pericardial Emergencies
12.1 Acute Decompensated Heart Failure & Cardiogenic Pulmonary Edema 12.2 Acute Valvular Regurgitation & Prosthetic Valve Emergencies 12.3 Pericardial Tamponade & Acute Aortic Syndromes
13 Chapter 13: Myocardial Disease, Hypertensive & Cardiac Device Emergencies
13.1 Fulminant Myocarditis, Stress & Peripartum Cardiomyopathy, and Hypertrophic Cardiomyopathy 13.2 Hypertensive Emergencies & Ruptured Abdominal Aortic Aneurysm 13.3 Implanted Cardiac Devices, LVAD Emergencies & Electrical Storm
14 Chapter 14: Sepsis & Systemic Infectious Diseases
14.1 Sepsis-3 Definitions & Surviving Sepsis Campaign 2026 Guidelines 14.2 Refractory Septic Shock & Adjunctive Therapies 14.3 Multidrug-Resistant Pathogens & Antimicrobial Stewardship in the ICU
15 Chapter 15: ICU-Acquired & Severe Focal Infections
15.1 Hospital-Acquired & Ventilator-Associated Pneumonia 15.2 Central Line-Associated Bloodstream Infections & Catheter-Associated UTIs 15.3 Intra-Abdominal Sepsis, Necrotizing Soft Tissue Infections & CNS Infections
16 Chapter 16: Focal, Special-Host & Systemic Infections
16.1 CNS Infections Beyond Bacterial Meningitis: Encephalitis, Brain Abscess & Epidural Abscess 16.2 Infections in the Immunocompromised Host, Tropical & Bioterror Infections 16.3 Infective Endocarditis, Device Infections & Other Focal Cardiovascular Infections 16.4 Antimicrobial Pharmacokinetics, Allergy, Toxicity & Infection Prevention 16.5 Gastrointestinal & Hepatobiliary Infections: Fulminant C. difficile, Typhlitis, CMV Colitis & Abscesses
17 Chapter 17: Neurocritical Care & Coma
17.1 Coma, Altered Mental Status & Acute Delirium in the ICU 17.2 Status Epilepticus & Non-Convulsive Status Epilepticus 17.3 Acute Ischemic Stroke & Intracranial Hemorrhage
18 Chapter 18: Cerebrovascular Syndromes, Encephalopathy & Withdrawal States
18.1 Cerebral Venous Sinus Thrombosis, PRES & Reversible Cerebral Vasoconstriction Syndrome 18.2 Alcohol & Sedative Withdrawal, Wernicke Encephalopathy & Drug-Induced Encephalopathy
19 Chapter 19: Intracranial Hypertension & Neuromuscular Weakness
19.1 Intracranial Pressure Monitoring, Cerebral Perfusion & Tiered ICP Management 19.2 Acute Neuromuscular Respiratory Failure, ICU-Acquired Weakness & Brain Death Determination
20 Chapter 20: Traumatic Brain Injury, Spinal Cord Injury & Toxin-Mediated Paralysis
20.1 Traumatic Brain Injury Management & Paroxysmal Sympathetic Hyperactivity 20.2 Acute Spinal Cord Injury, Neurogenic Shock & Autonomic Dysreflexia 20.3 Toxin-Mediated Paralysis & Neuromuscular Crises: Botulism, Tetanus, Tick Paralysis & Myasthenic Crisis
21 Chapter 21: Gastrointestinal, Hepatic & Abdominal Emergencies
21.1 Acute Upper & Lower Gastrointestinal Bleeding in the ICU 21.2 Acute Liver Failure & Severe Acute Pancreatitis 21.3 Abdominal Compartment Syndrome & Acute Mesenteric Ischemia
22 Chapter 22: Luminal GI Emergencies & Complications of Cirrhosis
22.1 Esophageal, Gastric & Bowel Emergencies: Perforation, Obstruction, Ogilvie Syndrome & Colonic Ischemia 22.2 Complications of Cirrhosis: Alcohol-Associated Hepatitis, Hepatorenal Syndrome & Pulmonary Vascular Syndromes
23 Chapter 23: Trauma, Burns & Perioperative Critical Care
23.1 Polytrauma Resuscitation, Damage Control & Massive Transfusion 23.2 Severe Burn Injury, Inhalation Injury & Environmental Emergencies 23.3 Perioperative Critical Care for High-Risk Surgical Patients
24 Chapter 24: Thoracic Trauma, Environmental Injury & Obstetric Critical Care
24.1 Thoracic Trauma: Flail Chest, Pulmonary Contusion, Great Vessel & Tracheobronchial Injury 24.2 Environmental Injury: Drowning, Diving, Altitude, Heat, Cold, Electrical & Radiation 24.3 Obstetric & Genitourinary Emergencies and the Physiology of Pregnancy
25 Chapter 25: Transplantation, Donor Management & Post-Cardiac Surgery Care
25.1 Solid Organ Transplant Recipients & Deceased Donor Management 25.2 Post-Cardiac Surgery Critical Care: Bleeding, Tamponade, Low Output & Vasoplegia
26 Chapter 26: Hematologic Emergencies, Toxicology, Critical Ultrasound & ICU Liberation
26.1 Hematologic Emergencies in the ICU: HIT, DIC, TMA & Anticoagulant Reversal 26.2 Critical Care Toxicology, Toxidromes & Specific Antidotes 26.3 Critical Care Point-of-Care Ultrasound (POCUS) 26.4 ICU Liberation, Analgosedation, Goals of Care & Critical Care Ethics
27 Chapter 27: Transfusion Medicine, Hematologic & Oncologic Disorders
27.1 Transfusion Medicine: Products, Thresholds, Reactions & Apheresis 27.2 Red and White Cell Disorders, Hemoglobinopathies, Factor Deficiencies & Hypercoagulable States 27.3 Oncologic Emergencies, Hematopoietic Cell Transplant Complications & Cellular Therapy Toxicity
28 Chapter 28: Clinical Pharmacology, Adverse Drug Reactions & Specific Poisonings
28.1 Pharmacokinetic Principles, Dose Adjustment & Drug Interactions in Critical Illness 28.2 Adverse Drug Reactions: Anaphylaxis, Severe Cutaneous Reactions & Hyperthermic Syndromes 28.3 Specific Poisonings: Sodium-Channel Blockers, Lithium, Valproate, Theophylline, Iron, Sulfonylureas & Methemoglobinemia
29 Chapter 29: Ethics, Research Methods, Administration & Abdominal Ultrasound
29.1 Advance Care Planning, Nonbeneficial Treatment, Informed Consent & Confidentiality 29.2 Critical Care Research Methods, Statistics, IRB Oversight & Quality Improvement 29.3 Abdominal, Vascular & Procedural Point-of-Care Ultrasound
27.3 Oncologic Emergencies, Hematopoietic Cell Transplant Complications & Cellular Therapy Toxicity
Key Takeaways Explain This Topic AI
Malignant spinal cord compression is treated with immediate dexamethasone and urgent whole-spine MRI, followed by surgery or radiotherapy, because neurologic function at treatment predicts outcome.
Hyperviscosity syndrome from IgM paraprotein causes mucosal bleeding, visual changes, and confusion, and is treated with urgent plasmapheresis.
Hepatic sinusoidal obstruction syndrome after transplantation presents with weight gain, painful hepatomegaly, and hyperbilirubinemia, and is treated with defibrotide.
Cytokine release syndrome is graded by fever, hypotension, and hypoxemia, and is treated with tocilizumab, adding corticosteroids for higher grades.
Hypercalcemia of malignancy is treated with isotonic saline plus calcitonin for rapid effect and zoledronic acid or denosumab for sustained control; loop diuretics are not routine.
Last updated: October 2026
- Structural Oncologic Emergencies
- Superior Vena Cava Syndrome
Causes : lung cancer (especially small cell), lymphoma, germ cell tumors, and increasingly indwelling catheters and pacemaker leads causing thrombosis.
Presentation : facial and upper extremity swelling, distended neck and chest veins, plethora, cough, and dyspnea worsened by lying flat. Stridor, severe dyspnea at rest, and altered mental status from cerebral edema mark true emergencies.
Management :
Elevate the head, give oxygen.
Establish the diagnosis before treating when the patient is stable, because treatment depends on tumor type: obtain tissue, since lymphoma and germ cell tumors respond rapidly to chemotherapy.
Endovascular stenting provides the fastest relief and is favored for severe symptoms.
Radiotherapy for radiosensitive tumors; anticoagulation and catheter removal for catheter-associated thrombosis.
Corticosteroids help in lymphoma and with airway edema, but can obscure a lymphoma diagnosis if given before biopsy.
Malignant Spinal Cord Compression
Presentation : back pain that precedes neurologic signs (often worse when recumbent or with Valsalva), then weakness, sensory level, and finally bladder and bowel dysfunction. Breast, lung, prostate, myeloma, and lymphoma are the common primaries.
Management :
Dexamethasone immediately (commonly 10 mg IV, then 4 mg every 6 hours; higher loading doses are used in severe deficits).
Urgent MRI of the whole spine , because multiple levels are common.
Surgical decompression and stabilization in suitable candidates, particularly with spinal instability, a single level, or radioresistant tumor; otherwise radiotherapy . Function at the time of treatment is the strongest predictor of recovery, so hours matter.
Cauda equina syndrome from malignancy follows the same urgent pathway.
Hyperviscosity Syndrome
Causes : Waldenström macroglobulinemia (IgM), multiple myeloma (especially IgA), and extreme leukocytosis or polycythemia.
Features : mucosal bleeding (epistaxis, gingival bleeding), visual changes with "sausage-link" retinal veins, headache, confusion, and heart failure .
Treatment : urgent plasmapheresis for paraprotein-driven disease, then treat the underlying malignancy. Avoid red cell transfusion before viscosity is reduced.
Tumor Lysis Syndrome
Covered in the electrolyte section: hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia with acute kidney injury. Prevention uses hydration plus allopurinol, with rasburicase for high-risk patients (contraindicated in G6PD deficiency because it causes hemolysis, and samples must be kept on ice to avoid falsely low uric acid readings).
Hypercalcemia of Malignancy
Mechanisms : parathyroid hormone-related peptide (squamous cancers, kidney, breast), osteolytic metastases, and calcitriol production in lymphoma.
Treatment :
Isotonic saline to restore volume and calciuresis.
Calcitonin (4 units/kg every 12 hours) for rapid but transient lowering over the first 48 hours, after which tachyphylaxis develops.
Zoledronic acid (adjusted for kidney function) or denosumab (useful in kidney impairment and bisphosphonate failure) for durable control.
Glucocorticoids for calcitriol-mediated hypercalcemia in lymphoma and granulomatous disease.
Dialysis for severe hypercalcemia with kidney failure.
Loop diuretics are no longer routine ; they are used only to manage volume overload.
Other Oncologic Emergencies
Malignant pericardial effusion and tamponade : drainage with a pericardial window or catheter; sclerosis or intrapericardial therapy for recurrence.
Malignant airway obstruction : stenting, laser, or radiotherapy; heliox as a bridge.
Massive hemoptysis and gastrointestinal bleeding from tumor : embolization or radiotherapy.
Adrenal insufficiency from metastases or checkpoint inhibitor hypophysitis.
SIADH from small cell lung cancer.
Thrombosis from Trousseau syndrome.
Bowel obstruction or perforation , including after bevacizumab, and neutropenic enterocolitis .
Hematopoietic Cell Transplant Complications
Timing Complication Key features and treatment
Days 0 to 30 Mucositis , infection (bacterial, Candida , HSV), engraftment syndrome (fever, rash, noncardiogenic pulmonary edema at neutrophil recovery, responsive to steroids) Supportive care, antimicrobials, steroids for engraftment syndrome
Days 0 to 30 Hepatic sinusoidal obstruction syndrome (veno-occlusive disease) : weight gain and fluid retention, painful hepatomegaly , hyperbilirubinemia, often with kidney injury; from endothelial injury of hepatic venules Defibrotide ; supportive care with fluid management; avoid hepatotoxins. Prevention with ursodiol
Days 0 to 30 Diffuse alveolar hemorrhage and idiopathic pneumonia syndrome High-dose steroids (limited evidence), supportive ventilation
Days 30 to 100 CMV reactivation , Aspergillus , Pneumocystis , acute graft-versus-host disease (skin rash, diarrhea, cholestasis) Preemptive antiviral therapy (letermovir prophylaxis), steroids first-line for GVHD, then ruxolitinib for steroid-refractory disease
Any time Transplant-associated thrombotic microangiopathy : schistocytes, high LDH, kidney injury, hypertension; associated with calcineurin inhibitors and GVHD Withdraw the offending agent, supportive care, eculizumab in severe cases
Beyond 100 days Chronic GVHD , encapsulated organism infection, bronchiolitis obliterans, late viral disease Immunosuppression, prophylaxis, vaccination
ICU admission for transplant recipients no longer carries the futility once assumed; early admission and noninvasive support strategies, with clear goals, improve outcomes.
- Cellular and Immune Therapy Toxicity
- Cytokine Release Syndrome (CRS)
Timing : hours to days after CAR-T cell infusion or bispecific T-cell engager therapy.
Grading (ASTCT) is based on fever plus hypotension and hypoxemia :
Grade 1 : fever alone.
Grade 2 : hypotension not requiring vasopressors, or hypoxemia needing low-flow oxygen.
Grade 3 : hypotension requiring one vasopressor, or hypoxemia requiring high-flow oxygen or noninvasive ventilation.
Grade 4 : multiple vasopressors or positive-pressure ventilation.
Treatment : supportive care and tocilizumab (an IL-6 receptor antagonist) for grade 2 or higher, with corticosteroids added for higher grades or inadequate response; anakinra and other agents for refractory cases. Rule out concurrent infection, which looks identical, and treat empirically.
Related syndromes : ICANS (see the encephalopathy section), prolonged cytopenias, hypogammaglobulinemia, and hemophagocytic lymphohistiocytosis-like toxicity.
Immune Checkpoint Inhibitor Toxicity
Severe (grade 3 or 4) immune-related adverse events are an ICU problem:
Myocarditis (high mortality; see the myocarditis section): high-dose methylprednisolone, escalate to abatacept or antithymocyte globulin.
Pneumonitis : stop the drug, methylprednisolone 1 to 2 mg/kg, add infliximab or mycophenolate if no improvement in 48 hours.
Colitis : steroids, then infliximab or vedolizumab; exclude infection and CMV.
Hepatitis : steroids; avoid infliximab, use mycophenolate.
Hypophysitis and adrenalitis : hormone replacement with hydrocortisone before levothyroxine.
Diabetes with ketoacidosis : insulin; the beta cell loss is permanent.
Myasthenia-like syndrome, Guillain-Barré-like neuropathy, and encephalitis : steroids plus IVIG or plasma exchange.
General principle : hold the checkpoint inhibitor, give corticosteroids early for grade 3 or 4 toxicity, and add a second-line immunosuppressant if there is no response within 48 to 72 hours. Steroids do not blunt antitumor efficacy enough to justify withholding them in severe toxicity.