• Page attending for admission (after examine pt and initial labs are back), death, MICU transfer, AMA. Usually attending likes FYI page for rapid response
• Neutropenic fever is an oncologic emergency.
  • Neutropenia is ANC ≤500 or <1000 and dropping. Count segs + bands
  • Fever is 100.4 measured twice consecutively or >100.4 once
  • New admission for neutropenic fever needs to be tested for Covid
  • If patient is >100.4 once and then came down on its own, treat as fever
• Each patient has fever plan for the night and usually composed of following:
  • Obtain new blood cultures if not any in last 24 hours, one peripheral, one central
  • Obtain new urine culture, chest xray if not in last 72 hours
  • Tylenol once. You can start with 650mg. If that doesn't work, add 325mg for 1,000mg dose
  • Antibiotic: no change or escalation. Order any new antibiotic as STAT
• Do not place patient on scheduled Tylenol as this can mask fever.
• Do not use NSAIDS. Most patients have low platelets and are at risk for bleed
• Do not use Tylenol for pain
  • You can try tramadol for mild/moderate pain. If that doesn't work, you can try oxycodone
  • If patients have headache, assess mental status especially if they have low platelets. Low threshold for head CT
• Do not do suppository, enemas, or administer medication rectally
• For diarrhea, do not give Imodium. Do not use Bismuth or Pepto-Bismol (has salicylate). You can use Fibercon tablets or just let be
• For constipation, you can use miralax/senna-docusate. Sorbitol q2h x 3 doses is next step
• Simethicone is ok for gas
• Patients are almost always on fluids for chemotherapy or KVO (keep vein open). When encounter shortness of breath on nights, look for I/O and volume status on exam/CXR/BNP. You can give lasix while they are on fluid.
• Patients are usually on electrolyte protocol, and nurses can replace lytes, unless they have low creatinine clearance.
• Patients are usually on transfusion protocol. Nurses will be able to order up to 1u pRBC and 1u platelet per protocol. If patient has lower hemoglobin (e.g. Hgb 5.5 with goal of >7), you can order extra pRBC on top of the protocol
• If paged for low fibrinogen on DIC panel, you can order cryoprecipitate, usually given in 5 units (1 bag) or 10 units (2 bags). Give 5u if fibrinogen < 100 and 10u if <60