Oncology Emergencies

Clinic 8 (Outpatient) Hours of Operation: Monday – Friday 8 a.m.–4:30 p.m.

Outpatient Nurse line: 205-638-9317. Call the nurse line Monday- Friday 8 a.m.-4:30 p.m. for emergencies or other questions. If the nurse does not answer leave a message.

Please DO NOT leave a message if you have an ONCOLOGY EMERGENCY, instead call 205-638-9285 for assistance, or call 205-638-9100 if after hours.

Office: 205-638-9285, Hours of Operation Monday- Friday 8 a.m.–4:30 p.m.

After hours: Nights, weekends, holidays: Call 205-638-9100, ask for the ONCOLOGY NURSE on call. If a nurse does not call you back in 15 minutes have the nurse repaged. Please use after hours number for emergencies only.

When to call 911:

  • Difficulty breathing
  • Rapid, painful, and/ or shortness of breath
  • Unresponsive, sudden change in behavior, confusion

When to call the nurse immediately:

  • A temperature of 101 degrees or greater
  • If your child’s temperature is 100.4-100.9 degrees, call for further instructions
  • Bleeding, bruising, tiny red spots on the skin, nosebleed, bleeding gums, blood in urine, stool, or vomit
  • Dehydration, vomiting not controlled by anti-nausea medications, more than 3 diarrheal stools in 24 hours, decreased urine output (less than 2 years old call if no urination within 6 hours, ages 3 and older call if no urination in 10-12 hours

PLEASE SEE ONCOLOGY GUIDELINES FOR DETAILED INSTRUCTIONS

Download the Oncology Emergency Information PDF.


Guidelines for Hematology/Oncology

Children's of Alabama
1600 7th Ave. S. Birmingham, AL 35233
205-638-9317
Hematology/Oncology Clinic #8

Hematology/Oncology
Your child’s illness and his/her treatment put him/her at greater risk for infections than most other children. Not only is he/she more susceptible to
infection, but he/she may also be less able to fight infection. This makes even minor illnesses more worrisome. Therefore, we must recognize infections early so they can be treated promptly.

Signs of Infection
Listed below are some signs and symptoms of infection. One or more of them could be the first indication that your child is ill. Therefore, they should be reported promptly.

You should notify the Hematology/ Oncology Office if your child develops any of these symptoms:

  1. Fever. A temperature of 101 F (38.3 C) degrees or greater is considered a fever. You should call us immediately (day or night) for fever. You may be instructed to go to the emergency room to be evaluated. We ask that you also call us for a temperature between 100.4 and 100.9 F (38.0 and 38.2 C) for further instructions on monitoring your child’s temperature and to discuss his/her symptoms. If your child’s temperature is 100.4-100.9 twice in a 12 hour period you may be instructed to go to the emergency room to be evaluated.
  2. Diarrhea (frequent watery stools; more than 3 per day)
  3. Stomach pains that are severe or persistent
  4. Cough that is severe or persistent
  5. Rapid, difficult or painful breathing
  6. Earache
  7. Sore throat
  8. Headache with a stiff neck or stiff back
  9. Blisters, ulcers, rashes, or bug bites on the skin that are painful, red, swollen, or warm to touch.
  10. Ulcers or thrush (white splotches) in the mouth
  11. Ulcers or pain around the rectum
  12. Listlessness or dramatic change in activity level

You should notify us immediately if your child is exposed to:

  1. Chickenpox
  2. Herpes zoster (shingles)

Appt. Discharge Teaching___________________________________

Contact Us
This information will hopefully give you some basic guidelines for handling problems you may have at home. Other situations my arise that concern you. We want to know about anything that worries you.

Clinic 8 (Outpatient) Hours of operation: Monday – Friday 8 a.m.–4:30 p.m.

Outpatient NURSE LINE: 205-638-9317. Call the nurse line Monday- Friday 8 a.m.-4:30 p.m. for routine questions, medication refills, appointments, and ONCOLOGY EMERGENCIES. If the nurse does not answer leave a message. Please DO NOT leave a message if you have an EMERGENCY, instead call 205-638-9285 for assistance, or call 205-638-9100 if after hours. (4:30 p.m.–8 a.m.)

Office: Hours of operation Monday- Friday 8 a.m.–4:30 p.m. 205-638-9285

After Hours (Nights, Holidays and weekends) call 205-638-9100, ask for the oncology nurse on call, if a nurse does not call you back in 15 minutes call again. Please use After Hours number for emergencies ONLY.

Preventing Infection
Preventing infections is more desirable than trying to treat them. Therefore, we suggest that you help your child avoid:

  1. Contact with children or adults with any obvious infections.
  2. Contact with anyone with a known contagious illness (flu, chickenpox,
    tuberculosis, etc.)
  3. Family pets unless they are healthy and receive appropriate immunizations.
  4. Crowds of people at times when your child’s white blood count is low.
    Usually, he/she can play, go to school, shopping, etc.
  5. Notify us prior to any dental work (cleanings, fillings, etc.)
  6. Your child may have a “implanted port”. Please notify us of any redness, swelling, or drainage to the area.
  7. Avoid placing anything rectally or vaginally (thermometers, suppositories, enemas, tampons etc.)

Medications and Their Impact on Blood Counts
Some of the drugs used to treat childhood cancer may cause a drop in the platelet count. Since platelets are necessary for normal clotting, people with low platelets may bleed abnormally. Some signs of low platelets are easy bruising and petechiae (small pinpoint size red spots under the skin). Call us for obvious signs of bleeding, including:

  1. Bleeding gums
  2. Nosebleeds
  3. Blood in urine, stool or vomit

Your child should not be given aspirin, aspirin-containing medicines (such as Pepto- Bismol, Kaopectate) or ibuprofen (Motrin, Advil) since these may interfere with blood clotting. When the platelet count is very low, we will suggest that you have your child play more cautiously than usual (no fighting, climbing trees, bike riding or diving in water).

Some of the drugs may cause a drop in the red blood count (anemia). Some signs of a low red blood count are:

  1. Paleness of lips and nail beds
  2. Decrease in energy level
  3. Headaches along with dizziness

If you notice any of the previous signs, please notify our staff.

Blood counts are checked with a test called a Complete blood count (CBC). Children who receive chemotherapy commonly have low blood counts. The blood counts are often lowest 7-10 days after chemotherapy treatment. This is important to note when monitoring your child at home for fever (infection), bleeding, and/or low red blood count.

Medications at Home
At some time, it will probably be necessary for you to give your child medications at home. If your child is unable to swallow pills, check with a pharmacist to see if his/her medication can be crushed and added to some small amount of food or liquid. Coke and apple sauce are probably the two most successful. Try not to mix medicines with milk or other important foods in your child’s diet. Only give medications prescribed or approved by our staff.

If your child absolutely refuses to take his/her medication, please call us. If your child vomits 30 minutes after medicine is given, do not repeat. If he/she vomits
before 30 minutes have passed, please repeat medication.

Over the counter medication:
Some over-the-counter medicines are acceptable to use during treatment. Sudafed, Dimetapp, or Triaminic may be used for nasal congestion/cold
symptoms as per instructions on the bottle/box. Robitussin DM or Delsym may be used for occasional mild cough. Please ensure any over the counter medication does not contain acetaminophen (Tylenol), aspirin, or ibuprofen (Motrin, Advil).

Some of the chemotherapy drugs your child receives may cause constipation. Colace (docusate) or Senna may be used as needed for children over the age of 2 according to dosing guidelines on the bottle.

Nausea and Vomiting
All children experience nausea and vomiting sooner or later. This may come as a result of chemotherapy or just from a stomach virus. If your child is nauseated,
here are some helpful suggestions:

  1. We can prescribe anti-nausea medicines.
  2. Offer frequent sips (never more than 4 ounces at one time) of clear liquids like sodas, water, tea, Kool-Aid, etc. Milk should be avoided if your child is
    nauseated.
  3. Solid foods should be given only if the child is keeping fluids down well. Even then, you should offer small, frequent feedings instead of 3 large meals
    per day.

Children can become dehydrated very quickly when they are vomiting and not drinking. Call us right away if your child:

  1. Goes more than 10-12 hours without urinating. (If your child is less than 2 years old, call us if he/she goes 6 hours without urinating.)
  2. Becomes listless (washed out, sluggish).

Immunizations
It is important that children receiving chemotherapy be protected from Influenza. Therefore, we do recommend injectable Flu vaccine every year for your child and all household members (parents, guardians, and siblings). The injectable vaccine (flu shot) is safe for children receiving treatment for cancer because it does not contain the live flu virus. We do not recommend the intranasal vaccine (nose spray or “Flumist”) for your child or any household member as it is a live virus vaccine.

Your child should not receive any other immunizations (baby shots such as MMR, Varicella, Dtap) while receiving chemotherapy. Your doctor will let you know when it is safe to restart vaccinations following completion of chemotherapy. Siblings may receive their standard immunizations at age appropriate times as recommended by your pediatrician. If you have questions regarding immunizations please ask your oncology doctor.

Download the Oncology Guidelines PDF.