Chemotherapy is widely recognized as an effective means of treating tumors and is widely used in pre-surgery, post-surgery and palliative treatment of advanced tumors. The vast majority of chemotherapeutic agents currently in use exert their anti-tumor effects by inhibiting cell proliferation, which is a common feature of both normal and cancerous cells. Therefore, these agents are highly toxic to the human body, and some chemotherapy-associated emergency illnesses may occur with normal use. Inventory of chemotherapy-related emergency diseases, briefly summarize their treatment methods and management measures, as follows: First, chemotherapy fluid extravasation Chemotherapy drugs are highly toxic and irritating, fluid extravasation often causes serious consequences, how to deal with it when it occurs? (1) the treatment of drug extravasation: chemotherapeutic drug extravasation can cause local pain, local tissue swelling and ulcer necrosis, or the formation of local hard knots. Intravenous infusion of extravasation of the general principles of treatment are: ① stop infusion; ② elevate the limbs; ③ retain the needle, pumping back the extravasation of drugs; ④ injection of 5 to 10 ml of saline to dilute the exudate drug; ⑤ local use of antidotes; ⑥ local topical steroid hormones; ⑦ 2% procaine local seal; ⑧ cold compresses; ⑨ local use of Chinese traditional Chinese medicine or magnesium nitrate powder magnesium sulfate topical, or topical application of thin slices of potatoes or cucumber slices. (2) phlebitis formation of the treatment: the first extravasation of the drug, followed by vein hardening of the cord-like changes in the local skin with hyperpigmentation, severe local limb numbness, swelling and pain. Phlebitis is about prevention. Choosing a good intravenous infusion, or choosing deep vein cannulation to infuse chemotherapeutic drugs, can eliminate such phenomenon. In addition, the drug should be diluted to a certain concentration, and the speed of infusion should be regulated. Therapeutic measures: local hot compresses and topical application of Xifaxol cream can help reduce symptoms and recovery. Second, allergic reaction Paclitaxel allergic reaction occurs frequently, the incidence rate of 10% to 20%, mainly to take precautions, always ready for anti-allergic drugs. Routinely give corticosteroids dexamethasone tablets and antihistamine benzylamine pretreatment before using drugs, can reduce or prevent allergic reactions. Of course there are other chemotherapeutic drugs that have allergic potential. For allergic reactions, without waiting for the results of laboratory tests, adrenaline, oxygen therapy, nebulized inhalation of β2 agonists, antihistamines and other treatments are given at the first time. (1) Epinephrine: In patients with laryngeal edema, bronchospasm, and urticaria, a dilution of 0.3-0.5 ml of 1:1000 epinephrine should be injected intramuscularly immediately. Repeat the administration every 10-15 minutes if necessary, for a total of 3 doses. Patients with critical conditions such as severe hypotension, severe bronchospasm, or severe upper respiratory edema may be given a single intravenous push of 0.5-1.0 ml of 1:10,000 epinephrine dilution (which may be repeated at 10-15 minute intervals). After the above treatment, if there is still no significant improvement in symptoms, epinephrine can be continuously infused intravenously at a rate of 1-4 Pg/min until the patient’s symptoms are relieved. If intravenous access cannot be established within a short period of time, in case of emergency, endotracheal medication can be administered at twice the dose of intravenous medication. (2) Oxygen therapy: If the patient has respiratory distress, oxygen may be given by mask. Tracheal intubation can be given in case of severe drowsiness and hypoxemia. Tracheotomy is required if the patient has upper airway edema that precludes tracheal intubation. The target value for oxygen therapy is blood saturation >90% (PO2 >60 mmHg). (3) Bronchodilators: For patients with persistent bronchospasm, nebulized inhalation with albuterol is indicated. (4) Antihistamines: Following epinephrine therapy, diphenhydramine 25-50 mg IV/intramuscular/orally every 4-6 hours and cimetidine 50 mg IV or 150 mg orally every 8 hours (or other H2-receptor antagonists) can help to attenuate the histamine-releasing effects and provide further relief of hypotension and mild urticaria-related symptoms. (5) Glucocorticoids: Glucocorticoid therapy may be given to patients who develop bronchospasm as a result of an allergic reaction. The first dose is methylprednisolone 120 mg IV once, followed by 60 mg IV every 6 hours. The above hormonal therapy also helps to reduce the late symptoms of anaphylactic reactions (which can occur 6 to 12 hours after the onset of early manifestations). (6) Circulatory support: Hypotension usually responds to epinephrine therapy, but saline supplementation may be necessary in patients whose blood pressure does not rise despite epinephrine therapy. In patients with persistent hypotension despite aggressive volume supplementation, vasopressor medications such as norepinephrine or epinephrine may be given to maintain it if necessary. (7) Cardiac monitoring: Patients who need to receive epinephrine treatment after the occurrence of allergic reactions should be routinely given close monitoring, and even need to be placed in the intensive care unit for observation. Sometimes the condition is recurrent, which can be manifested only a few hours after the early symptoms appear, so the monitoring needs to be continued for at least 24 hours before it can be withdrawn. Third, bone marrow suppression Most chemotherapeutic drugs can cause different degrees of bone marrow suppression. Regular review of routine blood tests is required, usually followed by leukopenia and then thrombocytopenia, the former is more severe than the latter, and a few may develop severe anemia. If severe myelosuppression occurs, combined with granulocyte deficiency infection, the patient should be transferred to laminar flow bed urgently, and bedside protective measures should be taken, and first-class nursing care should be given, and special nursing care should be given if necessary. Specific treatment measures: (1) Discontinue medication. (2) Prevention and treatment of infection. (3) Oral administration of various leukocyte-raising drugs. Ricodrine tablets, leukocyte-boosting amine, shark liver alcohol and so on. (4) In case of severe leukopenia (above degree III), granulocyte colony-stimulating factor (G-CSF) can be injected subcutaneously at 100 or 200 μg once or twice a day for 3 days. (5) Component blood transfusion if transfusion is indicated. (6) Albumin and plasma input. (7) If short-term platelets decrease significantly, IL-11 can be injected subcutaneously, and hemostatic drugs should be given to prevent bleeding. Fourth, gastrointestinal toxicity (1) mucosal inflammation Chemotherapeutic drugs are prone to cause stomatitis, lingual inflammation, esophagitis and oral ulcers, resulting in pain and reduced feeding. Common drugs include 5-fluorouracil and methotrexate. Treatment is mainly symptomatic. Oral hygiene should be paid attention to, keep clean and moist, and gargle with salt water or Rejuvenate; discontinue chemotherapy for severe stomatitis. (2) Nausea, vomiting The most common adverse reactions, severe vomiting can lead to dehydration, electrolyte disorders. Chemotherapy-induced vomiting can be divided into acute vomiting, delayed vomiting and anticipatory vomiting. Acute vomiting is vomiting that occurs within 24 hours of chemotherapy; delayed vomiting is vomiting that occurs after 24 hours and up to 7 days of chemotherapy; anticipatory vomiting is nausea and vomiting that occurs as a conditioned reflex after the patient has suffered from unpleasant acute vomiting during a previous cycle of treatment and before the next dose of chemotherapy. TREATMENT: Commonly used antiemetic agents are currently the most effective 5-HT3 receptor antagonists. Usage: granisetron 3mg, intravenous injection 0.5~-1 hour before chemotherapy; ondansetron 8mg in 0.5~1 hour before chemotherapy intravenous injection or oral; or with metoclopramide, phenylephrine and dexamethasone triple antiemetic, also has a better efficacy on light to moderate intensity vomiting. (3) Other Chemotherapy can also cause loss of appetite, abdominal distension, diarrhea and constipation, which can be treated symptomatically. Diarrhea is mainly seen in irinotecan and other chemotherapeutic drugs, the main recommendation is to spare “easy montage”, use when necessary. Fifth, skin toxicity Chemotherapeutic drugs can cause skin toxicity, including itching, alopecia, rash, dermatitis, hyperpigmentation and so on. Hair loss is a common adverse reaction of many chemotherapeutic drugs, the main drugs are anthracycline, paclitaxel, CTX, VP-16, VCR, 5-FU and so on. The resulting alopecia is reversible, and hair loss usually occurs 2 to 3 weeks after the first dose of chemotherapy, and then gradually grows back 6 to 8 weeks after stopping chemotherapy. There are reports on the use of adriamycin patients available special ice cap, there is a certain anti-hair loss effect. Sixth, chemotherapy cardiotoxicity Many antitumor drugs have certain toxic effects on the heart, mainly anthracycline antibiotics, which is the most important ADM, can cause a dose-related cardiomyopathy. If these drugs are used, cardiac monitoring must be performed and cardiac function tested regularly. Of the factors involved in adriamycin cardiotoxicity, the total cumulative dose is the most important risk factor. Liposomal adriamycin is chosen for its low cardiotoxicity. Anthracycline cardiomyopathies can be clinically categorized into three types: ① Acute myocardial pericarditis: usually occurs within a few days of administration and manifests itself as transient arrhythmias, pericardial effusion and myocardial insufficiency. Occasionally, it may lead to transient heart failure and death; ② Subacute cardiotoxicity: the onset is insidious and symptoms may appear after the last dose of the drug, but the onset is most frequent 3 months after the last dose. Clinical manifestations can be tachycardia and fatigue, and finally emphysema, right heart congestion signs and decreased cardiac output can occur. The condition can be stabilized by the application of cardiotonic drugs. Treatment of anthracycline cardiomyopathy usually requires intravenous administration of drugs to enhance myocardial contractility and reduce cardiac afterload. Angiotensin-converting enzyme inhibitors play an important role in stabilizing heart failure and slowing the progression of cardiomyopathy. Selective beta-blockers may also be used in ineffective cases. The manifestations of cardiotoxicity of high-dose continuous infusion of fluorouracil may be: precordial pain, ST-T changes, atrial arrhythmias, myocardial infarction, cardiac insufficiency, sudden death.The cardiac effects of DDP may be atrial fibrillation, angina pectoris and ST-T changes. Seventh, pulmonary toxicity A series of anti-tumor drugs can cause pulmonary toxicity, and many other non-anti-tumor drugs can also cause damage to lung parenchyma. Antineoplastic drugs caused by pulmonary toxicity is mainly manifested as interstitial lung inflammation and pulmonary fibrosis. Bleomycin is the most likely to cause pulmonary toxicity, 3% to 12% of cases of X-ray or physiologic function changes, 1% to 2% can occur acute fatal lung damage. The best way to manage chemotherapy-related pulmonary toxicity is prevention. There is no definitive treatment for the lung damage that has occurred, and once toxicity is detected, the first measure is to stop the drug. The effect of corticosteroid therapy has not been confirmed by controlled studies, but it is still available. Eighth, hepatotoxicity Anti-tumor drugs cause hepatotoxicity, there are three main ways: ① direct damage to liver cells; ② lead to liver disease underlying disease aggravation, especially viral hepatitis; ③ due to potential liver disease to change the metabolism of anti-tumor drugs, resulting in prolongation of the metabolism of the body time, side effects increase. Chemotherapy patients should know the medical history in advance, including the history of drug use, and those with liver insufficiency should use antitumor drugs with caution or reduce the dosage. During chemotherapy, liver function should be checked regularly, including AKP, GT and other enzymatic measurements, which need to be differentiated from metastatic hepatocellular carcinoma or hepatic infiltration as well as viral hepatitis. In general, hepatocellular injury, especially the transaminase elevation in the short term after the drug, is mostly transient and can be rapidly recovered after stopping the drug. Biphenyldiphenyl ester, glutathione, ezetimibe, diammonium glycyrrhizinate, hepatic tetrazolium, etc. can help to normalize the transaminases. If hepatoprotective drugs can be given most can still continue to receive treatment. Ninth, urinary system adverse reactions Anti-tumor drugs of the urinary system effects are mainly renal damage and hematological cystitis. (1) Renal damage Most of the cytotoxic drugs causing renal dysfunction damage renal tubules rather than glomeruli, which can occur immediately or delayed, appearing in the long-term use of the drug or after discontinuation of the drug.DDP nephrotoxicity is the most prominent, and there can be elevated serum BUN and CRE after the use of the drug. It usually occurs in 7 to 12 days, and can be recovered in about 1 month, a few need several months, and individual irreversible renal failure occurs. CTX and IFO are analogs with similar chemical structures and have similar toxicity and antitumor effects, but their nephrotoxicity is markedly different.CTX does not have any nephrotoxicity, whereas IFO can cause a variety of renal abnormalities, some of which can be fatal in severe cases or result in irreversible renal failure requiring long-term hemodialysis. The use of amphotericin may reduce or prevent the nephrotoxicity of DDP. Management: regular testing of renal function, adequate hydration, and the use of combination chemotherapy to reduce single-agent doses are preventive measures. To minimize the occurrence of nephrotoxicity, other drugs that may cause kidney damage should not be used concurrently with DDP chemotherapy. (2) Hemorrhagic cystitis Mainly seen with CTX or IFO, CTX can cause sterile chemical cystitis. Adequate rehydration should be done when the dosage is high. Long-term use of the drug requires regular follow-up of urine routine. If cystitis occurs, it is advisable to discontinue the drug and avoid its use in the future if possible.IFO causes chemical cystitis in the same way as CTX. The use of mesylate sodium can basically be prevented. Tenth, the nervous system reaction common is peripheral neurotoxic reaction. Paclitaxel analogs mainly cause peripheral neurotoxicity, which is dose-dependent and usually recovers gradually after discontinuation of the drug. The incidence of DDP neurotoxicity is about 50%, common neurotoxicity is peripheral nerve injury, motor function is generally unaffected.DDP neurotoxicity treatment is to reduce or stop having the drug, amphotericin has a protective effect. L-OHP peripheral neurotoxicity is particularly pronounced, the day of the drug or the next day need to be prophylactic wear protective gloves, cold and warm. Vitamin B6 is the main prophylactic use of the 5-FU class.