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4th Year CCC > emergencies > Flashcards

emergencies Flashcards

1
Q

What are the four oncological emergencies?

A

Hypercalcaemia

SVC obstruction

SCC

Neutropenic sepsis

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2
Q

Why does hypercalcaemia occur in cancer?

A
  1. Osteolytic- bones are invaded by cancer, cytokines activate osteoclast activating factor; calcium goes from bones into blood.
  2. Paraneoplastic- tumour secretes PTH related protein which induces bone resorption (MOST COMMON)
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3
Q

Is hypercalcaemia common?

A

Yes up to 1/3 patients

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4
Q

Hypercalcaemia sx may mimic?

A

Terminal malignancy

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5
Q

What might hypercalcaemia in metastatic disease indicate?

A

Poor prognosis

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6
Q

What is the thirty day mortality of patients admitted with hypercalcaemia?

A

about 50%

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7
Q

Symptoms hypercalcaemia

A

‘Stones, bones, groans, thrones, psychiatric overtones’

Confusion

Lethargy, weakness

depression/anxiety, cognitive dysfunction, insomnia, coma

Abdo pain, N&V

Renal/biliary stones

Constipation

Polyuria

Bone pain

Polydipsia

Anorexia

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8
Q

What is more significant in hypercalcaemia, the rate of calcium increase or the level?

A

Rate

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9
Q

What is normal calcium level?

A

2.2-2.6mmol/L

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10
Q

Investigations for hypercalcaemia?

A

Ionised calcium

Alk phosph

U&Es, eGFR

PTH

X-rays

Bone scan for mets

ECG (arrhyth)

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11
Q

What are you looking for in xrays in hypercalcaemia?

A

lytic or sclerotic bone lesions

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12
Q

hypercalcaemia management

A
  1. Saline 1L/4h for 24hr then every 6h for 48-72h.
  2. Bisphosphonates (IV pamidronate or zolandronic acid)
  3. If arrhyth/seizures give calcitonin and corticosteroids.
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13
Q

What steps can you take to reduce risk of fluid overload in hypercalcaemia?

A

Furosemide

Monitor output

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14
Q

Malignancy causes ___% SVC syndrome

A

90

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15
Q

What are three extrinsic and one intrinsic cause of SVC syndrome

A

Extrinsic- lung ca (65%), lymphoma (15%), other ca (10%)

Intrinsic- thrombosis due to central venous device (10%)

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16
Q

NSC lung cancer + SVC synd =?

A

poor prognosis

17
Q

What happens physiologically as a result of SVC syndrome

A

Collateral circulation forms

Central venous pressure increased

18
Q

How does SVCO present?

A

Headache

Oedema and redness of face and upper limbs

Cough and dyspnoea

Venous distention

Pemberton’s sign

19
Q

What is pemberton’s sign

A

raise arms above head and see flushing, distended veins, inspiratory stridor, increased JVP

20
Q

What 2 types of cancer often present with bulky lymph nodes?

A

Lymphoma

Germ cell tumours e.g. testicular

21
Q

Investigations for SVCO

A

CXR- mediastinal widening and ?primary cause

CT chest/abdo/pelvis with contrast (for malig)

Tissue (characterise the malignancy for Rx)

22
Q

Treatment SVCO

A

ABCDE, O2

16mg Dex/24hr with PPI

Elevate head

Potentially avoid IV cannula into arm veins so fluid doesn’t go to the SVC

Depends on cause… could give SVC stent (good for rapid sx relief), RT, chemo, LMWH if thrombus

23
Q

Hypercalcaemia is common in which type of cancer?

A

Myeloma

24
Q

Presentation of SCC

A

Back pain, worse lying down and getting worse over weeks

Radicular pain, can radiate to lower back, buttocks, legs

Saddle anaesthesia

Hyper-reflexia below lesion, maybe extensor plantars

Feel unsteady

Changes to bladder and bowel function (late finding)

Symmetrical weakness (Depends on level of lesion)

Parasthesia of toes, fingers, buttocks

25
Q

SCC investigations

A
  1. MRI whole spine: within 24h if neuro signs, within 1w if suspicious back pain.
  2. Need to know pt cancer status, fitness, neuro function and pain
26
Q

SCC management

A
  1. 16mg dex daily + PPI (make sure to check CBG regularly)
  2. analgesia
  3. Single beam RT
  4. Chemo
  5. Surgery if they are well enough in general. >1 part spine involved = less likely
  6. Catheterise if needed
27
Q

Is SCC a good prognostic indicator

A

No

28
Q

Diagnosis of neutropenic sepsis?

A

Pt having ca treatment

Neutrophil count <1x10^9/L

AND

Temp >/=38 OR other sepsis signs

29
Q

When does neutropenic sepsis usually present?

A

7-14 days after last chemo

30
Q

Mortality neutropenic sepsis?

A

5%

31
Q

Presentation neutropenic sepsis?

A

Lethargy

N&V

Mottled rash

High RR (or PaO2 <4.3kPa)

High HR

WCC <4 or >12

Febrile <36C or >38C

+ infective source (ANY!)

32
Q

Management/investigations of neutropenic sepsis?

A

Sepsis 6:

Blood cultures (peripheral), U&Es

Urine output and cultures

Fluids

Antibiotics (broad spec. e.g. piptaz. Trust guidelines)

Lactate

Oxygen 15L/min

+culture any indwelling lines

Bloods: LFT, U&E, CRP, lactate, FBC

4th Year CCC (19 decks)

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