Emergencies

Question 1

What is neutropenic sepsis?

Answer 1

Following chemo (2-3 w), bone marrow infiltration - pancytopenia, haem.

Question 2

What are the sx and diagnosis of neutropenic sepsis?

Answer 2

Sx: >38 temp/ other septic signs; clinical infection commonly GUM and chest but also skin, GI, lines

Question 3

What is the mx of neutropenic sepsis?

Answer 3

Mx: local guidance, broad spectrum abx eg taz, monitoring, fluids, FBC, UE, LFT, CRP, lactate, cultures

Question 4

What is the mx of SVCO?

Answer 4

ABC, high dose steroids as reduce tumour associated oedema, consider anti-ciag, stenting, radio

Question 5

What causes stridor in palliative?

Answer 5

Head and neck, lung, GI tumour

Question 6

What are the sx of stridor?

Answer 6

noisy breathing on insp, harsh breath sounds, SOB

Question 7

What is the diagnosis of stridor?

Answer 7

upper airway visualise or imaging

Question 8

What is the mx of stridor?

Answer 8

oxygen/ heliox (helium and oxygen mixed- flows more easily in narrowed airway), high dose steroids eg dexa, ENT review urgent, tracheostomy, stent, radio

Question 9

Which cancers go to the bone?

Answer 9

Cancer in bone, breast, lung, kidney, thyroid and prostate more liekly to go to bone

Question 10

What is the mx of stridor?

Answer 10

oxygen/ heliox (helium and oxygen mixed- flows more easily in narrowed airway), high dose steroids eg dexa, ENT review urgent, tracheostomy, stent, radio

Question 11

Which cancers go to the bone? What may this lead to?

Answer 11

Cancer in bone, breast, lung, kidney, thyroid and prostate more liekly to go to bone
hypercalcaemia

Question 12

What are the sx of hypercalcaemia?

Answer 12

acute - thirst, confusion, constipated, global deterioration. Chronic - depression, abdo pain, constipated, calculi

Question 13

What is the diagnosis of hypercalcaemia?

Answer 13

blds, >2,6 raised, >2.8 symptomatic

Question 14

What is the mx of hypercalcaemia?

Answer 14

IV fluids ASAP!!, longer term IV bisphosphonates (returns Ca to bones), denosumab if resistant

Question 15

What cancers are most likely to result in SCC?

Answer 15

Cancers that spread to bone/ spinal cancer

Question 16

What are the sx of SCC?

Answer 16

paraesthesia, sensory, weakness, functional loss, cauda equina, loss bladder/ bowel function, back pain but can be non-specific so may just be “off legs”

Question 17

How is the diagnosis of SCC made?

Answer 17

MRI spine (GOLD standard), otherwise CT +/- myelography

Question 18

What is the mx of SCC?

Answer 18

alleviate cord p, high dose steroids (dexa 16mg), lie down, radio, surgery if fitter

Question 19

Which cancers are prone to massive haemorhage?

Answer 19

Head and neck + GI, lung

Question 20

What is the mx of massive haemorrhage?

Answer 20

stop any anti-coag, ABC, use dark towels, remain with pt, midazolam if they’re unlikely to recover
thrombocytopenia, vitamin K deficiency, heparin-induced thrombocytopenia (HIT), hepatic impairment and renal impairment
Get rid of anti-coag
mild/ mod → tranexamic acid, radio for lung bleeds, topical - adrenaline soaked
Severe → eg if tumour interferes w artery, usually predicted so discuss w pt, stay w them, consider benzos, dark towels if bld visible

Question 21

What may signify an opioid OD?

Answer 21

If on strong opioids and change condition eg sudden improvement of pain
Sx: toxicity (LOC, RR down, myoclonic jerks, pinpoint pupils), SE eg confusion, hallucinate, N+V, constipated

Question 22

What is the mx of an opioid OD?

Answer 22

naloxone give via dilute 400 mcg and then 20mcg every 2 mins - different to other situations!!! Eg a heroin OD is done slower. Close obs,