Emergencies Flashcards
What is neutropenic sepsis?
Following chemo (2-3 w), bone marrow infiltration - pancytopenia, haem.
What are the sx and diagnosis of neutropenic sepsis?
Sx: >38 temp/ other septic signs; clinical infection commonly GUM and chest but also skin, GI, lines
What is the mx of neutropenic sepsis?
Mx: local guidance, broad spectrum abx eg taz, monitoring, fluids, FBC, UE, LFT, CRP, lactate, cultures
What is the mx of SVCO?
ABC, high dose steroids as reduce tumour associated oedema, consider anti-ciag, stenting, radio
What causes stridor in palliative?
Head and neck, lung, GI tumour
What are the sx of stridor?
noisy breathing on insp, harsh breath sounds, SOB
What is the diagnosis of stridor?
upper airway visualise or imaging
What is the mx of stridor?
oxygen/ heliox (helium and oxygen mixed- flows more easily in narrowed airway), high dose steroids eg dexa, ENT review urgent, tracheostomy, stent, radio
Which cancers go to the bone?
Cancer in bone, breast, lung, kidney, thyroid and prostate more liekly to go to bone
What is the mx of stridor?
oxygen/ heliox (helium and oxygen mixed- flows more easily in narrowed airway), high dose steroids eg dexa, ENT review urgent, tracheostomy, stent, radio
Which cancers go to the bone? What may this lead to?
Cancer in bone, breast, lung, kidney, thyroid and prostate more liekly to go to bone
hypercalcaemia
What are the sx of hypercalcaemia?
acute - thirst, confusion, constipated, global deterioration. Chronic - depression, abdo pain, constipated, calculi
What is the diagnosis of hypercalcaemia?
blds, >2,6 raised, >2.8 symptomatic
What is the mx of hypercalcaemia?
IV fluids ASAP!!, longer term IV bisphosphonates (returns Ca to bones), denosumab if resistant
What cancers are most likely to result in SCC?
Cancers that spread to bone/ spinal cancer
What are the sx of SCC?
paraesthesia, sensory, weakness, functional loss, cauda equina, loss bladder/ bowel function, back pain but can be non-specific so may just be “off legs”
How is the diagnosis of SCC made?
MRI spine (GOLD standard), otherwise CT +/- myelography
What is the mx of SCC?
alleviate cord p, high dose steroids (dexa 16mg), lie down, radio, surgery if fitter
Which cancers are prone to massive haemorhage?
Head and neck + GI, lung
What is the mx of massive haemorrhage?
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
What may signify an opioid OD?
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
What is the mx of an opioid OD?
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,
