Emergency Presentations Flashcards
What is Neutropenic Sepsis?
A patient on systemic anticancer therapy that presents with a temperature >38 degrees and a neutrophil count <0.5x10^9/L
What are some causative organisms for Neutropenic Sepsis?
Staph. Aureus Staph. Epidermis Enterococcus Streptococcus MRSA
What are some symptoms of Neutropenic Sepsis?
Fever
System Specific
Drowsiness
Confusion
What are some signs of Neutropenic Sepsis?
Febrile Tachycardia Hypotension Impaired MMSE Signs of Skin/Line infection
Which investigations are appropriate for suspected Neutropenic Sepsis?
Bloods - FBC, U+E, LFTs, Lactate, CRP, ABG, Cultures
CXR
How should suspected Neutropenic Sepsis be managed?
Prompt IV Tazocin - 4.5g QDS
Fluid Resuscitation
?Catheterisation
G-CSF if Profound Neutropenia
What are some preventative measures which can help to avoid Neutropenic Sepsis?
Patient Education including emergency information
Abx Prophylaxis
?Prophylactic G-CSF
What causes Malignant Spinal Cord Compression?
Either vertebral body collapse secondary to metastases or direct tumour spread within the cord
What can prolonged cord compression in Malignant Spinal Cord Compression lead to?
Vascular injury
Cord necrosis
Permanent damage
What are some symptoms of Malignant Spinal Cord Compression?
Prolonged back pain
Spinal/Radicular pain
Limb Weakness
Bladder/Anal Sphincter dysfunction
What may be demonstrated on examination of acute Malignant Spinal Cord Compression?
Flaccid Paralysis
What may be demonstrated on examination of chronic Malignant Spinal Cord Compression?
Hypertonia
Hypereflexia
Up-going Plantars
Palpable bladder
How should suspected Malignant Spinal Cord Compression be investigated?
Urgent MRI
How can Malignant Spinal Cord Compression be managed?
Steroids - 16mg Stat then BD. Remember PPI Cover
Surgery - Debulking of Tumour +/- Decompression
Radiotherapy within 24h
Urgent Chemotherapy if Chemosensitive
Supportive Care
What is Superior Vena Cava Obstruction?
Obstruction of blood through the SVC due to compression or occlusion
What are some causes of SVCO?
Lung Ca
Lymphoma
Thrombus occlusion
What are some symptoms of SVCO?
Breathlessness Face + Neck swelling Trunk + arm swelling Choking Headache Lethargy Chest pain Cough Dysphagia Hallucinations Seizures
What are some signs of SVCO?
Neck vein distension Facial oedema Increased respiratory rate Plethora Cyanosis
What is Pemberton’s Sign?
Arm raising leads to significant neck distension, suggestive of SVCO
Which investigation is appropriate for suspected SVCO?
CT Thorax + Contrast
How can confirmed SVCO be managed?
Steroids
Stent
Chemotherapy if sensitive - SCLC, Lymphoma, Teratoma
Radiotherapy
Why does Hypercalcaemia occur in malignancy?
PTHrp release leads to osteolytic bone destruction
Which cancer is commonly associated with Hypercalcaemia?
SCC
What are some symptoms of Hypercalcaemia?
Nausea Anorexia Thirst Polyuria + Polydypsia Fatigue and Weakness Constipation Confusion Reduced concentration Drowsiness
How should Hypercalcaemia be managed?
Rehydration
Bisphosphonates - IV Zolendronic Acid 4mg
What is Acute Tumour Lysis Syndrome?
Rapid malignant cell destruction releases cellular contents leading to systemic changes
How does Acute Tumour Lysis syndrome present?
Hyperuricaemia Hyperkalaemia Hyperphosphataemia AKI Hypocalcaemia
What are risk factors for developing Acute Tumour Lysis Syndrome?
Pre-existing renal impairment
Hypovolaemia
Raised LDH
Urinary obstruction by a tumour
What are some symptoms of Acute Tumour Lysis Syndrome?
Nausea and Vomiting Diarrhoea Anorexia Lethargy Haematuria then Oligouria then Anuria HF Cardiac arrhythmia/arrest
How should Acute Tumour Lysis Syndrome be managed?
Allopurinol - Hyperuricaemia
IV Rasburicase if high risk of complications from Hyperuricaemia
Calcium replacement
