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Palliative Care > Emergent conditions > Flashcards

Emergent conditions Flashcards

1
Q

Treatment options for airway obstruction

A

endoscopic options: microdebriedment, radiotherapy ablation, high dose endobronchial radiotherapy, brachytherapy
Trach
Bronchial stent

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2
Q

Medications to treat airway obstruction

A

Morphine 20mg/ml solution
lorazepam 2mg solution
SQ midaz
SQ phenobarb

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3
Q

signs and sx of cardiac tamponade

A

Dyspnea
cough
orthopnea
dizziness
hypotension, elevated JVD, pulsus paradoxus

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4
Q

treatment of cardiac tamponade

A

pericardiocentesis (if not recurrent ie malignant)
For recurrent:
- indwelling catheter
- pericardiostomy
- PERICARDIAL WINDOW
- med intrapericardial with sclerosing agent or antineoplastic

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5
Q

Causes of massive hemorrhage

A
  • invasion of tumor into vessels
  • Coagulopathy
    – liver disease
    – cancer in bone marrow
    – medications
    – DIC
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6
Q

Interventions for bleeding from surface wound

A

hemostatic dressing

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7
Q

treatment for bleeding from thrombocytopenia

A

aminocaproic acid

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8
Q

treatment for bleeding from hemoptysis

A

bleeding lung down
IV vasopressin or aerosolized vasopressin

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9
Q

General approach to treatment for massive hemoptysis

A

stop AC
avoid steroids
endoscopic: banding, sclerotherapy, embolization, radiotherapy

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10
Q

Adjustment for low albumin when looking at Ca

A

1g alb below 4 add 0.8mg Ca

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11
Q

Causes of hypercalcemia

A

non-small cell lung cancer, breast, head and neck, RCC, multiple myeloma, t-cell lymphoma
(usually because rPTH)

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12
Q

Symptoms of hypercalcemia

A

Groans – constipation
moans – fatigue, nausea
bones – bone pain
stones – kidney
psych overtones – depression, confusion

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13
Q

Treatment for hypercalcemia

A

-hydration
- loop diuretics
- bisphosphonate tx
- decrease external Ca
- Denosumab (prostate cancer and breast)
(calcitonin)

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14
Q

Bisphosphonates for hypercalcemia

A

pamidronate 60-90mg IV
Zolendronate 4mg IV

takes 2-4 days for effect
redose after 1-3 weeks

SE: Osteonecrosis (need dental check before start)

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15
Q

Risks for pathologic fractures

A

osteoporosis, bone primary, mets

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16
Q

Treatment for pathologic fractures

A

Bisphosphonates (osteoporosis and smaller diffuse mets)
Denosumab (met prostate and breast)
ortho (internal stabilization, replacement arthroplasty)
Vertebroplasty (Not really effective)

17
Q

When to avoid surgery in pts with pathologic fractures

A

prognosis <2-4 wks
high risk of failure to stabilize due to bone destruction
infected

18
Q

Common causes of spinal cord compression

A

breast, prostate and lung cancers

19
Q

Symptoms of spinal cord compression

A

pain, paraparesis, paralysis, incontinence
radicular pain wrapping around ribs or down legs
progressive polyneuropathy

20
Q

Physiology of spinal cord compression

A
  1. compression -> edema, venous congestion, demyelination (reversible)
  2. prolonged compression –> infarction (irreversible)
21
Q

Treatment for spinal cord compression

A

Steroids (dex 10mg then 16mg daily with 10-14d taper)
radiotherapy
surgery
Neuropathic adjuvants
IV bisphosphonates
radioisotope (prognosis months with widespread mets)

22
Q

When to recommend surgery for spinal cord compression

A
  • progressive neuro deficits
  • vertebral column instability
  • radio-resistant tumor (lung, colon, RCC)
  • intractable pain not relieved by XRT
23
Q

Causes of seizures

A

cerebral or leptomeningeal malignancy
(metabolic, infection, drugs, withdrawal, intracranial hemorrhage)

24
Q

treatment for nonconvulsive status epilepticus

A
  1. benzos + phenytoin
  2. benzos + valproic acid or barb
  3. levetiracetam or lidocaine
25
Q

Causes of SVC syndrome

A

Tumor in upper mediastinum
Lung Ca or lymphoma

26
Q

Sx of SVC

A

Early: facial plethora, facial and upper extremity edema, distended arm veins
Later: cough, hoarseness, headache, dyspnea, HD compromise

27
Q

SVC treatment

A

Steroids
thrombolytics
chemo
endovascular stenting
raise head of bed

28
Q

Common causes of urinary retention

A

Medications (anticholinergics, alpha adrenergic, opioids)
urethral stricture
lower abdominal tumor
fecal impaction

29
Q

Symptoms of urinary retention

A

oliguria or anuria
restlessness
delirium
diaphoresis
abdominal pain

30
Q

Treatment for urinary retention

A

Catheterization (intraurethral, suprapubic)
+/-indwelling stents, percutaneous nephrostomy
Watch for postobstructive diuresis

31
Q

Cancers that cause pericardial mets

A
  1. Lung cancer
  2. breast ca
  3. lymphoma

(myocardial mets from melanoma)

32
Q

When are steroids helpful for SVC syndrome

A
  1. emergency with severe airway obstruction and cant get stenting
  2. steroid response malignancies (lymphoma or thymoma)

otherwise conservative measures (O2, raising the head of the bed)

Palliative Care (11 decks)

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