Emergent conditions Flashcards
Treatment options for airway obstruction
endoscopic options: microdebriedment, radiotherapy ablation, high dose endobronchial radiotherapy, brachytherapy
Trach
Bronchial stent
Medications to treat airway obstruction
Morphine 20mg/ml solution
lorazepam 2mg solution
SQ midaz
SQ phenobarb
signs and sx of cardiac tamponade
Dyspnea
cough
orthopnea
dizziness
hypotension, elevated JVD, pulsus paradoxus
treatment of cardiac tamponade
pericardiocentesis (if not recurrent ie malignant)
For recurrent:
- indwelling catheter
- pericardiostomy
- PERICARDIAL WINDOW
- med intrapericardial with sclerosing agent or antineoplastic
Causes of massive hemorrhage
- invasion of tumor into vessels
- Coagulopathy
– liver disease
– cancer in bone marrow
– medications
– DIC
Interventions for bleeding from surface wound
hemostatic dressing
treatment for bleeding from thrombocytopenia
aminocaproic acid
treatment for bleeding from hemoptysis
bleeding lung down
IV vasopressin or aerosolized vasopressin
General approach to treatment for massive hemoptysis
stop AC
avoid steroids
endoscopic: banding, sclerotherapy, embolization, radiotherapy
Adjustment for low albumin when looking at Ca
1g alb below 4 add 0.8mg Ca
Causes of hypercalcemia
non-small cell lung cancer, breast, head and neck, RCC, multiple myeloma, t-cell lymphoma
(usually because rPTH)
Symptoms of hypercalcemia
Groans – constipation
moans – fatigue, nausea
bones – bone pain
stones – kidney
psych overtones – depression, confusion
Treatment for hypercalcemia
-hydration
- loop diuretics
- bisphosphonate tx
- decrease external Ca
- Denosumab (prostate cancer and breast)
(calcitonin)
Bisphosphonates for hypercalcemia
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)
Risks for pathologic fractures
osteoporosis, bone primary, mets
Treatment for pathologic fractures
Bisphosphonates (osteoporosis and smaller diffuse mets)
Denosumab (met prostate and breast)
ortho (internal stabilization, replacement arthroplasty)
Vertebroplasty (Not really effective)
When to avoid surgery in pts with pathologic fractures
prognosis <2-4 wks
high risk of failure to stabilize due to bone destruction
infected
Common causes of spinal cord compression
breast, prostate and lung cancers
Symptoms of spinal cord compression
pain, paraparesis, paralysis, incontinence
radicular pain wrapping around ribs or down legs
progressive polyneuropathy
Physiology of spinal cord compression
- compression -> edema, venous congestion, demyelination (reversible)
- prolonged compression –> infarction (irreversible)
Treatment for spinal cord compression
Steroids (dex 10mg then 16mg daily with 10-14d taper)
radiotherapy
surgery
Neuropathic adjuvants
IV bisphosphonates
radioisotope (prognosis months with widespread mets)
When to recommend surgery for spinal cord compression
- progressive neuro deficits
- vertebral column instability
- radio-resistant tumor (lung, colon, RCC)
- intractable pain not relieved by XRT
Causes of seizures
cerebral or leptomeningeal malignancy
(metabolic, infection, drugs, withdrawal, intracranial hemorrhage)
treatment for nonconvulsive status epilepticus
- benzos + phenytoin
- benzos + valproic acid or barb
- levetiracetam or lidocaine
