End of Life Part 2

Question 1

Palliative care emergencies Case 2 - Mrs F

Temp 38.9
FBC:
Hb 108
WCC 2.1
Neut 0.9
Platelets 138

Answer 1

What would be your differentials now ?

Question 2

What investigations might you add?
Differential ?

Answer 2

• Most likely 7-10 days after treatment
• Needs to be suspected in any patients who have had chemotherapy in last 6 weeks
• Early signs
  Temp, flu-like symptoms, rigors
• Late signs
  ↑HR, ↓Bp, confusion
• May not present with temperature! Low index of suspicion
• Needs urgent bloods including differential WBC count
• Blood cultures & line cultures if present
• IV fluids & antibiotics (1 hour door to needle)
• Contact acute oncology team

Question 3

Patient case 3 - Mr P

• 65 year old
• Ca prostate with multiple bone metastases
• Back pain on MST 50mg BD
• Constipated
• Mobility deteriorating, several falls recently
• Back pain worsening – “band-like”

Answer 3

MSCC - Metastatic spinal cord compression
- It can be Intrinsic or extrinsic

Question 4

Who has MSCC ?

Answer 4

• 5-10% patients with cancer
• Commonly prostate, lung, breast, myeloma
• Neurology often late presenting sign
• Can be catastrophic
• Aim to prevent loss of neurological function
• Needs same day assessment with neurological examination
• Contact MSCC co-ordinator at RPH bleep 2664