EXAM #3: ONCOLOGIC EMERGENCIES Flashcards
What is the most common cause of cancer (lifestyle factor)? What is number two?
1) Smoking
2) Obesity
What causes SVC Syndrome?
Mediastinal mass
What is a common cause of a mediastinal mass in a smoker?
Lung cancer
What is the result of a mediastinal mass compressing the SVC?
Blood flows through venous collateral networks, returning blood to the heart via the IVC or azygous vein
What is the definition of SVC Syndrome?
Any condition, benign or malignant that causes obstruction of blood flow through the SVC
Where does the SVC drain blood from?
Head
Arms
Upper torso
What are the signs of SVC Syndrome?
1) Presence of venous collaterals
2) Edema of the head, neck, arms, upper chest, larynx, and brain
3) Dyspnea, headache, cyanosis, chest pain, confusion, coma
What are the two most common malignant causes of SVC syndrome?
1) Lung cancer
2) NHL
What are the benign causes of SVC Syndrome?
1) SVC stenosis/ thrombosis due to venous catheter/ pacemaker wire
2) Fibrosing mediastinitis
What is the gold standard for imaging/diagnostics for SVC Syndrome?
Chest CT with contrast
How is SVC Syndrome treated?
1) SVC endovascular stent
2) Treat underlying cause
What are the treatments that would be appropriate for treating malignancy causing SVC Syndrome?
- Radiation
- Chemotherapy
Steroids and diuretics don’t really help*
What is the treatment for LIFE-THREATENING SVC Syndrome?
SVC Endovascular Stent
A 50 year-old patient presents to the ED w/ a fever of 103. She is s/p chemo for metastatic breast cancer one week ago. What is this until proven otherwise?
Neutropenic fever
What is mucositis?
Inflammation of the mucous seen in neutropenic fever
What is the definition of neutropenic fever?
- Single temp greater than 101 F or sustained temp greater than 100.4
AND
- Absolute Neutrophil Count less than 500
How do you calculate the ANC?
WBC x % neutrophils + %bands
Outline how neutropenic fever commonly develops?
- Cytotoxic antineoplastic therapy
- Compromises the integrity of GI tract
- Allows the translocation of bacteria/fungi
What is an absolute MUST for the treatment for neutropenic fever?
Broad-spectrum empiric antibiotics within 60 minutes of arrival to the ED
How do you evaluate patients with suspected neutropenic fever?
1) Detailed history and PE (naked)
2) Labs and culture
3) CXR
What PE procedure should you NOT do in a patient with a suspected neutropenic fever?
Rectal exam (DRE)
What is the most common cause of documented infections in neutropenic patients?
Infection from patients endogenous gut flora
Though fungal infections are uncommon causes of infection in neutropenia, what is Candida infection commonly associated with?
Central venous catheter associated infections
What increases the risk/ need for anti-fungal agents in neutropenia?
Prolonged neutropenia
Is GM-CSF a part of the normal treatment for acute neutropenia?
No–it doesn’t work fast enough
What is pulsus paradoxus?
Variable pulse with respiration
What is a common cause of a very narrow pulse pressure?
Cardiac Tamponade/ pericardial effusion
What is the EKG manifestation of cardiac tamponade?
Electrical alternans
What is the CXR finding that is pathogonomic for pericardial effusion?
Water-bottle sign
What is the gold standard for diagnosing pericardial effusion?
ECHOcardiogram
What is malignant pericardial effusion associated with?
1) Lung cacner
2) Breast cancer
3) Leukemia
4) Lymphoma
5) Prior chemo or radiation
What determines the severity of symptoms in pericardial tamponade?
How rapid the accumulation of fluid occurs
What are the signs of Cardiac Tamponade?
1) Tachycardia
2) JVD
3) Diminished heart sounds
4) Pulsus paradoxus
5) Reduced pulse pressure
6) Electrical alternans
What is the emergent treatment for Pericardial Tamponade?
Pericardiocentesis
What is the procedure for recurrent pericardial effusion?
Pericardial window
