Onc Emergencies Flashcards
What is the most common cause of inpt hypercalcemia
Cancer
What is the etiology of Humoral Hyper calcemia of malignancy
Excessive secretion of parathyroid hormone–related protein (PTHrP) by tumor cells
Most common cause of malignancy associated hypercalcemia
PTHrP acts on the same receptor as PTH, which then goes an increases serum calcium from the bones
What is the systemic effect of hypercalcemia
Hyper polarized membranes
- neuro/psych disturbances
- GI issues
- Renal dysfunction.
- MSK S/s
- CVD
Can you correctly calculate Calcium levels in hypoalbunemia
No
You must correct the Ca level with
(Calcium -albumin) +4
If corrected calcium is above 12 sudden death do to cardiac arrest can occur
In hypercalcemia if the PTH is elevated … what is that?
What if its low or NML
Elevated: primary hyperparathyroidism
Low/NML: PTHrP? Or low Vitamin D ?
What is the treatment approach to Hypercalcemia
IV fluids + Furosemide (if hypervolemic)
+IV Bisphosphonates if normal kidney fx
(Dronates)
Refractory:
-Calcitonin q12hrs or Denosumab qwkly x4 wks
Add corticosteroids if PCM or Lymphoma
What is the 1st and 2nd most common neurological complication of cancer
- Brain metz
2. Spinal cord compression
A pt that has new onset back pain, that gets worse when lying down or on their back
Think
CANCER !!!
Order a full spine MRI (1st choice)
If suspected cord compression then an MRI should be ordered within 24 hours
If back pain S/s are non specific a whole-body PET scan with F-2-deoxyglucose may be a useful screening procedure
Tx approach to cord compression 2/2 cancer
Immediate High dose steroids (dexamethasone q6hours)
+ Pain control
Refer for Surgical stabilization +/- chemo/rads
Should steroids be given to pts with cord compression without a cancer Dx
Preoperative corticosteroids should NOT be given
Corticosteroids might induce a tumor response and compromise the pathology results
A pt with cancer and a fever for longer than 1 hour =
Medical emergency!!
> 100.4°F (38.0°C) sustained for > 1 hour
OR
Single temperature of 101.0 (38.3°C) in the setting of absolute neutrophil count (ANC) <1500
(Severe less than 500)
How do you calc a ANC
Neutrophils x (Bands+segments) /100
Should be greater than 1500
What is the difference between a Microbiologically documented infection vs. A clinically documented infection
Neutropenic fever with a clinical focus of infection and an associated pathogen = Microbiologically documented infx
Neutropenic fever with a clinical focus (e.g., pneumonia), but without an associated pathogen = Clinically documented infection
A fever in a cancer pt=
Proceed directly to the ED !
inspect all IV sites for infection, TBSE, and catheters
If A DRE is going to be done, ABX must be admin first, however DRE is generally avoided unless there are S/s consistent with rectal abscess or prostatitis
Which is more common and with is more life threatening in a cancer pt
Gram neg or Gram pos infection
Gram positive infections are more common
Gram negative infections are more serious and life threatening
What should be considered in any pt with cancer, neutropenia and abd pain
Neutropenic enterocolitis
Presents as Thickened bowel on CT
What ABX are used in Febrile cancer pts
Ideally: Start empiric treatment within 60 minutes of presentation
- Cefepime (injectable cephalosporin)
- Carbapenem (beta lactam class of antibiotics)
- Piperacillin-tazobactam (penicillin-beta lactam class)
Continue antibiotics until absolute neutrophil count (ANC) is >500/µl AND afebrile for at least 48 hours
If persistently febrile (4-7 days after initiating antibiotics), initiate antifungal management:
-Amphotericin B, itraconazole, caspfungin
AND CALL INFECTIOUS DZ!!
Superior Vena Cava syndrome is most assoc with what cancer
Lung cancer and Lymphoma
What is the W/u for Superior Vena Cava Syndrome
Venous pressure >20 in the arm and NML in the legs
Eval with bronchoscopy
What is the procedure of choice for superior vena cava syndrome
Endovenous recanalization with stent placement
What Anticoagulation as appropriate
A pt presetnts with hyperkalemia, hyperurecemia, hyper phosphate, and AKI , +N/V SZR
After Chemo treatment of ALL or Burkitt lymphoma
Tumor Lysis Syndrome
A pt presents with arrhythmias, EKG changes, AKI, and N/V SZR after chemo treatment
Think
Tumor Lysis Syndrome
What is the treatment for tumor lysis syndrome
Aggressive hydration and possible Diaylisis for AKI
Allopurinol prior to chemo ( Lymphoma and Leukemia)
Rasburicase- any pt that develops hyperurecemia despite being treated with allopurinol
(C/I pregnancy, Lactating women, and G6PGD)
How does visceral pain present
Vague, diffuse
Opiods for cancer pain, approach
Start low over 24-48 hours to evaluate need
Then switch to ExRelease
