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Therapeutics II > onc emergencies > Flashcards

onc emergencies Flashcards

1
Q

superior vena cava syndrome

A
  • d/t occlusion or compression of SVC

- can be thrombosis of indwelling catheter or from a tumor

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2
Q

si/sx of SVC

A
  • dyspnea
  • cough
  • orthopnea
  • neck v distention
  • facial swelling
  • arm V distention
  • papilledema- emergency
  • horner’s syndrome
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3
Q

dx of SVC

A
  • CXR usu abnormal
  • confirm with other imaging
  • chest CT with contrast
  • MRI
  • contrast venography
  • Tc99m radionuclide venography
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4
Q

treatment of SVC

A
  • keep head up
  • IV steroids and diuretics
  • emergency mediastinal radiation- call radiation oncology*
  • remove central IV if in place
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5
Q

acute SC compression causes

A
  • tumor
  • epidural abscess/ hematoma
  • often from extension of spinal boney mets
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6
Q

where is SC compression most common

A
  • thoracic spine
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7
Q

si/sx of SC compression

A
  • localized back pain +/- tenderness
  • paraplegia
  • parasthesias
  • distal sensory deficits
  • gait disturbance
  • urinary incontinence
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8
Q

dx of SC compression

A
  • spine films- often abnormal but doesnt r/o dx
  • MRI*- study of choice
  • bone scan
  • CT with contrast
  • myelography
  • get imaging emergently
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9
Q

tx of SC compression

A
  • spine immobilization
  • foley cath
  • decadron
  • emergent decompressive laminectomy or radiation- urgent radiation and neurosurg consult*
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10
Q

hypercalcemia of malignancy etiology

A
  • parathyroid hormone related protein (PTHrP)
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11
Q

si/sx of hyperCa of malignancy

A
  • malaise/ weakness
  • polydipsia
  • anorexia
  • N/V
  • lethargy
  • confusion
  • back pain
  • sz
  • bones, stones, moans, groans
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12
Q

how do you calculate corrected Ca

A
  • total Ca + [0.8 X (0.4-albumin)]

- > 12 is dangerous

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13
Q

assessment of hyperCa of malignancy

A
  • corrected Ca
  • Cr, electrolytes, alk phos
  • EKG: short QT, low voltage, long PR
  • work up for skel lesions
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14
Q

treatment of hyperCa

A
  • IV hydration*: 150-22 cc/hr
  • once euvolemic then give loop diuretics (lasix)
  • bisphosphonates
  • subq or IM calcitonin- quickly lowers lev
  • steroids best for hematologic malignancy
  • dialysis of pt cant tolerate fluids
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15
Q

febrile neutropenia

A
  • single oral temp > 101.3 or sustained temp > 100.4 for 1 hour
  • neutropenia: ANC < 1000
  • severe neutropenia: ANC < 500
  • half of all cases have no identified organism
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16
Q

when does febrile neutropenia usu occur

A
  • during nadir after chemo

- nadir usu occurs 5-10 d after last dose

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17
Q

what is the nadir

A
  • when all cell counts drop after chemo

- lasts 5-7 days

18
Q

how do you calculate ANC

A
  • WBC X ( % neut + % bands)
19
Q

presentation of febrile neutropenia

A
  • severity ranges

- pay close attention to skin, oral cavity, perianal area, catheter, indwelling lines

20
Q

work up for febrile neutropenia

A
  • blood and urine cx
  • sputum cx and gram stain
  • generally avoid internal rectal exam unless indication
  • CXR may be normal but consider a CT if respir complaints
21
Q

tx of febrile neutropenia

A
  • abx ASAP- within 1 hour
  • usu give vanco + cefepime
  • most admitted
  • consider anaerbes, fungi, viruses, klebsiella
  • can consider admin of granulocyte colony stim factor (G-CSF)
22
Q

G- CSF

A
  • neupogen or neulasta
  • can speed resolution of neutropenia
  • no change in mortality
  • reduces hospital stay by 1 day
  • given SC
23
Q

indications for G-CSF

A
  • profound neutropenia, shock, comorbidities
  • worsening clinical course and expected prolonged neutropenia
  • pt not responding to abx despite documented infx
24
Q

ongoing tx once afebrile after febrile neutropenia

A
  • cont abx until blood cx
  • adjust abx based on cx
  • treat for 5-7 days of IV abx
  • consider PO abx if ANC > 1000
  • surveillance cx must be neg before d/c
25
Q

ongoing tx for febrile neutropenia

A
  • after 4 days add antifungal tx
  • broaden coverage to include anaerobes and candidia
  • ID consult
26
Q

when can a patient be discharged for febrile neutropenia

A
  • count recovery
  • afebrile for 24 hours
  • cx neg
27
Q

bacteremia in febrile neutropenia

A
  • infection only documented in 30-50% of cases
  • 30% have bacteremia
  • considered a true medical emergency
28
Q

tumor lysis syndrome

A
  • d/t rapid release of tumor contents -> metabolic complication
  • occurs after tx of bulky chemo responsive malignancy
  • may also be spont as tumor outgrows its own blood supply and dies off
  • d/t rapid release of tumor contents
29
Q

when does tumor lysis syndrome usu occur

A
  • 6-72 hours after initiation of chemo or radiation
30
Q

RF for tumor lysis syndrome

A
  • large tumor burden
  • high growth fraction
  • high pretreatment LDH or uric acid
  • preexisting renal insufficiency
31
Q

si/sx of tumor lysis syndrome

A
  • hyperP
  • hypoCa
  • hyperK
  • hyperuricemia
  • metabolic changes can be life threatening
  • acute renal failure and cardiac arrhythmias
32
Q

treatment of tumor lysis syndrome

A
  • stop chemo
  • aggressive IV hydration/ diuresis
  • +/- alkalinizing urine pH
  • Na, NaHCO3, glucose/ insulin, kayexalate for hyperK
  • consider emergency hemodialysis
  • allopurinol for prevention
  • rasburicase
33
Q

when is emergency hemodialysis indicated for tumor lysis syndrome

A
  • K > 6
  • uric acid > 10
  • Cr > 10
  • unable to tolerate diuresis
34
Q

what does rasburicase do

A
  • rapid deterioration of uric acid
  • occurs over a matter of hours
  • very expensive
  • not often used for tumor lysis syndrome
35
Q

thrombocytopenia in malignancy

A
  • avoid all NSAIDs
  • spont bleeding if plt < 10k
  • plt transfusion if count < 10k or any CNS bleed
  • avoid plt transfusion if consumptive state
  • use HLA matched single donor plt if sensitized
36
Q

acute malignancy related DIC

A
  • decreased plt
  • increased PT/ PTT/ FDP
  • decreased fibrinogen
  • treat with plt and clotting factors
  • may need tumor debulking
37
Q

chronic malignancy related DIC

A
  • labs may be normal

- treat intravascular thrombosis with heparin

38
Q

cause of malignant pericardial tamponade

A
  • tumor- would see tumor cells in aspirate

- radiation- no tumor cells

39
Q

si/sx of malignant pericardial tamponade

A
  • dyspnea, weakness
  • hypotension
  • narrow pulse pressure
  • JVD
  • muffled/ decreased heart tones
  • pulsus paradoxicus > 10 mmhg
  • low EKG QRS voltage
  • +/- pulsus alternans
40
Q

diagnosis of pericardial tamponade

A
  • echo
41
Q

treatment of pericardial tamponade

A
  • needle cath pericardiocentesis
  • pericardial window
  • radiation
  • paricardectomy- poor prognosis
  • intrapericardial chemo or sclerosis

Therapeutics II (8 decks)

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