Oncologic Emergencies

Question 1

Overstimulation of normal coagulation that causes a paradoxical disorder of diffuse clotting and profuse hemorrhage is what?

Answer 1

Disseminated Intravascular Coagulation (DIC)

Question 2

Acute DIC is associated with more ________ while chronic DIC is associated with more ________ formation

Answer 2

bleeding, thrombus

Question 3

Lab findings of DIC include

Answer 3

• Prolonged clotting times
• Increased levels of fibrin degradation product
• Increase D-dimer
• Low PLT count
• Low fibrinogen levels
• Low plasma levels of coag. factors

Question 4

Treatment of DIC

Answer 4

-Treat underlying cause:

1) Replacement therapies-
A) Fresh frozen plasma
B) PLT transfusion
C) Washed PRBC
D) Cryoprecipitate

2) Control coag. processes-
A) heparin, antithrombin, antifibrinolytic agents

3) Supportive care- IV hydration

Question 5

Definition of Systemic Inflammatory Response Syndrome (SIRS) AKA Sepsis

Answer 5

2 or more of the following:

• Temp >38 C (100.4 F) or 90 BPM
• Resp rate >20
• WBC >12k or <4K or greater 10% bands

Question 6

Presenting signs symptoms of Sepsis (SIRS)

Answer 6

• Fever, shaking chills and rigors, hypotension, tachycardia, tachypnea, and mental status changes
• Most will not have obvious source of infection

Question 7

Diagnosis and Assessment with sepsis

Answer 7

• Complete PE
• Lab: CBC w/ diff, CMET, LDH
• CXR
• UA, stool, sputum, pharyngeal swab
• Blood cultures (2 sets)

Question 8

Sepsis treatment and Prevention strategies:

Answer 8

Slide 16

Question 9

Electrolyte and metabolic disturbances caused by cell lysis as a result of chemotherapy, radiation therapy, biotherapy, or surgery is called what?

Answer 9

Tumor lysis syndrome (TLS)

Question 10

Prevention strategies for pts at high risk of TLS?

Answer 10

Allopurinol, hydration, urinary alkalinization

Question 11

Etiology of hypercalcemia

Answer 11

1) Primary hyperparathyroidism
2) Malignancy
- Many others

Question 12

What type of cancers has the highest incidence of hypercalcemia?

Answer 12

1) Lung
2) Breast
3) Multiple myeloma
4) Head and neck
others. .

Question 13

Symptoms of hypercalcemia

Answer 13

• Fatigue
• Anorexia
• N/V
• Constipation
• Ab pain
• Mental status change
• HA
• Coma
• Excessive thirst
• Polyuria
• Renal failure

Question 14

Lab assessment in hypercalcemia

Answer 14

• Calcium levels >12 mg/dL

- PTH

Question 15

Treatment for hypercalcemia

Answer 15

-Rehydration is essential. After rehydration, furosemide
Implement bisphosphonate therapy

-Prevention: maintain mobility, adequate hydration…

Question 16

Syndrome of inappropriate secretion of ADH

Answer 16

…