Oncological Emergencies

Question 1

Management of neutropenia sepsis

Answer 1

Pt on chemo with fever = IV Abx within 1hr, after cultures taken, Tazocin used (meropenem if allergic)
Sepsis 6 protocol
Gentamicin in shock

Unresolving >48hrs

• discuss with microbiology
• try Meropenem +/- Vancomycin
• senior review

Unresolving over 72hrs

• investigations for fungal infections
• antifungals

??GCSF

Question 2

Define neutropenic sepsis

Answer 2

Neutrophil count of <0.5 x 10^9 or <1 and falling

And

• fever of >38C
• signs and symptoms of sepsis

Question 3

History Qs for pt presenting with suspected neutropenic sepsis

Answer 3

Last chemo date and agent
Ask about lines
Infection symptoms
DH and allergies

Question 4

Causes of SVCO

Answer 4

Lung cancer 
Lymphoma 
Kaposi’s sarcoma 
Breast cancer 
Aortic aneurysms

Question 5

Presentation of SVCO

Answer 5

SOB 
Swelling - face, neck, arms 
Headache 
Pulseless raised JVP
Engorged neck and chest veins

Question 6

Treatment of SVCO

Answer 6

Oxygen 
Sit pt upright - increases venous return
Analgesia 
May give steroids if histology confirmed 
Consider intraluminak stenting