Oncological Emergencies Flashcards
when should you suspect neutropenic sepsis?
> 38 temp
<0.5 x10^9/L
when does neutropenic sepsis usually occur?
first 10-14 days
management of neutropenic sepsis
tazobactam
piperacillin
if penicillin allergic= gent + vanc + ciprofloxacin
IV fluids
what to use in neutropenic sepsis if penicillin allergy?
gentamicin
vancomycin
ciprofloxacin
causes of spinal cord compression
vertebral metastasis
retroperitoneal tumours growing through intervertebral foramina
compression of blood supply
which part of the spinal cord is most at risk of compression
thoracic spine
presentation of spinal cord compression
radicular pain
bowel/urinary changes
weakness/ sensation change
when can surgery be done in spinal cord compression?
no more than 1 level affected
management of spinal cord compression
dexamethasone + PPI + radiotherapy
bisphosphonates?
causes of superior vena cava syndrome (SVCO)
external internal compression (thrombosis)
presentation of superior vena cava obstruction
rapid onset swelling of face, neck and arms
distended veins
SOB
headache
late= injected conjunctiva and sedation
diagnosis of superior vena cava obstruction
Pemberton’s test
initial management of superior vena cava obstruction
prop patient up
oxygen
internal cause of SVCO management
anticoagulation
external cause of SVCO management
dexamethasone
stent
when are clinical features more pronounced in SVCO?
when obstruction occurs below the azygous vein
diagnosis of malignancy-associated hypercalcaemia
corrected calcium >2.6mmol/L
what does calcium bind to?
albumin
what causes malignancy associated hypercalcaemia?
PTH produced by tumour
tumour produces vit D analogues
local osteolysis
what does PTHrP do?
stimulates osteoclasts to resorb bone
increases reabsorption of Ca in DCT
production of 1.25 dihydrovitamin D3
management of malignancy associated hypercalcaemia
saline
bisphosphonates
calcitonin
which bisphosphonate is used in malignancy associated hypercalcaemia?
pamidronate IV
adverse of pamidronate?
renal failure if not properly hydrated first
why is malignancy associated hypercalcaemia life-threatening?
acute pancreatitis
renal failure
coma
what is tumour lysis syndrome?
chemotherapy leads to cell death with increased urate, K+, phosphate and reduced calcium
what does tumour lysis syndrome risk?
arrhythmias
renal failure
management of tumour lysis syndrome
hydration
uricolytics (allopurinol)
