Oncological emergencies Flashcards
What is superior vena cava syndrome
Where superior vena cava is blocked, can’t drain head
what type of cancer is in the brain mostly
it is mostly metasis from somwhere else
What type of new pain in a cancer payment should be evaluated immediately
New onset back pain,
What increases DVT risk in those with ccancer
increase viscosity
indwelling cathater
describe cancer pain in back ca
Pain may be localized or radicular
worse with percussion of spinus process**
worsened by movement , but unimproved with rest!
urinary or bowel incontinence cant pee
CAN NOT FIND RELIEF!
Lower extremity weakness
Worse with cough
Which level of spine has the most risk of getting cancer from mets
Thorasis
What should you think if somone is always constipated who suddenly move to watery diarrhea
That bowel obstruction is so great only diarrheah can get by
Side effects from medications
Bowel issue
- constipation, stasis,
- Diarrhea - - watery diarrhea
Who should you worry about even without feverwhy bluning fever in cancer
Who knows, cytokines or receptors
elderly
what percent of bone cancer is thorasic
70%
What PE for bone exam, may you see
Percussion of spinous process Valsalva maneuver: may make worse DTR: may be increased Lower symptom spasticity Babinski sign positionve
Cauda equina syndrome
Subset of spinal cord compression **** lower motor neuron presentation** DTR deminished weak lower extemity urinary retention/constipation
Imaging of spine
MRI
CT scan
Plain film: may miss para spinal lesions that a
what may plain film miss
para spinal leesion that are impinging upon neuronal foramina
intra-spinal turmor metasis
What is pathologic fracture
Fracture due to structural issue of bone
Treatment of spinal cord compression
Steroid: limited use
Radiation: indicatated
- may be followed by chemo
sx of brain cancer mets
Tumor, bleed
altered mental status: may precede by months
new onset HA or increased freq intensity**
visual field changes
focal neurolgical deficits
persistent neause and vomiting (projectile)
stroke sezures:
Focal neuroligical deficits
Weakness
diminished function or sensation
what is the most common type of tumor found in the brain
Mets
Drug problem, chemptherapy, because they are very tissue toxic
- extravactions at Chemo IV place, indwelling catheter
cool compresses.
Get it checked out urgent care
Nurological symtoms
IV steroids
don’t delay treatment
what is a pertinent negative, on ha
pain, visuality aquity changes: use snellen etc hx of HA nausing or Vomiting muscle testing
what does vomitiong for HA brain pressure cause
Projectile
Concern with new onset seizures
space occupying leasions untill proven otherwize, unless there is some other obvious reasion.
what is found in about 30% of cancer patients
Brain mets
what are the most commin cancers that lead to brain mets
lung ca breast renal cell colon ca melanoma
what are frequenly given for mets to brain
IV steroids to diminish pressure
supervena cava syndrome or obstruction ususallly results from what
Direct obstruction by malignances
- compression of vellel wal by lung ca
Gamma knife:
used for brain tumor
What often causes superior vena cava syncrome
- right upper lobe tumors
- thymoma
- mediasinal lymphadenopathy
- thrombosis around indwelling cathater
what is the most common cause of supervena cava syndrome
Brochogenic carcinoma
what does superior vena cava look light
halmark: facial and neck swelling headache venous distention varicositys over chest wall SOB is most common sx followed by facial or arm swelling
Morning headaches
high hematacritic
apnea
Sleep apnea
anyone with a solid tissue tumor (esp pancreatic cancer) one can develoep
trussos effect
veins pop up and come and go all over the body
Trussoes sign of mal
what is trussoes signe of malignancy
Incerased thrombossis
causeing crazy vericose
Trussoes sign of hypocalcemia
crossing thumb over to pinky
Extream superior vena cava syndrom
cerebral edema
altered conciousnes
seizures
airway obstruction
horners syndrome
PTossis lid drops
anhydrosis: unilateral not
myosis: pinpoint pupils
Becks triad***
For cardiac tamponade
muffeled heart sound
JVD
Hypotension
why does hypotension happen in cardiac tamponade
decreased stroke volume
what does chest xr reveal for Cardiac tamponade
cardiomegaly
should be middle of spine to edge of chest wall max at very boddtom
what does ultrasound reveal: cardiac tamponade
pericardial effusion, restricted heart wall motion
how much fluid can be in the pericardial sack
> 250CC
EKG of cardiac tambonaide
Electrical alterans : low vultage, lower T waves
Who gets cardiac tamponade
cancer patients
dyallisis
Electrical alterans
Patter of ever certain beat, QRS shorter
Febrile neutripenia
most common complications related to cancer treatment chemo
- 50% of deaths associated with leukemia, lymphomas and solid tumors
absolute neutropenia
what happens for
sx of febrile neutropenia
temp 101 or more,
what should happen for cancer patients who get fever risht after chemo
treatmetn until neutorphil count comes up.
Treatment od cardiac tamponade
Remove fluid Pericardiocentesis Place a windo in sack low dose radiation Sclerotic therapy
**Normal rance of calcemia
9-10.5 mg/dl
most common cause of hypercalcemia outpatient
hyperparathyroidism
effect of hypercalcemia
stones: renal
bones: bone pains
groans: abd pain, N/V
thrones: constipation/polyuria
psychiatric overtones: anxity, depression
what specificly raises calcium in cancer patients
bone lysis - mets breast or prostate
cytokine production
tumor production: PTH-rp
PTH-rH
tumore producing hormones PTHrP that causes body to react the same and increase Ca Bronchogenic carcinoma (lower than expected PTH)
prognosis of hypercalcemia with malignancy
grave prognosis, 1-2 mths of survival time increased lethargy, anorexia, nausea vomit como confusiton
hypercalcemia treatment
Saline infusion to correct the dehyration
Iv Lasix t**o promote renal excretion of calcium
Bisphophonates to block bone resorption. (alendronate)
what is the treatment of choice for hypercalcemia***
Lasix will promote renal excretion of calcium**
syndrome of inappropriate anti diruetic homone production
SIADH
Sodium is the electrolyte that is effected the most:
due to ectopic prodiction of anti-diruetic hormone ADH aka vassopressin
what is the most common cause of SIADH
lung cancer : small cell carcinoma of the lung
what is the electrolight effected most in siadh
sodiim will be really low, effected first.
Hyponatremia
What medication can cause SIADH
Hyponatemia: lithium can cause them, its a kidney issue
Tumor lysis syndrome when
in patient with large tumor burden that is sensitive to chemo and is dying off!
worse in leukemia
risk factors for tumor lysis syndrmoe
Pre exhisting renal dysfunction: major risk factor
how can tumor lysis syndrome effect electrolytes
Hyper : uremia, kalemia, phosphatemia
high uric acid, K and phosphate
sx of tumor lysis syndromia
acute renal failure
how are risks of tumor lysis syndrome reduced
vigarous hydration before chemo
urine allaline ization before chemo
allopurinol
DVT classic pain
dull deep aching pain
Ususally made worse by standing or walking or when the leg is in a dependend position
Risk factors of DVT
malignance elevated estrogen smokeing long sitting hx of DVT
Classic sign of DVT
swelling, tenderness and redness (may look like cellulitis)
Palpable coard
Homans sign: discomfor in calf behind knee
Pulmnary embolism
Anxiety
sob
chest pain pleuritic
tachypnea
where does 2/3 of PE happen in
1/3 knkown vascular disease
1/3 post operative
Not finnished
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