Oncological emergencies Flashcards
What is neutropenic sepsis?
Neutropenic sepsis is a life threatening complication of anticancer treatment, the term is used to describe a significant inflammatory response to a presumed bacterial infection in a person with or without fever.
What are the diagnostic features of neutropenic spesis?
Within 6 weeks of recieving chemotherapy
- Temp >38.0oC
- Neutrophil count is <1.0 x 109/L
- Features of sepsis
What percentage of neutropenic sepsis cases are due to endogenous flora?
85%
What proportion of neutropenic sepsis cases are due to gram negative bacilli?
75%
What symptoms might a paitent with neutropenic sepsis report?
- Anorexia
- Malaise
- Lethargy
- Sweats
- Fever, chills rigors
- Symptoms related to a focus of infection
What might you find on examination of someone with neutropenic sepsis?
Signs of shock/Sympathetic drive
- Tachycardia
- Tachypnoea
- Hypotension
- Decreased cap refill
What investigations might you do in someone who you suspected had neutropenic sepsis?
Move to isolation room
- Bloods - FBC, U+E, LFT, Bone profile, CRP, coagulation screen
- Blood cultures
- Get a sample - MSSU, Stool culture, Throat swabs, Sputum culture, Skin swabs
- CXR
How would you manage someone with suspected neutropenic sepsis?
ABCDE
- Fluids
- Oxygen therapy
STAGE 1 Broad spectrum antibiotics:
- Piperacillin/Tazobactam (tazocin) plus Gentamicin
- If mild penicillin allergy – Ceftazidime plus Gentamicin
- If severe penicillin allergy – consider Vancomycin and Gentamicin +/- Metronidazole
Consider G-CSF to boost neutrophil count
What dose of Tazocin would you give in someone with suspected neutropenic sepsis, who didn’t have a penicillin allergy?
4.5g IV every 6 hours
If you were giving Gentamicin to someone with neutropenic sepsis, what dose would you use?
7mg/kg IV
If you were using Ceftazidine to treat someone with neutropenic sepsis who had mild penicillin allergy, what dose would you give them?
2g IV every 8 hours
What antibiotics would you give someone who had neutropenic sepsis and was severely penicillin allergic?
Consider Vancomycin and Gentamicin +/- Metronidazole
How would you monitor someones initial response to therapy after treating them for neutropenic sepsis?
- Observations - temp, pulse, blood pressure, O2 sats, RR, urine output (catheterise if hypotensive)
- Check blood cultures - Optimise antibiotic therapy based on sensitivities
- Monitor Bloods - FBC, U+Es and CRP daily
When would you consider switching to stage 2 antibiotic therapy in someone with neutropenic sepsis?
If patient remains febrile on stage 1 antibiotics after 48 hrs, or if clinically deteriorating
What antibiotics would you give as Stage 2 treatment for neutropenic sepsis?
Meropenem
What dose of meropenem would you consider giving someone with neutropenic sepsis who had not improved clinically on stage 1 antibiotic treatment?
1g IV every 8 hours unless cultures suggest another more rational antibiotic regime
What cancers is malignant spinal cord compression most commonly seen in?
Cancers which typically spread to bone:
- Breast cancer
- Carcinoma of the bronchus
- Prostate cancer
- Myeloma
- Renal cancer
- Thyroid
5 B’s go to Bone - Breast, bronchus, byroid, bidney, brostate
What are the main ways in which malignant spinal cord compression occurs?
- Compression fracture/collapse of vertebrae from metastatic disease
- Direct invasion into the verebral column by tumour
What are symptoms of spinal cord compression?
- Back pain
- Progressive Limb Weakness
- Paraesthesiae
- Urinary/faecal incontinence
- Sensory loss
If you suspected malignant spinal cord compression, how would you manage it??
- Investigate - urgent MRI/CT, Serum calcium
- Supportive treatment
- Steroids
- Surgery +/- Radiotherapy
- Radio/chemotherapy