Oncological Emergencies**** Flashcards
Neutropenic Sepsis:
What is it?
What are the common causes?
Low neutrophils + Fever
Chemo ** - leading cause of death in chemo
Bone marrow irradiation
Malignant infiltration of bone marrow
Neutropenic Sepsis:
What are the typical S+S?
Investigations:
- Why should you not do a rectal or vaginal exam?
Management:
- What 2 ABs can be used?
Infection symptoms
Most present as an acute abdomen
It can increase the risk of spreading infection into the bloodstream
Piperacillin and Tazobactam IV
FOLLOW LOCAL GUIDELINES!!
Spinal cord compression:
Define?
Causes:
- Non-neoplastic - 4
- Neoplastic - list common origination of mets
Pressure on the spinal cord or the surrounding CSF or vascular system.
Trauma
Vertebral crush fracture due to osteoporosis
Slipped disc
Infection - discitis, epidural abscess, TB
Breasts Lung Prostate Myeloma Renal cell --
Spinal cord compression:
S+S:
First symptom
What makes this worse? - 2
Second symptom - sensory loss:
- Sym/assym
- How many dermatomes are effected?
- Is it on the same sensory level as the lesion?
Third symptom - motor loss:
- Where?
- Reflexes?
- Tone?
- What about sphincters?
What patient should this be a red flag in?
Back pain + worse on lying/coughing
Symmetrical sensory loss
1-2 dermatomes below lesions - remember they move down before exiting
Legs weakness
Hyperreflexia
Hypertonia
Sphincter dysfunction (hesitancy, frequency, and later painless retention)
CANCER PATIENTS!! - They present with worsening back pain or impaired mobility/sensation
Spinal cord compression:
Management:
- Who needs to be contacted and for what?
- What drug is given?
- What scan is only useful in spinal trauma?
- What scan will be used if there has been a history of trauma?
Neurosurgery
Dexamethasone (loading dose then daily)
MRI whole spine
Spine X-ray
SVC obstruction:
What causes this apart from lung cancer?
S+S:
- Main symptom
- Main signs
- Why may they get SOB, wheeze or stridor?
Pemberton’s sign is done to look for SVC obstruction. What is done?
Lymphoma, germ cell tumours, intravascular devices
Engorged veins in chest and arms
Raised JVP
Swollen face, neck or arm
Tracheal compression ----- Lifting both arms up Elbows touch ears Holding for 1 minute
SVC obstruction:
Investigations - 2
Management:
- Why is dexamethasone IV then PO given?
- Why can be done for lung cancer?
- What is done to open up SVC if Rx of cancer ineffective?
CXR and CT chest
Venography
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To reduce tumour burden in patients with steroid-responsive malignancies such as lymphoma or thymoma. Steroids are also helpful in reducing laryngeal oedema, which may result from the administration of radiation therapy.
Radio/chemotherapy
SVC stenting
What electrolyte becomes raised due to malignancy?
Calcium - hypercalcaemia
The cancer can make calcium leak out into the bloodstream from your bones, so the level in the blood gets too high. The cancer might also affect the amount of calcium that your kidneys are able to get rid of. Damaged areas of bone can release calcium into your bloodstream if you have cancer that has spread to the bone.
Tumour lysis syndrome:
Chemo causes tumour lysis.
What electrolytes does it release? - 3
LOOK AT ANSWERS!
What 3 complications develop?
Knowing what electrolytes it releases, how can this be managed?
Urate - causes AKI
Phosphate
Potassium - hyperkalaemia - causes cardiac death
AKI
Arrhythmias
Encephalopathy
Hydrate
Allopurinol - urate
Raspuricase - urate
Signs of brain mets?
What symptoms do they experience?
What signs would you see?
What drug can be given to reduce cerebral oedema?
Confusion
Fits
CNS signs
Headache
Ataxia
Fits
N&V
Focal neurological signs
Papillodema
Dexamethasone
HYPERCALCAEMIA IS ALSO A CAUSE! - READ IN CLINICIAL CHEMISTRY
HYPERCALCAEMIA IS ALSO A CAUSE! - READ IN CLINICIAL CHEMISTRY
