Oncology Flashcards
When is patient at risk of neutropenic sepsis?
7-21 days post SACT/ chemo
RF for neutropenic sepsis?
Age >65 poor performance status previous episode combined chemo + radiotherapy poor nutrition advanced disease co-morbidities active wounds and infections
Presentation of neutropenic sepsis?
Temp - >37.5 or <36.5
Low neutrophil count <0.5x10^9 /l
Other - related to source of sepsis - cough etc
How would you investigate someone with neutropenic sepsis?
All need hospital assessment
NEWS and MASCC
Look for: Central venous catheter surgical wounds previous MRSA colonisation Possible atypical respiratory pathogens
Get IV access - bloods, cultures
IV Antibiotics within an hour
Viral throat swabs
urine dip and MSU
Imaging - CXR
if diarrhea - stool culture, c diff toxin
What urgent bloods should you request on the 1st night and next day for someone with neutropenic sepsis on IV abx?
Daily CRP, FBC, LFTs
What antibiotic treatment should be given in neutropenic sepsis?
- should you wait to get results from FBC before giving it?
IV piperacillin/ tazobactam 4.5g qds
- dose depends on renal function. give 1st dose then check renal function
Do NOT wait for blood results.
Neutropenic sepsis
what antibiotic should be given if they have a known previous MRSA infection?
vancomycin
Neutropenic sepsis
what antibiotic should be given if suspect atypical pneumonia?
clarithromycin
Neutropenic sepsis
what antibiotic should be given in a true penicillin allergy?
what antibiotic should be given in a mild penicillin allergy?
TRUE
- COMBO: vancomycin, metronidazole, oral cipro
MILD
- ceftazidime
What is the oral step-down for antibiotics for neutropenic sepsis?
oral co-amoxiclav and ciprofloxacin
IF patient with neutropenic sepsis is at high risk with NEWS >6
what antibiotic should be given?
IV piperacillin/tazobactam + gentamicin
Use Cr clearance to check renal function for gentamicin use, not eGFR
Neutropenic sepsis
When would you consider using GCSF?
Profound neutropenia (<0.1) Prolonged neutropenia (>10 days) Pneumonia hypotension multiorgan dysfunction uncontrolled primary disease invasive fungal infections age >65 year olds hospital inpatient at time of developing fever
What should you do in someone with suspected malignant spinal cord compression?
Urgent MRI of whole spine within 24 hours
Admit for bed rest
Treatment of malignant spinal cord compression
Immediate dexamethasone 16mg oral stat then 8mg bd oral with PPI
Analgesia thromboprophylaxis physiology ensure spine stable - may need brace radiotherapy
Or consider surgery
- single vertebral region involved
SVCO
causes
lung cancer
lymphoma
other malignancy - thymoma, germ cell cancers
benign cause - aneurysm, goitre, fibrosis, infection, central line-in-situ
