Oncology

Question 1

Brain met

Answer 1

Ward complain

• Call MO
• Neurobs
• PO dexamethasone 4mg QID/ 8mg BD +- H’stix
• PO pantoloc 40mg daily
• Consult neuro-surg (increased ICP)

Question 2

Cord compression

Answer 2

Ward complain (from MRI report)

• Call MO
• Urgent RT if previously no RT
• PO dexamethasone 4mg QID/ 8mg BD (if no contraindication)
• PO pantoloc 40mg dialy
• +- foley

Question 3

EOL

Answer 3

Ward complain

• +- NPO
• O2 0-100%
• +- off obs
• Keep comfort
• Call relative
• prn visit
• No more blood taking +- drip setting
• Off IVF/med if drip out
• Off PO meds if not tolerating
• Morphine drip
  &raquo_space;» IV morphine 5mg +- midazolam 5mg in 500mL NS q8-12H
  &raquo_space;» SC morphine 10mg q24H via syringe driver
  &raquo_space;» +- SC haloperidol 3mg q24H via syringe driver
  &raquo_space;» +- SC buscopan 80mg q24H via syringe driver
  &raquo_space;» +- SC midazolam 10mg q24H via syringe driver
  &raquo_space;» +- SC dexamethasone 4mg q24H via syringe driver
  &raquo_space;» +- SC maxolon 20mg q24H via syringe driver
• • SC morphine 3mg q4H prn
• • SC buscopan 20mg q4H prn
• • SC haloperidol 3mg q4H prn
• • SC midazolam 3mg q4H prn
• • PR/PO panadol 500mg q4H prn
• • LA to both eyes hypermellose 1drop q2H

Question 4

Hiccups

Answer 4

Ward complain

• Paper bag for self re-breathing
• PO Lacgactil (Chlorpromazine) 25mg tds prn
• PO Stemetil (prochlorperazine maleate) 5-10mg tds prn

Question 5

Hypercalcemia

Answer 5

Ward complain

• Corrected Ca: 0.02 * (40-albumin) + calcium; >3 ~usu malignancy
• Symptomatic: polyuria, polydipsia, constipation, arrhythmia, mental disturbance
• ECG
• W/H Ca supplement
• IV NS 500mL q6-8H (fluid status, CHF, renal)
• Bld x RFT
• IV pamidronate 30-90mg in 500mL NS infused q4-6H; effect last 3/52
• IV zometa 4mg in 100mL NS q15min (if failed pamidronate)
  &raquo_space;» Cr >60: 4mg zometa
  &raquo_space;» Cr 50-60: 3.5mg zometa
  &raquo_space;» Cr 40-49: 3.3mg zometa
  &raquo_space;» Cr 30-39: 3mg zometa
  &raquo_space;» Cr <30: not recommended
• Bld x RFT 3/7 afterwards

Question 6

Neutropenic fever

Answer 6

Admission

• Post chemo D7-10
• Check fever, ANC (<0.5 or <1 but anticipated <0.5)
• Reverse isolation

 - Septic workup
 >>>> Bld C/S
 >>>> Sputum C/S
 >>>> MSU stix, C/S
 >>>> CXR

• IV tazocin 4.5g q6H
  &raquo_space;» not respond in 1-2/7: + IV gentacmycin 3.6mg/kg q24H
  &raquo_space;» gram-: IV meropenem 500mg q8H
  &raquo_space;» gram+: IV cloxacillin 500mg q6H / IV vancomycin 500mg q6H
  &raquo_space;» not respond in 5/7: IV amphotericin B 0.5-1mg/kg/D + PO amiloride 10mg daily + IV hydrocortisone 100mg q24H premed + IV piriton 10mg q24H premed
  &raquo_space;» still fever: gram- amikacin, gram+ linezolin
• IVF if septic shock
• SC GCSF 30millionU q24H, at least 1D post-chemo

Question 7

Transfusion reaction

Answer 7

Ward complain
Fever before transfusion
 - Septic workup
 - Abx
 - Panadol
 - Transfusion after fever down

Fever <1.5 increase; even T>38

• PO panadol 500mg q4H prn
• Bld C/S if T>38

Fever >1.5 increase, chills/rigors/septic

• Stop transfusion
• IV tazocin 4.5g q8H
• Blood product to blood bank x C/S

Rash, no shock
- IV piriton 10mg prn