Oncology Emergencies Flashcards
Spinal Cord Compression:
1st presenting sign is usually what?
Other symptoms include?
Back pain
Numbness (saddle anesthesia)
tingling
weakness
falls
dropping things
changes to bowel/bladder habits (incontinence or retention)
If there is concern for Spinal Cord Compression then get what imaging?
MRI w/ and w/o contrast
can also get x-rays and CT of spine but MR provides most information
Spinal Cord Compression treatment:
Give steroids: Generally start with what?
loading dose of dexamethasone 10mg x1 followed by 4mg q6hrs, then taper
Spinal Cord Compression treatment:
Dont forget what with steroids?
PPI or H2 blocker
C/s necessary when onc patient has Spinal Cord Compression?
Ortho spine vs neurosurgery
Rad onc
med onc
PT/OT
Superior Vena Cava Syndrome (SVC) Occurs when what?
blood flow becomes obstructed d/t external compression by tumor or internal occlusion by tumor invasion that impairs venous drainage from head, neck, upper extremities and thorax
SVC Syndrome S/Sx?
dypnea
arm/face swelling
skin discoloration
collateral circulation
chest pain
cough
venous distention of neck/chest wall
increased ICP
Concerned for SVC syndrome? get what imaging?
CT chest w/ contrast
SVC syndrome symptomatic treatment?
Supplemental O2
diuretics
HOB elevation > 45 degrees
SVC syndrome treatment?
Radiation
Radiation + Chemo
Chemo alone
SVC syndrome treatment other options include?
stenting
angioplasty
thrombolysis pending etiology
mild SIADH s/sx?
fatigue
anorexia
myalgias
mod/severe SIADH s/sx?
AMS
seizures
coma
death from increased ICP
Diagnosis of SIADH
Urine Osmo > 100mOsm/kg of water
clinical euvolemia
urine sodium > 40 mmol/L
serum osm < 275 mOsm/kg
normal thyroid and adrenal fxn
SIADH treatment
Fluid restriction (limit to 500 to 1,000ml /day)
Slow correction of serum Na (<12 mEq/L) in 24 hrs and < 18 mEq/L avoids central pontine myelinolysis
Salt tabs 2-3g TID, 0.9% NaCl, htn saline is used when hyponatremia develops rapidly
Vasopressin receptor antagonists - convaptan, tolvaptan
Nephro vs Endo c/s
TREAT THE CANCER
S/Sx of Hypercalcemia of Malignancy: Mild
fatigued, nasuea
S/Sx of Hypercalcemia of Malignancy: Mod/Severe
confusion
dehydration
bradycardia
arrhythmias
shortened QT interval
prolonged PR interval
Cardiac arrest
Treatment of Hypercalcemia of Malignancy
If asymptomatic (Ca < 13)?
Symptomatic (Ca > 13)?
start IVF
Start IVF, bisphosphonates (pamidronate, zoledronic acid, etc) calcitonin
Tumor Lysis Syndrome is what?
Metabolic imbalance that occur when malignant cells rapidly undergo lysis dumping the cell contents into the bloodstream at a rate that exceeds the kidney’s clearance ability
TLS results in what?
Uricemia
Hyperkalemia
Hyperphosphatemia w/ secondary hypocalcemia
Lab TLS is diagnosed when levels of 2 or more serum values of what are abnormal at presentation or if there is a 25% change w/n 3 days before or 7 days after initiation of treatment?
Urate
K
Phos
Ca
When left untreated, TLS can lead to what?
lactic acidosis
acute renal failure
death
TLS treatment of:
Hyperkalemia?
HYperphosphatemia?
Hypocalcemia?
IVF, initiate hyperkalemia protocol, dialysis
IVF, phosphate binders, dialysis
IVF, if uric acid >/=10 can give rasburicase 3 or 6 mg, allopurinol, dialysis
TLS monitoring
BMP, phos, uric acid and LDH q4-8hrs pending on severity
