Oncology Emergencies Flashcards
Neutropenic sepsis examination and investigations?
Full physical examination - to find source
Obs
Evaluate potential infection sites (lines, catheters)
FBC, LFT, U&E, CRP, Lactate Blood culture (aerobes and anaerobes) - central and peripheral Swabs as indicated Sputum culture Urine analysis and culture Stool analysis and culture CXR
Neutropenic sepsis definition?
Neutropenia (< 0.5 x10_9)
Fever (>38.5 on one occasion, or >38 for more than an hour)
7-10 days after chemo - endogenous pathogens mostly
Neutropenic sepsis management?
ABCDE IV access - rehydration + bloods (FBC, U+E, CRP, LFT, Lactate) Urine output, BP, oxygen sats, pulse Oxygen if required Blood product support if required
Empirical broad spec abx within one hour, immediately after cultures.
Senior review + discuss with micro, await culture results + switch to targeted therapy
-ve cultures + apyrexial for 48 hours –> stop Abx
Abx in neutropenic sepsis?
Tazocin
Vancomycin +/- gentamycin (?aztreonam)
Definition of hypercalcaemia? Grading?
> 2.6 mmol/L
Mild = 2.6-3.0 Mod = 3.0-3.5 Severe = >3.5
Cancers causing hypercalcaemia?
NSCLC Ca breast Renal cell Ca Multiple myeloma and lymphoma H + N cancers
BONY METS
Presentation of hypercalcaemia?
Stones - renal or biliary
Bones - bone pain
Abdominal groans - abdo pain, N+V, dyspepsia, constipation
Psychiatric overtones - depression, anxiety, cognitive dysfunction, coma
Dehydration, weakness, fatigue, polyuria, seizure, cardiac arrhythmia –> syncope, arrest
Examination and investigation in hypercalcaemia?
Neuro exam
ECG
PTH levels (primary hyperparathyroidism) Review medications - thiazides, vitamin D/Ca supplements
Management of hypercalcaemia?
0.9% Saline rehydration - 1L 4 hourly for 24 hours, then 6 hourly for 48-72 hours with adequate K+. Consider furosemide if at risk of overload.
Bisphosphonates - only after they are rehydrated (IV pamidronate/zolendronic acid)
Salmon Calcitonin + corticosteroids (if resistant, need endocrinology input)
Causes of MSCC?
Breast, prostate and lung cancers
Pb KTL - prostate, breast, kidney, thyroid, lung
Usually thoracic spine (2/3)
Presentation of MSCC?
Back pain - band like, radicular quality
Leg weakness - symmetrical
Sensory loss - saddle anaesthesia
Bowel/bladder dysfunction - urinary retention, constipation, overflow
Examination and investigations in MSCC?
Palpate spine for tenderness
Full neurological examination (arms and legs)
Palpate abdomen for urinary retention
PR - reduced anal tone
Bloods - haemtology, biochemsitry (Ca and alk phos)
Radiology - MRI whole spine in 24 hours (CT myelogram if contraindicated)
Management of MSCC?
URGENT MRI SPINE IN 24 HOURS
Lie flat to reduce movement of spine
Analgesia
16mg dexamethasone with PPI cover (monitor glucose)
Laxatives if bowel care needed
Prophylactic LMWH if immobile
Refer to neurosurgery and clinical oncology fot palliative radiotherapy
Catheterisation if needed, occupational therapy and physio referral.
Prognostic score for MSCC?
Tokuhashi prognosis score
Causes of SVCO?
Lung cancer Lymphoma Mediastinal lymphadenopathy Germ cell tumours Thymoma oesophageal cancer Tumour associated thrombus
