Oncology Emergencies Flashcards
most common presenting symptom of spinal cord compression
radicular back pain
- band like burning pain
other symptoms of spinal cord compression
weakness
sensory changes
changes in bladder - urinary retention
changes in bowels - constipation
investigation of suspected spinal cord compression
urgent MRI spine
initial management of spinal cord compression
dexamethasone
- 16mg IV followed by 8mg oral twice a day
- aims to reduce vasogenic oedema
main treatment for spinal cord compression
radiotherapy
when should surgery be considered for spinal cord compression
in patients with:
- single vertebral level involved
- no widespread metastasis
- radio-resistant cancer
- prev radiotherapy to site
symptoms of superior vena cava obstruction
swelling of face, neck, arms
distended veins
headache
shortness of breath
causes of superior vena obstruction
intrinsic blockage
- Clot
- foreign body (e.g. line)
- tumour in vessel
extrinsic compression
- lung mass
investigations for superior vena cava obstruction
CXR - is there a mass?
Venogram - is there a clot?
CT chest
treatment of clot causing SVC obstruction
thrombolysis - alteplase
treatment for extrinsic compression causing SVC obstruction
dexamethasone
chemotherapy - used for SCLC, lymphoma, teratoma
radiotherapy - used for other malignant disease
stent - rapid relief of symptoms but doesn’t treat cause
symptoms of hypercalcaemia in cancer patient
‘Bones stones groans and moans’
- bone pain
- kidney stones
- thirst, polyuria
- abdominal pain, constipation, nausea
- confused, drowsy, altered mood
initial management hypercalcaemia
IV saline
pathophysiology of pericardial tamponade
pericardial effusion develops + compresses ventricle
– reduced cardiac output + collapses right atrium increasing venous back pressure
Becks triad pericardial tamponade
Jugular venous distension
hypotension
muffled heart sounds
