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CCC > Palliative Care Emergencies > Flashcards

Palliative Care Emergencies Flashcards

1
Q

What are the common cancer causes of MSCC?

A

Breast
Bronchus
Prostate
Can occur with any

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2
Q

How is MSCC caused?

A

Tumour/mets in the vertebral body/paraspinal region

Press on spinal cord

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3
Q

Where does MSCC occur most often?

A

2/3 thoracic region

1/3 cervical/lumbar

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4
Q

What are the outcomes of MSCC?

A

Paraparesis
Paraplegia
Incontinence

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5
Q

What are the symptoms of MSCC?

A
  • Back pain/nerve root pain: Uni/bilateral, aggrevated by movement,coughing,lying
  • Motor weakness: Rapid/slow onset, subtle in early stages, perceived changes in strength
  • Sensory disturbance: Precedes objective physical signs (feel like walking on cotton wool)
  • Bladder/bowel dysfunction: Late, insidious urinary retention
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6
Q

What are the signs of MSCC?

A
  • Weakness/paraparesis/paraplegia
  • Sensory changes below level of compression
  • Reflexes inc below level of lesion
  • Clonus & painless bladder distension
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7
Q

How is MSCC investigated?

A

Whole spine MRI within 24hours

Plain X-ray NOT helpful

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8
Q

How is MSCC managed?

A

Corticosteroids: Dex 16mg commenced on suspicion DO NOT WAIT FOR RESULTS
Subsequent: RT or surgery

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9
Q

How is SVCO caused?

A

Extrinsic compression, thrombosis, invasion of the wall of the SVC

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10
Q

Which cancers is SVCO most commonly seen?

A

Lung-90% SCLC
Lymphoma
Germ cell tumours
Can occur with any solid tumour

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11
Q

What are the symptoms of SVCO?

A 
Headache/fullness in the head
Facial swelling
Cough
Dyspnoea (worse lying flat)
Hoarse voice
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12
Q

What are the signs of SVCO?

A

Facial oedema
Cyanosis
Prominent blood vessels on neck, trunk, arms

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13
Q

How is SVCO managed?

A

Corticosteroids: Dex 16mg

Vascular stunting often followed by RT/chemo

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14
Q

Which cancers is hypercalcaemia most commonly seen in?

A 
Breast
Lung
SCC
Myeloma
Lymphoma
Renal
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15
Q

What are the symptoms of hypercalcaemia?

A 
Early: Lethargy/malaise
Anorexia
Polyuria
Thirst (polydipsia)
N&V
Constipation
Late: Confusion
Drowsiness
Fits
Coma
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16
Q

What investigations are done for hypercalcaemia?

A

Serum Ca corrected for serum albumin

17
Q

How is hypercalcaemia managed?

A

Rehydrate: Normal saline 3L/24hours
IV bisphos: Lag of 2-3days before max effect Pamidronate/Zoledronic acid
Max response: 6-11days, average duration of response 3-4weeks
Monitor renal function

18
Q

What are the 2 main causes of hypercalcaemia?

A 
Bone mets (bone components leak into blood)
PTH-RP secreting tumours (mimics PTH)
19
Q

How is major haemorrhage in cancer patients treated?

A

Green towels

IM/sc Midazolam if time allows

20
Q

What is the definition of neutropenic sepsis?

A

Fever >38 or <36

with neutrophil count <0.5 x 10(9) (expected to fall 24-48hours)

21
Q

How is neutropenic sepsis treated?

A

If ONE of the following: Temp >38/<36, suspicion of infection, NEWS >3
INITIATE SEPSIS 6
15L/min non-rebreathe O2
IV 500-1L Hartmann’s
Blood Cultures
Abx: IV Tazocin 4.5mg TDS (60mins from admission to Abx started)
Bloods: Lactate, FBC, Glucose, U&E, LFTs, Clotting, CRP
Monitor urine output & MSU
Other: CXR, Swabs, swab & culture from any lines in-situ

22
Q

When does neutropenic sepsis usually occur?

A

7-10 days post-nadir

23
Q

When should neutropenic sepsis be considered?

A

Glucose >7.7 in a non-diabetic
RR >20
HR > 90
Temp > 38 or <36

24
Q

What are the causes of neutropenic sepsis & neutropenia?

A

Sepsis: Infection- Bacterial
Neutropenia: Drugs (chemo, DMARDs, antithyroid, antipsychotics), BM transplant, infection (HIV, TB), Fit B12 & folate deficiencies

25
Q

How is the decision made between RT and surgery in MSCC?

A

Surgery: Limited extent of disease (small no. of levels), decent prognosis, structural failure
RT: Inoperable, multi-level, poor prognosis, patient choice (less effective for structural failure), 1 above & 1 below vertebrae of compression

CCC (21 decks)

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