Palliative Care Emergencies Flashcards
What are the common cancer causes of MSCC?
Breast
Bronchus
Prostate
Can occur with any
How is MSCC caused?
Tumour/mets in the vertebral body/paraspinal region
Press on spinal cord
Where does MSCC occur most often?
2/3 thoracic region
1/3 cervical/lumbar
What are the outcomes of MSCC?
Paraparesis
Paraplegia
Incontinence
What are the symptoms of MSCC?
- 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
What are the signs of MSCC?
- Weakness/paraparesis/paraplegia
- Sensory changes below level of compression
- Reflexes inc below level of lesion
- Clonus & painless bladder distension
How is MSCC investigated?
Whole spine MRI within 24hours
Plain X-ray NOT helpful
How is MSCC managed?
Corticosteroids: Dex 16mg commenced on suspicion DO NOT WAIT FOR RESULTS
Subsequent: RT or surgery
How is SVCO caused?
Extrinsic compression, thrombosis, invasion of the wall of the SVC
Which cancers is SVCO most commonly seen?
Lung-90% SCLC
Lymphoma
Germ cell tumours
Can occur with any solid tumour
What are the symptoms of SVCO?
Headache/fullness in the head Facial swelling Cough Dyspnoea (worse lying flat) Hoarse voice
What are the signs of SVCO?
Facial oedema
Cyanosis
Prominent blood vessels on neck, trunk, arms
How is SVCO managed?
Corticosteroids: Dex 16mg
Vascular stunting often followed by RT/chemo
Which cancers is hypercalcaemia most commonly seen in?
Breast Lung SCC Myeloma Lymphoma Renal
What are the symptoms of hypercalcaemia?
Early: Lethargy/malaise Anorexia Polyuria Thirst (polydipsia) N&V Constipation Late: Confusion Drowsiness Fits Coma
What investigations are done for hypercalcaemia?
Serum Ca corrected for serum albumin
How is hypercalcaemia managed?
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
What are the 2 main causes of hypercalcaemia?
Bone mets (bone components leak into blood) PTH-RP secreting tumours (mimics PTH)
How is major haemorrhage in cancer patients treated?
Green towels
IM/sc Midazolam if time allows
What is the definition of neutropenic sepsis?
Fever >38 or <36
with neutrophil count <0.5 x 10(9) (expected to fall 24-48hours)
How is neutropenic sepsis treated?
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
When does neutropenic sepsis usually occur?
7-10 days post-nadir
When should neutropenic sepsis be considered?
Glucose >7.7 in a non-diabetic
RR >20
HR > 90
Temp > 38 or <36
What are the causes of neutropenic sepsis & neutropenia?
Sepsis: Infection- Bacterial
Neutropenia: Drugs (chemo, DMARDs, antithyroid, antipsychotics), BM transplant, infection (HIV, TB), Fit B12 & folate deficiencies
How is the decision made between RT and surgery in MSCC?
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
