Palliative Care - Oncological Emergencies Flashcards
What is neutropenic sepsis? Highlight some red flags for this condition
• Patient undergoing systemic anti cancer treatment
• Temp >38
• Neutrophil count <0.5 x 10^9
• Red flags:
◦ Query all patients on chemo who become unwell as well as chemo patients who are immunosuppressed (steroids) and cannot mount fever response
◦ Neutrophil dip occurs 10-14 days post treatment
◦ New biological drugs and Radiotherapy: less propensity to cause neutropenia
◦ Haematological malignancy treatment: causes greatest dip in neutrophils - greatest duration of neutropenia
What are some signs and symptoms of neutropenic sepsis?
What are some precipitates of neutropenic sepsis?
What is the most common mechanism by which neutropenic sepsis occurs? What organisms are normally involved?
Usually begins by infection in the gut and mucositis. Infection then spreads to the blood.
• endogenous flora: staph aureus, staph epidermidis, enterococcus and streptococcus
• MRSA and VRE (vancomycin resistant enterococcus) are increasingly prevalent
*Only 30% of patients have an identifiable pathogen - cultures normally come back negative
- Co-amoxiclav: good against gut anaerobes and gram -ve bacterial but no activity against pseudomonas (not appropriate for neutropenic sepsis)
- Tazocin: effective against anaerobes, gram-ve and pseudomonas (good for neutropenic sepsis)
- Anti-pseudomonas antibacterials: Gentomicin, Meropenem and Tazocin
Investigations for patient with suspected neutropenic sepsis
How would you manae neutropenic sepsis?
- Further management: GCSF - consider in profoundly neutropenic/septic patients
- Prevention: patient education, prophylactic antibiotics, consider risk of further chemotherapy cycles
Name some antibiotics which are appropriate for:
- Gram -ve bacteria
- Anaerobes
- Pseudomonas
Co-amoxiclav: good against gut anaerobes and gram -ve bacterial but no activity against pseudomonas (not appropriate for neutropenic sepsis)
Tazocin: effective against anaerobes, gram-ve and pseudomonas (good for neutropenic sepsis)
Anti-pseudomonas antibacterials: Gentomicin, Meropenem and Tazocin
Metastatic spinal cord compression: % of patients affected, main cancers involved, main sites involved
What is the mechanism of metastatic spinal cord compression?
Metastatic spinal cord compression: early and later signs
MSSC: examination findings
MSSC: management (including surgery)
MSSC: management (radiotherapy)
MSSC: important supportive care
Hypercalcaemia: normal Ca2+ range, % of patients affected and most common causative cancers
Outline the mechanisms of malignant hypercalcaemia
Outline the symptoms of hypercalcaemia
Outline the treatment and prognosis for hypercalcaemia
What is tumour lysis syndrome? Outline the important electrolyte imbalances found
What is the presentation of a patient with tumour lysis syndrome?
Name some patient specific risk factors for tumour lysis syndrome and identify which cancers are most likely to cause this
How do you prevent and treat tumour lysis syndrome?
What is SVCO? Name some causes of this condition
Name some signs and symptoms of SVCO
SOB
Name some investigations and treatment for a patient with SVCO
