palliative emergencies

Question 1

sx to suggest spinal mets

Answer 1

thoraci or cervical spine
sebere inremitting or progressive lumbar
aggrevated by strianin
nocturnal spinal pain prevent sleep
localised tenderness

Question 2

red flags cord compression

Answer 2

loss of bladder and bowel sx
radciular pan
limb weak
difficulty walking
sensory loss

Question 3

mx MSCC

Answer 3

high dose steriods - dexamethasone 16m g
tx to prevent paralysis - surgical options and or radiotherapy ( more likely to operate if higher up the spine such as cervical)

treatments for pain - who ladder, bisphosphonates, radiotherapy, surgery and specialist procedures

support and care at home - discharge planning, involving community teams - DNs , PT , OT , rehab approach may be possible, support to families and carers

Question 4

neutropenic sepsis

Answer 4

low neutrohil count
sepsis severe infection

fatal post chemo - highest rik 7-10

Question 5

ix neutropenic spesis

Answer 5

urgent bloods
blood cultures
cxr - if chest signs
MSU
sstool cutlure if diarrhoea
cather
no indication for PR

look hard for source of sepsis

Question 6

mx

Answer 6

Iv abx as per micro - Taz and gent amikacin

supportive care such as IV fluids and esclation fo care

acute hospital addmision offered - contact their oncologist
not possible to treat effectively in hospice