S18C235 - Emergency Complications of Malignancy Flashcards
1
Q
Malignant Airway Obstruction
A
- get a CT
- don’t do DL if you can help it b/c this can invoke bleeding or edema
- give O2, give heliox
- if upper airway may require cricothyroidotomy
2
Q
Bone mets/pathologic #
A
- pathologic #s usually affect axial skeleton
- present with POOP
- can use bone scan but bear in mind increased uptake dose not necessarily mean mets
- can treat with palliative radiotherapy
3
Q
Malignant Spinal Cord Compression
A
- mets in vertebral bodies from solid ogan tumors is most common cuase
- thoracic vertebrae is most common location
- mets enlarge, erode into spinal canal, compress cord
- back pain, worse when supine, muscle weakness, radicular pain, bbowel/bladder dysfxn
- MRI
- dexamethasone 10mg IV then 4mg PO/IV q6h
- radiotherapy emergency or surgery
4
Q
Malignant pericardial effusion with tamponade
A
- often occur with breast and lung but also melanoma, leukemia, lymphoma
- shock, tachy, HoTN, narrow pulse pressure
- ECG - decreased voltage
- electrical alterans
- pericardiocentesis or pericardial window for tx as well as chemo and RT
5
Q
Superior Vena Cava Syndrome
A
- elevated venous pressure in the upper boday from obstruction of venous blood flow through the SVC
- external compression of the SVC by an extrinsic malignant mass
- associated cancers: lung, lymphoma
- only an emergency if neurologic abnormalities are present due to increased ICP
- Sx: facial swelling, dyspnea, cough, arm swelling are typical
- other sx: hoarse voice, syncope, h/a, dizziness, confusion, Sz, aLOC
- dx: CT with contrast (CXR can also help)
- tx: raise head of bed, steroids, loop diuretic, RT, stent, chemo, bypass graft
6
Q
Hypercalcemia: etiology
A
- common in malignancy, esp BrCa, LuCa, multiple myeloma
- mechanisms:
1. production of parathyroid hormone related protein (most common) - binds receptors, mobilizes calcium from bones and increases renal absorption of Calcium
2. extensive local bone destruction - bone mets
3. production of vit D analogues (lymphoma)
7
Q
Hypercalcemia: sx and tx
A
- lethargy, confusion, constipation, anorexia, nausea
- tx: IV NS at 250-500cc/h until euvolemic then 100-150cc/h (will reduce but not normalize the calcium)
- only use lasix if pts have CHF or renal insufficiency, do not use it routinely
- other tx of malignancy assoc hyperca.: calcitonin, glucocorticoids, bisphosphonates
- hemodialysis if profound Sx or renal failure
8
Q
SIADH: normovolemic hyponatremia
A
- ectopic secretion of ADH common fro bronchogenic cancer but also chemo, opioids, carbamazepine, SSRI
- hyponatremia, decreased serum osmolality, less than max dilute urine, euvolemic
9
Q
SIADH: hyponatremia sx
A
Sx: anorexia, nausea, malaise, h/a, confusion, obtundation, seizures, coma
Sz usually generalized tonic-clonic
10
Q
SIADH: tx
A
- water restriction
- if >125mEq/L do water restriciton of 500cc /d and close f/u
- 10 in first 24h
11
Q
Adrenal Insufficiency
A
- can by from direct invasion and destruction of adrenal tissue but more commonlyl from physiologic stress with chronic glucocorticoid therapy
- vasomotor collapse
- hypoglycemia, hyponatremia, hyperkalemia, eosinophilia, HoTN refractory to volume loading and pressors
- if on steroids give a dose of IV steroids with glucocorticoid and mineralocorticoid effect
- hydrocortisone 100-150mg IV
- methylprednisolonge 20-30mg IV
- dex 4mg IV
12
Q
Tumor Lysis Syndrome
A
- massive cytolysis and release of intracellular contents
- usually occur with tx of cancer
- rarely seen in solid tumors
- hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia (hypoca may cause tetany, Sx, arrhythmias)
- end organ damage: renal failure from uric acid precipitation in renal tubules, cardiac arrest
- prevention: alllopurinol, hydration
13
Q
Febrile neutropenia and infection
A
fever dfn: 38.3 (100.9) or 38 for >1h (100.4)
- lowest count usually occurs 5-10d after last dose and recover w/in 5d
- NO DRE
- thorough exam, cultures, chem panel,
- low risk for severe infxn if: appear well, no abdo pain, no physical signs of infxn, normal CXR – may be considered for out-pt care
- treat with empiric Abx
- add vanco if: severe mucositis, signs of catheter site infxn, recent use of fluoroquinolones, HotN, prevalence of MRSA
- outpatient: cipro and amox-clav
- monotherapy: cefepime, ceftazidime, imipenem, pip-taz
14
Q
Hyperviscosity syndrome
A
- causes: waldenstrom macroglobulinemia, IgA myeloma, polycythemia, leukemia, deydration
- Sx: vague, dyspnea, fever, fatigue, abdo pain, h/a, blurry vision, aLOC
- smear: rouleaux formation
- tx: IV fluids, plasmapheresis, leukapharesis, phlebtomry of 2 units
15
Q
Thromboembolism
A
VTE common in malignancy
-cancer pts not at increased risk for AC-related bleeding complications, including brain mets
