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Oncological Emergencies (Neutropenic Sepsis (Absolute neutrophil count of…
Oncological Emergencies
Neutropenic Sepsis
Absolute neutrophil count of <1 x10^9/l AND
A single temp of >38.5 or sustained temp of >38 for 1 hour
History
- Chemo drugs, timing, line
- Previous episodes
- Localising symptoms?
- Allergies
Exam
- Temp, circulation, ABC
- NEWS
- Potential sites of infection?
- Lines, catheters
-
Investigations
- BUFALO
- Culture from all lines, and peripheral ( 2 peripheral if no lines)
- Swabs
- Sputum, urine, stool, CXR if indicated, atypical pneumonia screen?
Common pathogens:
- Gram +ve = 70%, s. aureus, coag -ve staph, alpha and beta haemolytic strep
- Gram -ve = 30%, E.Coli, klebsiella, pseudomonas
- Fungi = candida, aspergillosis
Management
- START ABX - immediately after cultures
- Review once FBC back - continue if ANC <1 and fever / hypotension / tachycardia etc
- MASCC score - assesses risk of complications
- G-CSF - not routinely prescribed
Hypercalcaemia
-
NSCLC, Breast Ca, RCC, Myeloma/Lymphoma, Head and Neck Ca. Most common if spread to bone.
Presentation
- General - dehydration, weakness, fatigue
- CNS - confusion, seizure, proximal neuropathy, hyporeflexia, coma
- GIT - weight loss, nausea, vomiting, abdo pain, constipation, ileus, dyspepsia, pancreatitis
- GU - polyuria
- Cardiac - bradycardia, short QT, wide T, prolonged PR, BBB, arrhythmia, arrest
Treatment
- Normal saline: 1L 4 hourly for 24 hrs, then 6 hourly for 48-72hrs (consider furosemide, forceful diuresis promotes calcium excretion)
- Bisphosphonates: IV Pamidronate or Zolindronic acid (inhibit osteoclastic bone resorption)
- Calcitonin and corticosteroids: S/C/IM salmon calcitonin with oral prednisolone
Spinal Cord Compression
Presentation
- Back pain
- Leg weakness
- Sensory loss
- Difficulty controlling bladder/bowels
- Urinary retention
- Saddle anaesthesia
- Loss of anal tone
Prostate, breast, myeloma, lymphoma
Management
- Lay flat
- Dexamethasone 16mg with PPI cover
- Urgent MRI spine within 24 hrs
- Consider neurosurgical intervention
- Radiotherapy
-