Neutropenic sepsis Flashcards
neutropenic sepsis hx taking
Type and timing of chemo regimen and any other immunosuppressive medication being taken
Localizing symptoms e.g right lower-quadrant pain associated with neutropenic enterocolitis
Recent infections and antibiotics used
Latent infections are known to reactivate (e.g. TB), sick contacts, blood transfusions
Co-morbidities
Any intravascular devices - swab indwelling lines
brief PMH
cancer - type (blood cancer?) // date of diagnosis
chemo - type, cycle no., date most recent cycle (nadir 7-14days)
screen for other chemo SEs: N/V/D // mucositis
check mood
systems review
general - fever, rashes
CNS - headache, photophobia
cardiac - chest pain, palpitations
resp - cough (sputum, haemoptysis), SOB
GI - pain, vomiting, changes in bowel habit (blood, mucus)
urinary - oliguria, dysuria
lines - cellulitis, pus from indwelling IV catheters
cancer - recent weight loss, anorexia
management: risk, Ix, Tx
MASCC score for risk
A-E + BUFALO - O2, ABG (lactate), CXR, fluids, bloods (FBC - neutrophil <=0.5, U&E, LFTs, clotting, Ca), x2 blood cultures (peripheral + line), WCC
ENT, fundoscopy. Sputum, urine, stool samples
Serology and PCR for viruses e.g. CMV
DO NOT perform DRE until antibiotics given)
BSAbx - tazocin (pen-allerg. = meropenem)
post mx thoughts
consider alterations to regime for subsequent cycle or GCSF
