Clinical presentation is blurred vision, papiledema, SOB/ cyanosis, ataxia, mental status changes. Asp associated with AML, ALL and CLL during blast crisis. What emergency?
Hyperleukocytosis, WBC greater than 100,000
Medical management of hyperleukocytosis?
hyperhydration to maintain urine output 1-2 ml/kg/hr to help prevent kidney damage, correct electrolytes, allopurinol for uric acid, leukapheresis/exchanges as needed
Urine output goal
1-2 ml/kg/hr
Who has the greatest risk of developing intracranial bleeding/sudden death due to hyperleukocytosis?
AML, WBC greater than 250,000
What are the ‘hallmark symptoms’ of hyperleukocytosis
leukocyte accumulation in microvasculature of lungs, CNS
What is hyperuricemia?
uric acid greater than 8
what is hyperkalemia
potassium greater than 6
what is hyperphosphatemia
PO4 greater than 6.5
what is hypocalcemia
Ca less than 7
What is acute tumor lysis syndrome? What does it do to uric acid, potassium, phosphate, and calcium?
metabolic issues due to rapid breakdown of cancer cells, can lead to renal failure and cardiac dysfunction.
hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia
What is a normal phosphate
less than 5. for an adult it is 2.5-4.5 but kids can be a little higher naturally. High phosphate would be greater than 5 for adults or greater than 7 in children
What are the usual malignancies associated with ATLS
T cell, large tumor burdens, high WBC, and lymphomas. neuroblastoma is the usual primary solid, but its still rare
rapid onset oliguria, back pain, hematuria and arrhythmias 24-48 hours after starting treatment
ATLS. renal symptoms include back/flank pain, hematuria or oliguria, and anuria - often have cardiac symptoms or neuro symptoms related to electrolyte imbalance
What is the ‘hyperhydration’ indicated for ATLS?
3000 mL/m2/day
What 2 meds do you use to treat high uric acid
allopurinal (prevents high level) and rasburicase (actually decreases level)
What should urine output and spec grav be for ATLS
3-5 ml/kg/hr, and 1.01 or greater
What is a god urine pH when managing ATLS
7-7.5. below 7 decreasses uric acid excretion, and above 7.5 can lead to stones
What are chvosteks and trousseau’s signs?
hypocalcemia. The Chvostek sign is a facial muscle twitch, and the Trousseau sign is carpal pedal spasms when arterial blood flow in the arm is temporarily occluded (as when taking blood pressure [BP]) that occur with hypocalcemia.
What are the common organisms that cause sepsis
gram neg from internal flora like e coli, enterobacter, and pseudomonas
Slide 17??
Should you use diuretics with cardiac tamponade
No. Positioning, o2 and hydration. Needs paracentesis
What is a major cause of hemoptosys? Tx?
Aspergillosis. Protect airway, stop bleeding, and transfuse as necessary
Treatment of septic shock
Fluid resuscitation to maintain perfusion, usually 20ml/kg over 5-20 min. Antibiotics.
Burrkitts lymphoma is assoc with which onco emergency
TLS.
What are the first priorities of any onc emergency
ABCs
Vincristine, vinblastine, CPM, ifosfamide, cisplat, steroids and mephalan can all cause what onc emergency
SIADH and as a result hyponatremia
RLQ pain that spreads throughout abdomen within a few hours, with some fever/diarrhea, is what
Typhlitis
How to diagnose typhlitis
CT
Treatment of typhlitis
NG suction, fluid replacement and antimicrobial therapy, can need entire bowel removed
Which diagnosis is at highest and 2nd highest risk of spinal cord compression
Ewing’s, neuroblastoma
Why are anxiety confusion and lethargy signs of superior vena cava syndrome
Increase in CO2
D dimer is over 500, platelets under 20,000 and PT/PTT is 1.5-2 times normal. What is the diagnosis? What other lab value do you expect
DIC. Fibrinogen will be less than 75000 (low)
Treatment of DIC?
most important to treat underlying cause. manage symptoms, blood products, clotting products. Keep PT-PTT 1.5-2 times normal. Used to use heparin, but often not any more because treating the cause is more effective.
What do bowel sounds sound like with typhlitis?
can be high pitched ‘tinkling’ sounds, but may also be absent or diminished
What is an important nursing assessment in typhlitis
bowel girth
Treatment of SVCS?
treat underlying cause (shrink tumor with radiation or get rid of thrombus from CVAD with antithrombolytics) consider steroids
When to sedate SVCS patients?
never, only if you are prepared to intubate
Nurse management of SVCS
position, elevate head of bed, oxygen
What is profound hyponatremia
Na less than 120, leads to cerebral edema and death
What meds are most commonly associated with anaphylaxis
antibiotics
What is the most common cause of septic shock in AML? How to treat?
alpha hemolytic strep - gram neg. give vanc.
Definition/criteria of septic shock?
Sepsis with systolic BP less than 90 that doesn’t respond to fluids
Main electrolyte imbalances with TLS
High K, low calcium
Pt with decreased UOP, increased weight gain and anorexia and thirst may have?
siadh
