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Emergencies Flashcards

1
Q

Neurological Emergencies

A

Cord Compression
CNS metastases
Vascular events: Hyperviscosity/ leukostasis

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2
Q

Cardiopulmonary Emergencies

A

Cardiac tamponade

SVC syndrome

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3
Q

Metabolic Emergencies

A

Tumor lysis
Hypercalcemia
SIADH

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4
Q

Hematological Emergencies

A

Neutropenic fever
Severe thrombocytopenia
Overanticoagulation

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5
Q

Emergencies That Need to be Approached Immediately

A

Neutropenic fever
Tamponade
Cord compression
CNS metastases with symptoms

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6
Q

Emergencies That Need to be Approached Today

A 
Coagulopathies
Tumor lysis
Leukostasis
Hyperviscosity
Severe thrombocytopenia (
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7
Q

Emergencies That Need to be Approached Today or Tomorrow

A

SVC Syndrome
Most hypercalcemia
Most CNS mets without edema
INR 5-9

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8
Q

Neurological: Cord Compression

A 
Inflammation
Paresthesia
Autonomic dysfunction
Usually with vertebral mets
Rapid deterioration = worse outcome
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9
Q

How does cord compression occur?

A

Thecal sac becomes compressed

Spread through venous plexus & blood stream

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10
Q

Examination of Cord Compression

A

MRI/CT of whole spine
Decadron
Neurosurgery
XRT: radiation if multiple levels

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11
Q

How do steroids help with cord compression?

A

Decreased risk of paralysis due to reduction in inflammation

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12
Q

What is the most common brain tumor?

A

Brain mets

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13
Q

CNS Metastases with Symptoms

A 
Headaches
Altered mental status
Vision changes
Ataxia
CN problems
Seizures
Personality changes
Confusion
Sensory changes
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14
Q

Which cancers like to go to the brain?

A 
Lung
Breast
Colorectal
Melanoma
Kidney
Germ cell
Neuroblastoma
Sarcoma
Prostate
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15
Q

Presentation of Brain Metastases

A

Headache
Seizures
Altered mental status
Focal deficits

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16
Q

What improves survival of isolated brain mets?

A

Surgery + radiation

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17
Q

Necessary Steps to Treat Brain Metastases with Symptoms

A

Decadron: edema, focal symptoms
Dilantin: seizures
MRI imaging
Neurosurgery

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18
Q

Symptoms of Leukostasis

A 
Altered mental status
Coma
Other organs involved: brain, respiratory
Hypoxia
Renal insufficiency
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19
Q

Leukostasis Mostly In

A

AML: WBC > 100,00

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20
Q

Relatively Nonspecific Symptoms Hyperviscosity

A

Somnolence
Headache
Blurry vision
Dizziness

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21
Q

What condition is hyperviscosity most common with?

A

Waldenstrom’s

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22
Q

Less Common Conditions with Hyperviscosity

A

Multiple myeloma
Polycythemia vera
Essential thrombocytosis

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23
Q

Polycythemia Vera Hemoglobin Levels

A

> 19 or 20

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24
Q

Essential Thrombocytosis Platelet Level

A

> 10^6

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25
Necessary Steps to Treat Hyperviscosity
Hydrated Apheresis for IgM + chemotherapy Phlebotomy for polycythemia vera Hydroxyurea & aspirin for essential thrombocytosis
26
Necessary Steps to Treat Leukostasis
``` Hydrated Quentin access (renal) Chemotherapy LP for cytology rule in/out CNS leukemia Steroids ```
27
Most Common Primaries with Cardiac Tamponade
Lung | Breast
28
What does an EKG show with cardiac tamponade
Electrical alternans Low voltage ST elevation in all leads
29
Presentation of Cardiac Tamponade
Left or right sided failure Pulsus paradoxus Big heart on CXR
30
3 Main Reasons for Tamponade
Malignancy Idiopathic Autoimmune
31
Beck's Triad
Low arterial blood pressure Distended neck veins Distant, muffled heart sound
32
Necessary Steps to Treat Cardiac Tamponade
Echo & cytology from pericardiocentesis Catheter drainage of pericardial space Medical management Chemotherapy Subxiphoid pericardial window or balloon percardiotomy
33
Define Pulsus Paradoxis
Drop of 10 mmHg in arterial blood pressure on inspiration
34
Cancers with SVC Syndrome
``` Lung cancer Bronchogenic carcinomas Lymphoma Breast cancer Mediastinal tumors ```
35
Presentation of SVC Syndrome
Facial edema Symmetric or asymmetric upper extremity edema common SOB but not hypoxic
36
Necessary Steps to Treat SVC Syndrome
``` Pulse Ox/CSR Chest CT to outline mass Chemo for small cell, lymphoma, germ cell Radiation for almost all else Heparin or corticosteroids IR: stenting ```
37
Tumor Lysis Syndrome
Occurs in tumors with high body burden & high chemrsensitivity Usually due to therapy Few clinical symptoms other than being ill with obvious lab abnormalities due to renal failure
38
Cancers Associated with Tumor Lysis Syndrome
High-grade lymphomas High-grade leukemias Small cell Germ cell
39
Tumor Lysis Syndrome Lab Abnormalities
Hyperuricemia Hyperkalemia Hyperphosphatemia Hypocalcemia
40
Necessary Steps for Pre-Treatment of Tumor Lysis Syndrome
Fix conditions that will make effects worse: dehydration, renal obstruction, IV contrast Baseline labs: K, Ca, Phos, Uric acid, LDH, Cr Alkaline diuresis: D5 1/2 with 2-3 amps NaHCO3/1 at 200+ cc/hr Allopurinol 600 mg, then 300/day to keep uric acid production down Rasburicase
41
Necessary Steps During Treatment for Tumor Lysis Syndrome
High K+, low Ca++ Keep alkaline urine output high Check BID electrolytes, phos, UA, Ca, LDH, Cr Keep phosphate 6, K
42
Cancers Associated with Hypercalcemia
Breast Lung Multiple myeloma SCC make PTH-rP
43
Presentation of Hypercalcemia
``` Gradual in onset Fatigue N/V Constipation Anorexia Apathy Decreased consciousness ```
44
Pathologic Role of PTH-rP
Does everything PTH does but without negative feedback system
45
Necessary Steps to Treat to Hypercalcemia
Volume replete patient Furosemide IV Pamidronate (Aredia) or IV Zoledronic (Zometa) Adjunct: dialysis, calcitonin (Miacalcin), steroids
46
Symptoms of SIADH with Serum Sodium
``` Anorexia Irritability N/V Constipation Muscle weakness Myalgia ```
47
Symptoms of SIADH with Serum Sodium
Seizure Coma/Death Abnormal reflexes Papilledema
48
SIADH Most Common in What Cancer
Small cell lung cancer
49
Lab Results of SIADH
Decreased BUN & serum osmolarity | Increased urine osmolarity & sodium levels
50
Necessary Steps to Treat SIADH
Treat tumor Limit fluid intake to 500-1000 mL/day Furosemide Parenteral sodium replacement with severe neurological symptoms Monitor electrolytes: Magnesium, K+, Ca++
51
Presentation of Neutropenic Fever
Initially subtle | Rapid development of hypotension, dyspnea, sepsis
52
Short-term Neutropenia Predicts What Type of Organisms
Gram-negative >> gram-positive
53
Long-term Neutropenia Predicts What Type of Organisms
Fungal Viral Opportunistic
54
Necessary Steps to Treat Neutropenic Fever
Evaluate patient for a source: blood, CXR, sputum, urine, skin, LP Suspected source: treat it Not a suspected source: treat empirically
55
Empiric Antibiotics to Treat Gut Flora
``` Cefipime Moxifloxacin Pip/Gent Aztreonam Add coverage for lack of response ```
56
Symptoms of Severe Thrombocytopenia
``` Asymptomatic Epistaxis Gingival bleeding Bullous hemorrhages Petechiae Eccymosis Menorrhagia CNS bleeding least common ```
57
Platelet Defect Bleeding
``` Site: skin, mucous membranes Minor cut bleeding: yes Petechiae: present Ecchymoses: small, superficial Hemarthrosis: rare Bleeding after surgery: immediate, mild ```
58
Clotting Factor Defect Bleeding
``` Site: deep in soft tissue Minor cut bleeding: not usually Petechiae: absent Ecchymoses: large, palpable Hemarthrosis: common Bleeding with surgery: delayed, severe ```
59
Necessary Steps to Treat Thrombocytopenia
Be sure it's not TTP, DIC, HIT, HELLP Assess for active bleeding Transfuse if patient is actively bleeding Prednisone 1mg/kg/day if patient well IVIG x 2 days if patient ill Kids: remit Adults: relapse & require splenectomy
60
What does HELLP stand for?
Hemolysis Elevated Liver enzymes Low Platelet count
61
Overanticoagulation
Agents being used more & more INR's up to 5 INR's >9
62
Necessary Steps to Treat Overanticoagulation for Patients on Warfarin
Assess whether there is significant bleeding Assess for head trauma Assess whether the patient should be anti coagulated again in the future Give FFP & Vitamin K for significant bleeding Give PO Vitamin K for INR >9 without bleeding Avoid SQ Vitamin K
63
Necessary Steps to Treat Overanticoagulation for Patients on Non-Warfarin Agents
Assess for bleeding & head trauma Identify the specific agent & call pharmacy/hematology For significant bleeding, consider protamine sulfate for heparin or LMWF Significant bleeding, consider recombinant activate Factor VII

Oncology (11 decks)

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