neutropenic sepsis + SVCO Flashcards
(13 cards)
neutropenic sepsis presentation
7-14 days post chemo
- neutrophils <0.5
- temp >38
- other infections signs
common causative organism in neutropenic sepsis
staph epidermidis!
- coag neg, gram pos
- prob due to use of indwelling lines
neutropenic sepsis prophylaxis
fluoroquinolone
- if anticipated that patient likely to have neutrophil count of <0.5
management of neutropenic sepsis
piperacillin with tazobactam (Tazocin) immediately
- start antibiotics immediately, do not wait for WBC
if dont respond after 4-6days - test for fungal infections
which cancer is superior vena cava pbstruction most commonly assoc with
lung
features of SVCO
dyspnoea - commonest
headache - worse in morn
visual disturbance
pulseless jugular venous distension
swelling of face, neck + arms - conjuctival + periorbital oedema may be seen
causes of SVCO
- common cancers - small cell lung, lymphoma
- others - metastatic seminoma, breast cancer
- aortic aneurysm
- mediastinal fibrosis
- goitre
- SVC thrombosis
management of SVCO
- stenting
- chemo/radio therapy
- glucocorticoids
which cancers most commonly lead to neoplastic spinal cord compression
lung
breast
prostate
investigation + management of Neoplastic spinal cord compression
ix = whole MRI spine with 24hrs
mx = high dose oral dexamethasone
Neoplastic spinal cord compression presentation
back pain
- earliest/commonest sx
- may be worse lying down + coughing
lower limb weakness/ sensory changes
Neoplastic spinal cord compression neurological signs based on level of lesion
lesions above L1 = upper motor neuron signs in legs + a sensory level
lesions below L1 = lower motor neuron signs in legs + perianal numbness
tendon reflexes increased BELOW level of lesion + ABSENT at level of lesion
