Flashcards in Oncologic Emergencies Deck (38):
What are the metabolic emergencies?
3. Tumor Lysis Syndrome
5. Syndrome of inappropriate Secretin of ADH
What are the structural emergencies?
1. Superior vena cava syndrome
2. Cardiac tamponade
3. Spinal Cord Compression
4. Increased intracranial Pressure
What is DIC?
a condition in which blood inappropriately clots form throughout the body's small blood vessels. These blood clots can reduce or block blood flow through the blood vessels, which can damage the body's organs. There is diffuse clotting and profuse hemorrhage.
What is DIC always precipitated by?
an underlying pathologic condition...such as sepsis, trauma, obstetric conditions, and malignancy, especially acute promyelotic leukemia and mucin secreting adenocarcinomas of the prostate, lung and breast.
What is acute DIC more associated with? how about chronic?
bleeding. thrombus formation
What are the signs/symptoms of DIC?
bleeding out of every office.
thrombotic signs: skin, lung involvement: sob, decreased 02, renal involvement: hematuria , cardiac involvement: hypotension, thready pulse, neuro involvement: altered mental status.
What lab findings will you see with DIC
1. prolonged clotting times
2. increased levels of fibrin degradation
3. increase d-dimer
4. low PLT count
5. low fibrinogen count
6. low plasma levels of coagulation factors.
Should DIC treatment focus on repairing the bleeding or at the underlying disorder? are there any prevention strategies?
underlying disorder. no, just treat the underlying disorder.
What should be the first thing to oder for DIC?
fresh frozen plasma.
What is sepsis?
a complex interaction between an infecting microorganism to the immune, inflammatory system, and coagulation responses by an individual.
What are the most common causative agents for sepsis?
gram postiive bacteria and fungi. CHECK CURRENT!!
What are the sepsis treatment strategies?
respiratory support, fluid resuscitatino, inotropic and vasporessor agents, DVT prophylaxis, insulin therapy, antibiotic and anti fungal agents, activated protein C, blood transfusion support, nutritional and electrolyte replacement.
What is systemic inflammatory response syndrome (SIRS)?
temp > 38 degrees C or 90 min
RR> 20 breaths/min
WBC count > 12,000 less than 4,000 or greater than 10% bands.
What are the classic signs of sepsis?
2. shaking chills
7. mental status changes
T/F: Most patients with sepsis have an obvious source of infection?
what you should do first for a patient presenting with sepsis?
start antibitoic therapy immediatley!!!!!
Should patients on chemo who are at a high risk for infection receive prophylactic antibiotic treatment? What about low risk but uncomplicated neutropenic fevers?
yes. FQ for 7 days.
fevers: IV therapy of carabapenem, with psuedomonas coverage.
Tumor Lysis Syndrome:
TLS is characterized by electrolyte and metabolic disturbances caused by cell lysis as a result of chemo, radiation therapy, biotherapy or surgery. tumor lysis syndrome occurs when large numbers of neoplastic cells are killed rapidly, leading to the release of intracellular ions and metabolic byproducts into the systemic circulation. Clinically, the syndrome is characterized by rapid development of hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia, and acute renal failure.
What is the treatment for TLS?
allopurinol, hydration, and urinary alkalinzation. Treatment strategies are aimed at correction of lab and metabolic abnormalities.
A lab result of hypercalcemia could be indicative of a cancer?
true, it is highest with lung cancer.
What are the symptoms of hypercalcemia?
fatigue, anorexia, N/V, constipation, abd. pain, metnal status changes, lethargy, HA, coma, excessive thirst, polyuria, renal failure.
What additional lab work would you want to get if you saw hypercalcemia? what would be the expected results?
PTH, PTHrP, serum phosphorus.
malignancy: high phosphorus, low PTH, high PTHrP
hyperparathyroidism: low phosphorus, PTH high, PTHrP not found.
How should you treatment hypercalcemia?
moderate = rehydration, loop diurectics
severe= treat underlying malignancy, IV bisphophonate, fluid replacement, diuretics
What is SIADH?
an endocrine paraneoplastic disorder that causes increased ADH with fluid overload and dilution hyponatremia. Signs and symptoms are related to degree of hyponatremia.
What is the treatment of SIADH?
treat underlying cause, oral fluid restriction, IV hydration, diuretics, and demeclocyline, lithium, or urea therapy.
In what cancer do we normally see SIADH?
small cell lung cancers
What cancers are associated with superior vena cava syndrome?
lung cancer, lymphoma, breast cancer, metastatic cancer.
What are the emergencies of superior vena cava syndrome?
tracheal obstruction, cerebral edema
What are the signs and symptoms of superior vena cava syndrome?
dyspnea, upper extremity edema, facial edema, distended neck veins, tachypnea, cyanosis, periorbital edema, cough, hoarseness, stridor.
What is the most precise diagnostic tool for cardiac tamponade?
What are the symptoms of cardiac tamponade?
dyspnea, fatigue, chest pain, apprehension/anxiety.
What is the treatment for cardiac tamponade?
removal of pericardial fluid to restore hemodynamic stability via pericardiocentisis.
Spinal cord compressions are usually due to cancers that have METS there, versus one that starts there. So in all cancer patients, back pain should ALWAYS be suspicious for...
spinal cord compression until proven otherwise.
what are the symptoms of spinal cord compression?
50% bladder dysfunction
50% sensory loss.
Where do MOST sites of cord compression come from?
THORACIC SPINE, then lumbosacral then cervical
What is the procedure of choice for spinal cord compression?
How do you manage spinal cord compression?
1. corticosteroids. 2. radiation therapy 3. neurosurgery