Urgent Medical Conditions Flashcards
Treatment for spinal cord compression for a previously ambulatory patient?
Open decompressive neurosurgery of spine following by XRT- best chance to improve long term functional status
Best predictors of survival with cord compression? (5)
Ambulatory prior to SCC
1 Spinal Met
No Visceral Mets
Tumor that is Radiosensitive (not melanoma, osteosarcoma, HCC, thyroid, kidney cancer)
Quick start to therapy
When would you do radiation alone for a spinal cord compression? (6)
1) Multiple areas of cord compression
2) “Poor surgical candidate” (survival < 3 months, non ambulatory at baseline)
3) No spinal compression or instability
4) Known radiosensitive tumor (breast, SCC, lymphoma, myeloma)
5) Subclinical cord compression (no SX, found incidentally on imaging)
6) Prior radical spinal decompression
When would you DEFINITELY due surgery first prior to XRT for spinal cord compression? (3)
Spinal instability
Previous good ambulation with loss of ambulation for < 48 hours
Single focus of cord compression
62% of “reasonable surgical candidates” can ambulate after surgery compared to 19% with RT alone
Prognosis after Cord Compression
Patients who can WALK after tx–> median 7-9 months
Patients who are NON AMBULATORY after cord compression–> median 1-2 months
Shorter px with multiple metastases, visceral or brain metastases, lung cancer
Drug treatment for Status Epilepticus
Midazolam 10 mg subQ/IV
Midazolam intranasal 5 mg x 2 (peds)
Lorazepam is SLOWER ONSET but dosing would be 2-4 mg IV/IM
20 mg rectal diazepam (NOT drug of choice)
What interventions might you consider after a sentinel bleeding event for a lung cancer patient? For an high risk ENT patient?
After sentinel bleeding event for
Lung cancer–> XRT
ENT–> Endovascular stenting (uncontrolled head and neck cancer with ulceration/fungation, wrapping around carotid artery)- EVEN IF ON HOSPICE as long as they are still ambulatory
Treatment of hypercalcemia of malignancy?
1) Fluid resuscitation
2) IV bisphosphonate (zolendronic acid, pamidronate) unless Cr >4.5 (may need HD if goal concordant)
- lasts about 1-3 weeks
Treatment of SVC Syndrome?
With alarm symptoms (stridor, confusion, syncope) and without alarm symptoms?
Consult rad onc!
With alarm symptoms
1) Endovascular stenting + steroids –> then XRT
Without alarm symptoms
1) Steroids and XRT
Prognosis after SVC Syndrome?
5 months in patients with NSCLC
Longer for folks with Small Cell (very radiosensitive)
What is standard of care for prevention of pathologic fracture for patients with known bone metastases?
Monthly IV bisphosphonates
Focal radiotherapy
Who should get surgical stabilization of a pathologic fracture?
1) Long bone involvement
2) Persistent or increasing pain
3) Solitary LYTIC lesion involving > 50% of cortex
4) Involvement of FEMUR + LESSER trochanter
5) Diffuse long bone involvement
6) Prognosis > 4 weeks, good surgical candidate
