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4. Tumor meta spinal compression
5. Neutropenic fever
6. N/V in Oncologic Emergencies
7. Typhlitis (Neutropenic colitis)
Metastatic spinal cord compression (MSCC) :
- Prostate, Breast, Lung 之 spine meta (esp T spine)
- Known cancer + new back pain = spinal metastases until proven otherwise!
癌症病患出現背痛, 放射性疼痛, 腰痛, 就要高度懷疑脊椎壓迫的可能性
腿部無力, 感覺喪失, 自主神經功能的喪失 ( Incontinence )
好好做 PE, NE -> Sensory level ? Cauda equine ?
X ray, Ca level
MRI !!
當診斷確定為脊椎壓迫的時候 :
- 應該立即給予 IV steroid
Dexamethasone 10mg STAT + 6-10mg Q6H
- Surgical decompression ( Emergent laminectomy )
- For bone mets bisphophonate may be given after dental evaluation.
Bisphosphonates may decrease bone resorption in patients with metastatic disease to the bone,
and relieve pain better than placebo
- RT, Chemo
Neutropenia fever
- Look for subtle signs : mucositis, abscesses, skin breakdown, line infections
- Give a steroid stress dose to any patient on chronic steroids.
- Neutropenia typically occurs 3–14 days after chemo
IDSA guidelines for cancer patients with neutropenia fever
* Antibiotics ASAP
* Wide spectrum covergage with pip-tazo, meropenem or imipenem
* Add vancomycin for patients with low BP, suspected line sepsis, mucositis,
history of MRSA, or recent antibiotic use
* Add an aminoglycoside in patients in septic shock or suspected/ proven antibiotic resistance
* Add IV acyclovir if there are signs of a herpetic infection or encephalopathy,
and consider anti-fungal coverage for patients with fever > 4 days
Neutropenia fever patients are ‘low-risk’ and could go home ?
Oral antibiotic regimes : Amox-clav 875/125 bid plus a fluoroquinolone (i.e. cipro)
* Antibiotics ASAP
* Wide spectrum covergage with pip-tazo, meropenem or imipenem
* Add vancomycin for patients with low BP, suspected line sepsis, mucositis,
history of MRSA, or recent antibiotic use
* Add an aminoglycoside in patients in septic shock or suspected/ proven antibiotic resistance
* Add IV acyclovir if there are signs of a herpetic infection or encephalopathy,
and consider anti-fungal coverage for patients with fever > 4 days
Neutropenia fever patients are ‘low-risk’ and could go home ?
Oral antibiotic regimes : Amox-clav 875/125 bid plus a fluoroquinolone (i.e. cipro)
N/V in Oncologic Emergencies
Gastritis, GI obstruction, medication reactions, metabolic/electrolyte disorders
- Ondansetron work best on chemoreceptor trigger for nausea
- Anti-dopaminergic medications work best when the nausea
is secondary to opioids or slow GI transit time.
Typhlitis (Neutropenic colitis)
Appendicitis Mimic, usually involving the iliocecal region
常發生於化療後第二週, 右下腹疼痛, 壓痛, 反彈痛等類似闌尾炎的症狀
和闌尾炎不同的是, 病患血液檢查白血球數下降而非上升
約有 60% 的 typhlitis 患者被診斷為闌尾炎而開刀
化療後的右下腹疼痛第一個想到的疾病因為 typhlitis 而非 appendicitis, 這對於血液腫瘤科而言是常識
https://emergencymedicinecases.com/episode-33-oncologic-emergencies/
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