How does spinal cord compression present?
Most people present with back pain,,particularly radical are (band like)
What is the character of the pain in SCC?
Worse on coughing and straining. Burning pain in a band like distribution.
Investigation of spinal cord compression?
MRI spine.
Management of SCC>
16mg IV dexamethason followed by 8mg oral BD.
What is the mainstay of treatment of spinal cord compression?
Radiotherapy (20Gy/5#)
What are the symptoms of superiorvena cava obstruction?
Welling of face, neck or both arms.
Distend veins.
Shortness of breath.
Headache
Lethargy.
Options for Vena cava obstruction if clot causing it?
Thrombolyis with alteplase or anticoagulastion with LMWH / warfarin.
Best treatment option for vena cava obstruction?
Stent (95% response rate)
Relieves symptoms but does not treat the cause.
How is SVCO best diagnosed?
CXR
Venogram (clots)
CT chest
1st line management of someone with malignant hypercalcaemia?
IV fluids.
Symptoms of hypercalcaemia in cancer patient?
Nauseated anorexia.
Thirsty
Polyuria + polydipsia.
Confused
Most important blood test after calcium for hypercalcaemia?
U+Es to look for dehydration.
Management apart from fluids for hypercalcaemia?
Bisphosphonates
- IV pamidronate over 2 hours.
Becks triad of pericardial tamponade/
JVP distension.
Pulsus paradoixcus
Muffled heart sounds.
INbvestigation for pericardial tamponade?
CXR
ECG (low complex size)
Echo (rim of fluid)
Cytology of fluid.
Treatment of pericardial tamponade?
Pericardiocentesis.
Does diastolic or systolic heart failure cause pericardial tamponade?
Diastolic.
How is neutropenic sepsis defined?
Sepsis + neutrophil count <0.5
Neutropenic sepsis criteria in someone who has had chemo in last 21 days /
Neutrophils count < 1.0
Note:
If chemo within the last 3 weeks and temp > 37.5 or clinically septic give ABx within 1 hour
Neutropenic sepsis and NEWS score < 6 management?
Piperacillin and tazo bactam (no gent)
Neutropenic sepsis and NEWS > 7
Piperacillin, tazobactam and gentamicin.
Management of PE in cancer patient?
LMWH for 6 months.