Friday, August 21, 2015

Emergencias oncológicas II

emDocs - August 21, 2015 - By Brit Long
  • Consult heme/onc quickly for all heme/onc emergencies.
  • Leukostasis occurs with WBC count greater than 50,000 with symptoms (usually 100,000), predominantly pulmonary and neurologic symptoms.
    • 80% of patients will have fever, so treat for infection concurrently.
    • Chemotherapy is the only treatment that decreases mortality, but if not available, leukopheresis is the next step.
    • DIC and TLS are major risks of treatment.
  • Neutropenic is defined as a single oral temperature greater than 38.3 oC or temperature >38.0 oC for one hour, with absolute neutrophil count (ANC) of < 1500 cells/microL, with severe defined as an ANC less than 500 cells/microL or an expected drop to < 500 over 48 hours
    • 30% of fevers are due to infection, with gram positives accounting for 60% of infections.
    • MASCC risk index can be helpful and is validated.
    • Broad coverage targeting gram positives and pseudomonas is needed.
  • VTE is common in cancer, with 15% of patients with malignancy experiencing DVT/PE.
    • Risks are broken down into patient, cancer, biochemical, and treatment related.
    • Khorana score is validated for VTE risk stratification in this patient population
    • CT PE and DVT US are the best tests.
    • Anticoagulation with LMWH has the best literature support for treatment.
  • Drug extravasation is exceedingly rare, with 0.01% of patients over a 15yr period experiencing extravasation.
  • Two classes exist: irritant vs. vesicant.
  • Best approach is prevention.
  • If extravasation occurs, maintain the line to aspirate and inject antidote.
  • Apply heat for alkaloids and etoposide, but ice for everything else.
  • Consult plastic surgery."

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