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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Friday, August 14, 2015

Emergencias oncológicas

emDocs - August 13, 2015 - Author: Long B. // Edited by: Koyfman A. & Bright J.
  • SVC syndrome occurs predominantly due to malignancy, with thrombosis and intravascular catheter obstruction distant causes (catheters as main cause quickly rising). Symptoms depend on rate of obstruction and collateral formation. CT chest with IV contrast is key to diagnosis. Treatment includes radiotherapy or stent placement.
  • Malignant pericardial effusion most commonly presents with dyspnea. Acute accumulation of fluid causes decompensation. Ultrasound is key in diagnosis. Most patients require fluid loading and pericardiocentesis.
  • Malignant spinal cord compression most commonly affects the thoracic spine, with back pain the most common complaint.MRI of the whole spine is needed for diagnosis, with steroids and surgery or radiation for treatment. Close to half of patients will have bowel/bladder dysfunction at presentation.
  • Hypercalcemia of malignancy has three different mechanisms: PTHrP production, osteoclast activating factor, and calcitriol production. Breast cancer, lung cancer, and multiple myeloma are most common. Patients with severe symptoms and/or calcium >14mg/dL require treatment, predominantly with hydration, calcitonin, and bisphosphonates. Loop diuretics are controversial.
  • TLS causes massive electrolyte changes, with increases in potassium, phosphorus, and uric acid. Treatment with isadequate hydration and rasburicase. Allopurinol is helpful in avoiding Urinary alkalinization with sodium bicarbonatedoes not have literature support.
  • All of these are poor prognostic findings
  • These require heme/onc consult when the patient is in the ED."