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Oncological Emergencies Notes

Medicine Notes > Oncology Notes

This is an extract of our Oncological Emergencies document, which we sell as part of our Oncology Notes collection written by the top tier of University Of Leicester students.

The following is a more accessble plain text extract of the PDF sample above, taken from our Oncology Notes. Due to the challenges of extracting text from PDFs, it will have odd formatting:

Oncological Emergencies Neutropenic Sepsis (Febrile Neutropenia) Neutrophils < 1.0 x 10x9/L Temperature > 37.5 degrees C on two occasions or > 38.5 degrees C once Hypothermia/hypotension Aetiology
- Predisposing factors to sepsis o Disruption of anatomical barriers e.g mucositis o Intravascular lines o Local obstruction o Neutropenia o Dysfunctional immune system
- Bone marrow suppression = major side effect of chemotherapy 80% of infections are from endogenous flora Pathogens Often no infection
- Gram negative source found and o E.Coli, klebsiella, pseudomonas patient treated empirically
- Gram positive o Staph epidermidis, staph aureus, B haemolytic strep
- Fungal o Candida, aspergillus Clinical features
- Often absent signs and symptoms
- But can be febrile, hypotensive, tachycardic Investigation
- History and examination (find out about previous infections and pathogens)
- IV access
- Bloods o FBC, U+E, LFT, Ca, Mg o Cultures (including lumens of any lines)
- MSU + culture
- Swab and culture lines, mouth, sputum, stool
- CXR Treatment
- Start IV antibiotics (within an hour of patient presenting) DO NOT WAIT FOR FBC o IV tazocin/meropenam (gram positive) and gentamycin (gram negative)
- Isolate patient
- Fluid balance (give fluids if hypotensive, tachycardic, dehydrated, febrile)
- Regular obs
- Senior review
- Liase with micro re antibiotics and cultures
- Early advice from ITU if appropriate

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