Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
53 Cards in this Set
- Front
- Back
types of emergencies: urgency approach |
Right now this minute:
today
If not today, tomorrow
|
|
what's the difference between pericardial effusion and cardiac tamponade |
effusion becomes tamponade once pressure on heart affects diastolic filling |
|
what number constitutes severe thrombocytopenia |
<50 |
|
sx of SVC syndrome |
tortuous veins on chest, neck, face swollen face when they wake up treat with filter |
|
why is hypercalcemia classified as today but not right now urgency? |
Why is hypercalcemiaimportant but not right now Weakness or tetany,parasthesias, numbmess, N/V Have to treatelectrolyte abnormalities slowly or it can irritate the heartMore K+ but Ca2+ aswell |
|
how do you treat hypercalcemia |
slowly so the heart isn't irritated same with K+ |
|
high number of people with these cancers present with lower back pain |
prostate breast lung these cancers go to the bone |
|
most frequent presenting symptom of cancer |
pain |
|
neurological: cord compression |
|
|
neurological: cord compression imaging/labs/treatment |
MRI/CT +/- pyelogram of the WHOLE spine decadron neurosurgery in most circumstances XRT radiation therapy IF multiple levels |
|
progression of pain with cancer |
Pain precedes othercancer symptoms by about 7 weeks Then the painbecomes more redicular: becomes nerve pain Usually symmetricbefore weakness presents Will complain ofnumbness in extremeties Then loss of boweland bladder Then ataxia wherethey can't walk |
|
a very common met area in the back |
sacroiliac joint |
|
some sx of brain mets |
|
|
what is the most common brain tumor |
metastatic 60% of lung ca = brain mets 20% of breast ca = brain mets |
|
primary cancers that tend to met to brain |
adults:
kids:
|
|
where do brain mets tend to go in the brain? |
|
|
intervention for neurological brain mets |
Get steroids onboard Control for seizures Get MRI done asap Turn over tooncology and neuro |
|
what is centipose |
comparing viscosity of something to water cP |
|
if your blood is too viscous what problems can it cause |
PE Stroke |
|
what is polycythemia vera |
too many RBC |
|
what is erythrocytosis |
too many RBC |
|
why does multiple myeloma cause hyper viscous blood |
too many messed up plasma cells |
|
what is waldenstroms macroglobinemia |
Waldenström's macroglobulinemia is a type ofcancer affecting B cells, a type of white blood cell. The main attributingantibody is immunoglobulin M. WM is an "indolent lymphoma". It is atype of lymphoproliferative disease, which shares clinical characteristics withthe indolent non-Hodgkin lymphomas. |
|
normal serum viscosity PV Hgb ET platelet count |
normal serum viscosity usually >5cP polycythemia vera, Hgb >19 or 20 essential thrombocytosis, platelets well over 10^6 |
|
if you see neurological symptoms of hyper viscosity, go this: |
|
|
what causes too many white blood cells |
ALL in kids AML in adults lots of huge blast cells in the system which cause neurological and pulmonary infarcts this is what kills these patients 20-40% mortality if not treated |
|
leukostasis is most common in what cancer |
AML with WBC >100,000 CLL, CML uncommon even with WBC >300,000
|
|
three things that will give a false positive on a mono spot test |
lymphoma ALL AML |
|
treatment of leukostasis |
AML and ALL two mostcommon CLL, CML less common Once you get more ofthese blast cells, you get more hypoxic, direct endothelial damage, reducedblood flow, cells release massive cytokines, inflammation, inflammatory cellscome, Very delicatebalancing act Need rapidcytoreduction via chemo Will need profylaxisfor tumor lysis syndrome These are thehighest risk for running into all kinds of electrolyte abnormalities: uricacid, hyperphosphatemia, etc |
|
what is Beck's triad? |
|
|
what will you see on EKG with cardiac tamponade |
electrical alternans where qrs gets bigger and smaller low voltage on EKG ST elevation in all leads |
|
what might you hear with cardiac tamponade |
rub |
|
if it's tamponade, what do you do? |
drain it |
|
what if it's just a pericardial effusion at 200mL not into Beck's triad |
treat with NSAIDs |
|
causes of cardiac tamponade |
malignancy effusions are common but not commonly symptomatic most common primaries are lung and breast cancers to do this |
|
presentation of cardiac tamponade |
left or right sided failure, pulses paradoxus (drop in bp of 10mmHg on inspiration), big heart on CXR (water bottle heart) |
|
cardiac tamponade intervention |
|
|
who do you commonly get SVC with cancer |
thymomas and mediastinal lympadenopathy commonly compress the SVC the most common is bronchogenic carcinoma |
|
symptoms of SVC |
SOB arm/face swelling |
|
is SVC an emergency |
a relative emergency, even with CNS symptoms |
|
intervention of svc syndrome |
pulse ox cxr chest ct to outline mass that will need tx oncology (chemo for small cell, lymphoma, germ cell) radiation for all others heparin or steroids IR? stenting? |
|
chemo for these three cancers involved with SVC |
small cell lung cancer lymphoma germ cell |
|
metabolic: tumor lysis syndrome |
occurs in tumors with high body burden and high chemosensitivity usually high grade lymphomas or leukemias small cell, germ cell less common usually due to therapy, so you know the dx already may occur at onset of therapy, or after a day or two, up to 5 days few clinical sx other than being ill with obvious lab abnormalities due to renal failure |
|
why lab abnormalities in tumor lysis syndrome |
renal failure |
|
tumor lysis syndrome notes |
|
|
labs with tumor lysis syndrome |
hyperuricemia hyperkalemia hyperphosphatemia HYPOcalcemia due to rapid turnover of tumor cells (with or without anti-tumor therapy) |
|
pre-treatment for tumor lysis syndrome |
fix conditions that will make effects worse, such as dehydration, renal obstruction, IV contrast get baseline labs: K, Ca, Phos, Uric acid, LDH, Cr alkaline diuresis: D51/2 NS with 2 or 3 amps bicarb at 200+ cc/hr keep urine pH >7 keep urine output high: lasix, mannitol how to keep uric acid production down: allopurinol 600mg load, then 300mg/day |
|
keep urine output high with these meds for tumor lysis |
lasix mannitol |
|
keep urine pH at ____ for tumor lysis syndrome |
>7 |
|
how to keep uric acid PRODUCTION down in tumor lysis syndrome |
allopurinol 600mg load, then 300/day |
|
what kind of sx will a pt with tumor lysis syndrome have |
hypocalcemia: n/v diarrhea, anorexia, lethargy, blood in urine from kidney damage, seizures hyperkalemia: heart irritation, can't have heart go into tetany K+/Ca2+ very irritating to myocardium, check 2-3x/day there will be changes that fast!!! |
|
how often do you check K+/Ca2+ with tumor lysis syndrome? |
2-3x/day |
|
start on slide 38 |
38 |