“-ibs and -abs”

Dr Sally Greenberg – Breast and General Oncologist

Immunotherapy – newest line of therapy, “check point inhibitors”

Toxicity: immune mediated inflammation of ANY system, 60% of patients (transaminitis and rash are most common)

Management:

• exclude other causes
• stop the drug
• antibiotics (cover infection as differential)
• steroids or immunosuppressant in emergency

Oncology Emergencies

Spinal cord compression

Febrile neutropenia – antibiotics within 1st hour! (Tazocin +/- vancomycin)

Delerium

SOB – multiple causes, consider immunotherapy pneumonitis

Tumour lysis syndrome

 

Metastatic does not mean dying!

Palliative intent – early referral to palliative care services improves quality of life and prognosis

Peter Mac “SMART CLINIC” – letters are available n “correspondance” section on BOSNET

 

Journal Club

http://jamanetwork.com/journals/jama/article-abstract/2598268

Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department – JAMA, Jan 17, 2017

qSOFA – RR, mental status, systolic BP

useful for early identification of patients needing escalation of care – ie: ICU referral

 

Necrotising Fasciitis

Red flags:

rapidly progressive

pain out of context to signs

bullae, crepitus

 

Management:

early identification

referral to plastics/general surgery

antibiotics: clindamycin, meropenem, vancomycin

 

CVC insertion

Documentation

Ultrasound use

practice seldinger technique