Winter’s Wrap 21.06.2017 – Oncology, necrotising fasciitis, CVC insertion

“-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)


  • 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)


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

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



early identification

referral to plastics/general surgery

antibiotics: clindamycin, meropenem, vancomycin


CVC insertion


Ultrasound use

practice seldinger technique

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