Neutropenic sepsis- Definition:
- Neutrophils <1 E9/L
- Fever >38
- Nadir of blood cells is 7-10 days post-chemo
- Algorithm:
- H istory
- E xamine for a focus
- Shivering
- BO >3/day
- Mouth ulcer
- Lines
- UTI
- Chicken pox/shingles
- Chest pain/DIB
- Vomiting
- A ction
- T reat
- Late-stage (can come on within 3 hrs)
- SIRS
- Temp >38 or <36
- Pulse >90
- RR >20
- WCC is already <4
- Restless
- Reduced consciousness
- Cold/clammy
- Hypotension
- Treatment
- Straight to majors / Don't wait for bloods!
- IV ABx within an hour
- Amikacin / Tazocin immediately
- Consider Meropenam / Vanc / Antifungals if not responding after 48 hrs
- Macrolide (clarithromycin) for CAP atypicals
- Vanc for line infections (MRSA)
- Aciclovir for herpetic lesions
- Prevention
- Protective isolation
- Reverse barrier nursing
- Clean diet
- Damp dusting
Metastatic cord compression
- Found in 5-10% of advanced cancer patients
- Causes
- Breast, thyroid, lung, prostate, renal
- Myeloma, lymphoma
- Symptoms
- Intractable back pain
- Wakes at night
- Progressive
- Aggravated by straining (stool, coughing, sneezing)
- Sensory level
- Urinary/faecal symptoms
- Reduced anal tone
- Management
- MRI spine
- Dexamethasone 4 mg QDS
- Urgent surgery
- Urgent radiotherapy
Lethal triad
- Coagulopathy / Metabolic acidosis / Hypothermia
- => Hypothermia => Reduced clotting
- => Coagulopathy => Blood loss
- => Metabolic acidosis => Reduced myocardial performance
Blood times
- ABO blood within 10 mins
- Full cross-match takes 30-40 mins
- Requires full antibody screen
Notes
- European trauma guidelines 2007
- CABC vs ABC
- 1:1:1 PRBC:FFP:Platelets ?
- Stat tranexamic acid
- Novoseven
- Recombinant factor VIIa
- Very expensive!
- Requires 2 consultant signatures
- Fibrin sealants
- Costs
- RBC £123
- FFP £38
- Platelets £240
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