• 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