Pearl of the day - Managing Oncologic Emergencies

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Metastatic spinal cord compression - Corticosteroids are first line. In most cases, give dexamethasone 10mg IV.
Tumor lysis syndrome - First line therapy is IV fluids. Worsening renal function will require hemodialysis/CRRT. Avoid IV calcium for hypocalcemia because the concurrent hyerphosphatemia will cause worsening precipitation.
Neutropenic fever - Patients need at least 2 sets of blood cultures. Additionally, cultures need to be drawn from each lumen of any indwelling lines.
Neutropenic fever patients with abdominal pain/diarrhea should be tested for C.diff, even in the absence of traditional risk factors.
More:
MASCC Risk Index: www.mdcalc.com/ mascc-risk-index-febrile-neutropenia - may help determine suitability for inpatient vs. outpatient management of febrile neutropenia.
ANC calculator: www.mdcalc.com/absolute-neutrophil-count-anc - determines severity of neutropenia.
 
Source: EBMedicine.net
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Pearl of the day - The LUCAS Device

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In some scenarios, manual chest compressions may be logistically challenging (i.e. staffing). The Lucas device (see website) can provide external and automated closed chest compression, thus enabling even complex invasive procedures without interrupting CPR. However, no randomized trial has proved to date its benefit in comparison to standard manual chest compression, only observational studies and consensus opinion support its clinical use, and it may be inappropriate to use on patients at the extremes of size.
 
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Pearl of the Day - Blunt Cerebrovascular Injury (BCVI)

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One hard indication for ordering a CTA neck in the setting of trauma is to evaluate for BCVI. BCVI is an occult traumatic injury to the vessels of the neck that carries a high rate of morbidity and mortality if left untreated. In the past, BCVI was often diagnosed after a stroke.

When to suspect it: severe mechanism of injury (high energy, hyperextension/rotation, direct blow to vessels, adjacent bone fractures - C2-C6) coupled with clinical signs - focal neuro deficit or epistaxis after trauma from a suspected arterial source. Traumatic carotid-cavernous fistulas can also develop and lead to orbital pain/proptosis, hyperemia, cerebral swelling, and seizures.
How is it classified: Grades I (intimal irregularity) - V (transection/extrav) .
How is it managed: In general, patients need admission because the injury often does not occur in isolation. Patients need four vessel cerebral angiogram (FVCA) to fully diagnoseanticoagulation and a multidisciplinary approach.
East guidelines (Level II recommendation):
1. Patients presenting with any neurologic abnormality that is unexplained by a diagnosed injury should be evaluated for BCVI.
2. Blunt trauma patients presenting with epistaxis from a suspected arterial source after trauma should be evaluated for BCVI.
3. Duplex ultrasound is NOT a useful screening tool, FVCA is the gold standard diagnostic imaging modality.
Who should be screened (Level III recommendation)? LeFort fx, C-spine fx, Petrous bone fx, GCS <8, diffuse axonal injury.
Source: https://www.acep.org/uploadedFiles/ACEP/Membership/chapters/chapter_services/small_chapter_emails/BLUNT%20CEREBROVASCULAR%20INJURY.pdf
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