Name That Emergency
an adverse reaction to the administration of a drug which is allergic in nature, typically more common in subsequent doses
hypersensitivity reaction
true or false - fever >38.0 must be present to diagnose a patient with CRS?
true
Name 3 symptoms of MSCC that patients may present with
back pain, muscle weakness, loss of sensation, motor weakness, perianal numbness, autonomic dysfunction
name two potential issues that can occur from tumour lysis syndrome
- renal failure
- cardiac arrythmias
- seizures
- neurological complications
- death
true or false - anaphylaxis is a type of hypersensitivity reaction
true
tumour lysis syndrome
name the characteristics of Grade 2 CRS
- fever >38.0
with
- hypotension not requiring pressors
and/or
- hypoxia requiring low-flow nasal cannula
which cancers most commonly lead to metastatic spinal cord compression?
[double points: roughly what percentage of patients with advanced cancer will experience MSCC? (within 5%)]
lung, breast, prostate - all have higher incidence of spinal metastases
[double points answer: approx. 15%]
what is the nursing role in the management of a patient with tumour lysis syndrome?
- strict monitoring of fluid intake + output
- escalation of abnormal vital signs
- escalation of abnormal blood results
when can hypersensitivity and anaphylaxis occur (time wise)?
during the infusion, within a few hours, or up to 48 hours post administration
an acute systemic inflammatory response, characterised by fever
cytokine release syndrome
name one treatment type that can trigger CRS
- bispecific antibodies
- CAR-T cell therapy
- haploidentical blood and marrow transplant
- monoclonal antibodies, though markedly less common
how can MSCC be treated?
surgical intervention (decompression +/- stabilisation), radiation, chemotherapy (for patients with high chemo responsive tumours [lymphoma, neuroblastoma, breast cancer])
- these interventions can be used alone or in combination with one another
what blood tests are ordered for patients on TLS monitoring?
[double points: which values do we monitor for laboratory TLS?]
- EUC
- CMP
- LFT
- LDH
- urate
- FBC
[double points answer: uric acid, potassium, phosphate, corrected calcium]
describe the signs and symptoms of hypersensitivity
- dyspnoea - tight, scratchy throat - increased temperature - tachycardia - tongue + lip tingling - nausea + vomiting - diarrhoea - rash - urticaria - back + abdo pain - dizziness
metastatic spinal cord compression
how is CRS managed?
[double points: name the drug utilised for anti-IL6 therapy]
- increased monitoring/obs
- symptomatic management (antihistamines, antipyretics, oxygen, IVF, pressors)
- corticosteroids
- ICU admission depending on severity
- anti-IL6 therapy
[double points answer: tocilizumab]
how do we manage + monitor MSCC on the ward?
limiting mobilisation until imaging reviewed, corticosteroids, analgesia, bowel + bladder monitoring, pressure injury prevention, neurological assessment + monitoring
name the hypouricaemic agents utilised in TLS prevention and management?
- allopurinol; can be used for both prophylaxis and treatment
- rasburicase; given IV, has a faster onset than allopurinol, used for TLS treatment
what is the immediate nursing management of hypersensitivity reaction with no symptoms of anaphylaxis?
- stop infusion
- remain with patient
- call for help/clinical review
- recheck obs
- symptom management (meds/therapies)
- do not wait for medical review to administer PRN drugs for symptom management
- document + IIMS