MyCpdZw - Protocols Details

FEBRILE NEUTROPENIC OR CONCOLOGY PATIENTS

Antifungal agents can be withheld in a specific subset of high-risk febrile neutropenic patients. These patients include those who remain febrile after 4-7 days of broad-spectrum antibiotics but are clinically stable and without clinical or radiographic signs of fungal infection.

Diagnosis

Fever is “a temperature > 38.5 on any occasion or > 38.0 for > 1 hour”.

Neutropenia is “a Neutrophil count of < 1.0 x /I”.

Fever is always presumed to be ineffective until proven otherwise.

Often very few clinical findings.

If left untreated there is a very high mortality.

Take a careful history especially with regards to the typr of cancer & its management.

Ensure temperature, pulse, resp rate, BP & oxygen saturations are documented.

Thorour examination including oral cavity, perianal, skin & venous access sites.

Early recognition of septic shock is essential to patient survival.

High risk patients are patients with cancer plus at least one of:

· Haemotological malignancy,

· Myelosupressive chemotherapy,

· Concurrent chemotherapy or radiotherapy,

· Age >60,

· Co-morbidities eg Daibetes,

· Bone marrow involvement of cancer,

· Significant mucusitis,

· On steroid doses of > 25 mg Prednisolone,

· Rapidly declining Neutrophil count,

Recent hospitalization for infection.

Management

1. Discuss with medical officer & Oncologist expediently (preferably) prior to

any treatment,

2. Reverse barrier nurse,

3. ABC’s & Resuscitation as indicated,

4. All patients should get FBC, Blood Cultures (including one from each lumen of any IV

catheter plus a peripheral sample- don’t flush tubes first), U&E’s, LFT’s, urinalysis & MSU,

CXR & other tests as indicated (Sputum, feaces, LP etc),

5. Urgent treatment with IV antibiotics within ½ hour of arrival.

6. HIGH RISK patients IV Caeftazidime 2 g tds (or Ciprofloxacin 400 mg IV BD if

hypersensitive to Penicillin or Cephalosporins.) plus IV Gentamicin 5mg/kg,

7. Low risk patients IV Ceftazidime 2 g tds,

8. If suspected IV catheter infection add IV Vancomycin 1g BD (modify dose in renal

impairment),

9. For suspected bowel related or perianal focus add IV Metronidazole 500mg BD,

10. If severe beta-lactam allergy replace Cefepime with IV Ciprofloxacin 400 mg BD,

11. If clinical Oropharyngeal candidiasis or high dose steroids add Fluconazole 400 mg IV

or orally daily,

12. Choice of antibiotic should be modified on basis of culture results,

13. Consider use of G-CSF to increase neutrophil count,

14. If fever unresolved after 48 hours & negative cultures consider CT chest & adding IV

Vacomycin.

15. If fever persists a further 48 hours consider adding Fluconazole.

Recent Protocols

COVID 19

COVID 19 is a disease caused by the most recently discovered coronavirus which is a large family of corona viruses causing illnesses. In humans it causes Respiratory infections for example Severe Acute Respiratory Disease (SARs) PRESENTATION Fever 77-98% Cough 46-82% Myalgia/Fatigue 11-52% Shortness of breath 3-31% Incubation period 14 days, most people develop symptoms between 5-6ays from exposure Stage1 (Early infection). Stage 2. Stage 3(Hyperinflation phase) Viral response---------------------------Pulmonary Phase----------------------Host Response *Anyone presenting with flu like symptoms should be assumed to be a COVID 19 case until proven otherwise*

WARFARIN OVERDOSE/ TOXICITY

Overdose of the oral anticoagulant warfarin (Coumadin), or drug interactions with warfarin, can lead to toxicity. Similarly, toxicity can result from exposure to superwarfarins, which are long-acting anticoagulants used in rodenticides. ... Warfarin is the most common oral anticoagulant in current use

SUICIDAL IDEATION

Suicidal ideation, also known as suicidal thoughts, is thinking about or having an unusual preoccupation with suicide.

SPINAL CORD INJURY

Emergency signs and symptoms of a spinal cord injury after an accident may include: Extreme back pain or pressure in your neck, head or back. Weakness, incoordination or paralysis in any part of your body. Numbness, tingling or loss of sensation in your hands, fingers, feet or toes. Loss of bladder or bowel control.