Page 216 - Critical Care Notes

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HEMA/
ONCO
■ New onset of back pain, worsening at night with lying down
■ Epistaxis
Late Symptoms
■ Decreased cardiac output → hypotension
■ Hemorrhage
■ Edema in arms and hands
■ Venous distention of neck veins
■ Dyspnea
■ Pleural effusions
■ Erythema of upper body
■ Cyanosis
■ Mental status changes
■ Death (if compression not relieved)
Diagnostic Tests
■ Spiral CT with contrast or MRI of chest
■ Selective venography
■ ECG
Management
■ Monitor cardiac, respiratory, and neurological status.
■ Keep head of bed elevated.
■ Maintain patent airway. Provide O 2 therapy as indicated.
■ Administer diuretics and corticosteroids as needed.
■ Provide high-dose radiation to the mediastinal area (provides temporary
relief).
■ Avoid chest and neck central venous catheters.
■ Interventional radiology may place a metal stent in the vena cava to relieve
swelling.
■ Be aware thrombolytic therapy or follow-up angioplasty may be needed to
keep the stent open longer.
■ Surgery rarely is performed. The tumor may have caused a large increase
in intrathoracic pressure, so closing the chest postoperatively would be
impossible. Surgery may be indicated in patients who have a life expectancy
of >3 mo and are at risk for paraplegia.
■ Know best treatment results occur in the early stages of SVCS.
■ Monitor for complications such as right-sided heart failure, blood vessel
rupture, and radiation pneumonitis.
Tumor Lysis Syndrome (TLS)
Tumor lysis syndrome (TLS) occurs when large numbers of tumor cells are
destroyed rapidly → the release of intracellular contents (K + and purines) into
the bloodstream faster than the body can eliminate them → tissue damage and
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