Feere Neutropenic E nder Kimoterapi e Emergency Safrude Kanser¶

Kala keɓoowo kemikal (chimiothérapie), walla safaara ƴiiƴam gonɗo e ƴiiƴam, walla ƴeewndo ƴiiƴam, feso ɓuuɓngo meeɗaa wonde « ɓuuɓri tan » : ko ñawu nguu ina waawi warde nguurndam, ina wiyee Febrile Neutropenia (Fever Neutropenic). Simiterapi ina halka ƴiiƴam ɗam feccata ko yaawi, anndiraaɗam neutrophiles, woni ƴiiƴam ɓalejam gonɗam e yeeso bakteriiji e funeeɓe, haa teeŋti noon e sahaa "nadir" windo (\(7\text{ haa }14\text{ balɗe}\) caggal nde ƴiiƴam ɗam waɗaa). So limre neutrophiles ustiima haa zero walla ko ɓadii zero, bakteriiji ɗi ngalaa ko bonnata, nguurɗi e nder hunuko, e nder ɓalndu, walla e dow ɓalndu saraaji porto ƴiiƴam hakkundeejo ina mbaawi naatde e ƴiiƴam, ina ɓeydoo laabi ɗiɗi e nder hojomaaji 20 kala tawa ina mbaɗa ɓuuɓri, ɓuuɓri, walla ɓuuɓri. So neɗɗo safraaka e galle mum hay waktuuji seeɗa, ñawu nguu ina yaawi yahrude yeeso haa fulminant sepsis e ɓuuɓri septik. Wuurde fawii ko e Kuulal "Damal-to-Antibiyotik" waktu kaŋŋe : yettaade departemaa emergency ɗoon e ɗoon ngam antibiyotikuuji keewɗi e nder ƴiiƴam ina njuutee e e nder hojomaaji 60 caggal triage, tawa kadi meeɗaa maskude nguleeki ɓeydotooki e ekipaaji onsetamolcology walla parabucology (para) mo alaa ko woni e mum.

Waɗde ɗum jooni¶

1. **Ƴeewto nguleeki hunduko (hunduko) walla nguleeki timpanik/waktu ɗoon e ɗoon, mbaɗtaa ɗoon e ɗoon kuutorgal tiiɗngal \(38.3^\circ\text{C}\) (\(101.0^\circ\text{F}\)) / $38.0^\circ Fedde Amerik (IDSA), Fedde Ameriknaare Onkoloji (ASCO), Fedde Oropnaajo ngam Onkoloji Safaara (ESMO), e laabi NICE UK, Fever Neutropenic ina siforee :
2. Tampere hunduko wootere ko \(38,3^\circ\text{C}\) (\(101,0^\circ\text{F}\)) walla ko ɓuri ɗum, WALLA
3. Nguurndam hunduko \(38.0^\circ\text{C}\) (\(100.4^\circ\text{F}\)) walla ko ɓuri ɗum ina duumoo waktu 1 (walla ina fotndee laabi ɗiɗi ko famɗi fof waktu 1).
4. (Tesko: Hoolaare NHS e nokkuuji kanseer keewɗi to Angalteer ina kuutoroo limre janngugol wootere ɓurnde tiiɗde, hono \(38.0^\circ\text{C}\) [\(100.4^\circ\text{F}\)] laawol gootol, walla \(99.5^\circ\text{C}ce\F}ur\)5 apart sahaa kala rewa e limre kartal ɓurnde tiiɗde e nokku maa kanseer.);
5. Noddu limoore emergency nokkuure maa ɗoon e ɗoon so tawii ñawɗo oo ina wondi e ɓuuɓri/rigor, ɓuuɓri, jiiɓru, ɓuuɓri foofaango, walla ɓuuɓri ƴiiƴam. Noddu 911 to leyɗeele dentuɗe Amerik e Kanadaa, 112 e nder Dental Orop, 999 to leydi Angalteer, walla ƴeew fof limooje caɗtuɗe so tawii ñawɗo oo ina wondi e ɓuuɓri dimmbotoondi (rigors), ina wondi e ɓuuɓri so ina darii, ina wondi e ɓuuɓri ɓernde yaawnde (\(>100\text{ bpm}\)), ina wondi e tansiyoŋ sistolik les \(100\text{ mmHg}\), walla ina nanndi e ɓuuɓri, ina ɓuuɓna, walla ina ɓuuɓna, hay so tawii thermometer maɓɓe ina ŋakki walla ina famɗi no feewi (\(<36.0^\circ\text{C}\) walla \(<96.8^\circ\text{F}\))**, nde tawnoo sepsis toowɗo ko sifaa ɓurɗo bonde e ɓuuɓri septik.
6. So tawii aɗa darii e nguleeki, noddu Line Triage Oncology maa 24 hours ɗoon e ɗoon, njahaa to Departemaa Emergency. Woto ɗaɓɓu haa waktuuji golle subaka. Haa goɗɗo nawta ñawɗo oo to suudu safrirdu ɗoon e ɗoon, naamndo onkoloji mo noddata oo yo noddu yeeso to biro triage emergency mbele cultures ƴiiƴam e antibiotikuuji nder ƴiiƴam ina ngoodi so o arii.
7. WOTO ndokku hay pillol ustoowo nguleeki (alaa asetaminofen, parasetamol, ibuprofen, walla aspiriin) kadi hoto meeɗ huutoraade termometre rektal. Fotde nguleeki les ɗemngal (hunduko) walla les junngo (aksilaari; tesko-ɗen wonde janngugol aksilaar ina doga ko ina tolnoo e \(5^\$}te [\)0.9^{\circ\text{F}\(] ɓuri lesɗude e jaŋngugol hunduko, ko ɗum waɗi jaŋngugol les ɓuuɓri **\)37.8}\circ\text{C}$ [\(100.0^\circ\text{F}\)]** ina foti e nguleeki hunduko).
8. Waɗde mask ɓuuɓɗo walla mask N95/FFP2 e dow ñawɗo oo hade maa naatde e suudu safrirdu Emergency. Sabu ñawɗo neutropenic ina jogii ko famɗi fof zero defense immune, jooɗaade e nder suudu safrirdu heewndu yimɓe sara ñawɓe ɓuuɓɓe ina bonna. Hokku "Kartal jeertinaango sepsis neutropenic" maa to infirmière triage ɗoon e ɗoon, naamndoɗaa yo o waɗte e suudu ƴeewndo isolated ɗoon e ɗoon.
9. Ƴeewto Emergency Onkoloji Nay Mawɗi goɗɗi ɗii. So aɗa heblanaa yah-ngartaa, ƴeewto-ɗaa ko yaawi ngam anndude so tawii ko Compression Spinal Cord Malignant (nafoore ɓaleere hesere tawa ina wondi e tampere koyɗe, ɓuuɓri, walla caɗeele ɓuuɓri), Sindrome de LyTumor Supérieur de Cava (SVC), ɓuuɓri yeeso/ɓuuɓri Sindrom** (ɓuuɓri ɓalndu, ɓuuɓri ɓaleeri/alaa, ɓuuɓri ƴiiƴam e nder balɗe puɗɗagol kemikal), e Hypercalcemie of Malignancy (ɓuuɓri mawndi, ɓuuɓri keewndi, ɓuuɓri ƴiiƴam, e jiiɓru).

Triage emergency e lekki pellital kiriis safaara kanseer¶

Huutoro ndeeɗoo limre (flowchart) ngam ƴeewde kala maande ɓuuɓnde e ñawɗo mo ñawu nguu safrata walla e nder yontereeji 6 caggal nde ñawu nguu heɓtotoo (chimiothérapie).

flowchart TD
    Start["Ñawɗo Kanser e Kimoterapi, Immunoterapi,<br/>walla Rajo ina heɓa maale caɗtuɗe"] --> SepsisFlags{"Ɗatal 1: Ƴeewto Septik Sok / Kiriis Banndiraaɓe Boɗeeji<br/>1. Diwgol ɓuuɓri (rigors), hay so tawii nguleeki toowki alaa?<br/>2. Hipotermiya: Nguleeki < 36,0°C (96,8°F)?<br/>3. Diwgol, ɓuuɓri, jiiɓru, walla haala ɓuuɓka?<br/>4. Fooftere juutnde, fooftere yaawnde, walla ɓuuɓri ɓernde?<br/>5. Boɗeejo, ɓuuɓri, walla mette dow laabi Port-a-Cath / PICC / Hickman ?"}

    SepsisFlags -->|"EEY: Kala 1 ina woodi"| Call911["SEPSIS / KIRIIS ONKOLOJI ƁURƊO ƁURDE:<br/>1. Noddu 911 / 112 / 999 Ɗoon e ɗoon ngam Ambulance<br/>2. Bayyinaade 'Emerjensi sepsis neutropenik'<br/>3. Doole 60-hojom damal-to-IV-antibiotik<br/>4. Waɗde lelnude (walla tiiɗde so tawii fooftere ina famɗi); NPO"]

    SepsisFlags -->|"ALAA"| TempCheck{"Ɗatal 2: Ƴeewto nguleeki hunduko<br/>(WOTO huutoro termometre rectal)<br/>Mbele nguleeki >= 38,3°C (101,0°F) LAABI WOƊƊI<br/>WALLA >= 38,0°C (100,4°F) fotde waktu 1?"}

    TempCheck -->|"EEY: Damal feso hawri"| NeutFever["ƊAƁƊI ƊIƊI ƊIƊI NEUTROPENIIK:<br/>1. WOTO ndokku Tilenol/parasetamol, ibuprofen, walla aspiriin<br/>2. Noddu Line Triage Onkoloji waktuuji 24 JOONI nde njaltataa<br/>3. Waɗde mask e ñawɗo; yah to Departemaa Emerjensi JOONI<br/>4. Hollit Kartal Jeertinaango Kemikal e triage : ɗaɓɓu seertude +<br/> Pine ƴiiƴam (Port + Periferik) & Antibiyotik IV < 60 mins"]

    TempCheck -->|"NO: Alaa maale nguleeki walla sepsis"| OncEmerg{"Ɗatal 3: Ƴeewtaade Emerjensi Kanser gonɗo e mbaydi & Metabolik:<br/>A. Naamne keso ɓalndu/wuddu + tampere koyɗe, ɓuuɓri, walla waylo-waylo ɓuuɓri?<br/>B. Yeeso/wuddu/juuɗe ɓuuɓɗe + ɓuuɓri/ɓuuɓri ɓurndi bonde e lelnude les?<br/>C. Kimo ɓooyɗo (balɗe 1-7) + ɓuuɓri, ɓuuɓri, ɓuuɓri ɓaleeri?<br/>D. Ɓooygol mawngol, jiiɓru, ɓuuɓri, naafigaagal ƴiye?"}

    OncEmerg -->|"A: Naafigaagal ɓalndu + maandeeji neuro"| MSCC["TUUMAADE ƁURDE ƁURDE ƁURDE ƁURDE ƁURDE:<br/>MRI Ɓoornugol Emergency + Deksametason IV Dose Toownde JOONI"]

    OncEmerg -->|"B: Ɓuuɓri yeeso/wuddu + ɓuuɓri fooftere"| SVCS["SINDROOM ƁURƊO WOƊƊUDE E ƁOOƊO TOOWƊO (SVC):<br/>Jooɗto tiiɗngo (45-90 deg); CT ɓernde Emergency + Toppitagol Onkoloji"]

    OncEmerg -->|"C walla D: Kiriis metabolism"| Metabolic["LIISIS TUUMOR WALLA HIPERKALSEMIYA TUUMAAƊO:<br/>Departemaa Emergency JOONI ngam ECG, Elektrolit, & IV Fluids"]

Feccere 1: Faamde Feere Neutropenic e Winndere Hakkunde "Nadir".¶

1. Hol ko woni "Limre Neutrophiles Absolues" (ANC) e Nadir Kemo?¶

Ƴiiƴam ɗam (leukocytes) ina waɗi sifaaji ƴiiƴam keewɗi, kono ko neutrophiles woni ƴiiƴam gadanal warde bakteriiji. Safrooɓe ina limta Limre Neutrophiles timmunde (ANC) tawa ina ɓeyda limre ƴiiƴam ɗam fof e teemedere e nder teemedere (100) limre neutrophiles segmentées ("segs") e banngeeji ɗi mbaylaaki : - ANC celluɗo no woorunoo: \(1,500\binndi{ haa }8,000\binndi{ cellal e mikrooliter }(\mu\binndi{L})\) (walla \(1.5\binndi{ haa }8.0 \laabi 10^9/\binndi{L}\)). - Neutropeni: ANC les \(1,500\binndi{ cellal}/\mu\binndi{L}\) (\(<1,5 \laabi 10^9/\binndi{L}\)). - Neutropenia tiiɗɗo (Risk Fever Toowɗo): ANC les \(500\binndol{ cellal}/\mu\binndol{L}\) (\(<0.5 \laabi 10^9/\binndi{L}\)), walla Les \(1,000\binndol{ cellal}/\mu\binndol{L}\)** les \(1,000\binndol{ cellal}/\mu\binndol ɗaminaade to\)0 Waktuuji 48. - Neutropenie luggiɗnde (Risk mawɗo): ANC les \(100\text{ cellal}/\mu\text{L}\) (\(<0.1 \laabi 10^9/\text{L}\)), ko heewi e sahaa gonɗo e ɓuuɓri ƴiiƴam walla e nder ɓuuɓri gonndi e ƴiiƴam.

Hol nde "Nadir" waɗata? Caggal nde cirƴam gonɗam e nder ƴiiƴam ɗam waɗaa e ñalawma 1, neutrophiles gonɗe e ƴiiƴam ɗee ina nguura balɗe seeɗa tawi fabriik ƴiiƴam ina ɓuuɓtoo e sahaa gooto. Ko ɗum waɗi, limre ƴiiƴam ɗam ina yettoo toɓɓere mum ɓurnde lesɗude (nadir) ko ɓuri heewde ko hakkunde ñalngu 7 e ñalngu 14 caggal nde ƴiiƴam ɗam ƴettata kemiterapi (hay so tawii noon ina waawi waɗde kala sahaa e nder safaaraaji gonɗi e hunuko ñalnde kala, radiyee, walla kanseeruuji hematoloji ko wayi no leukemiya, limfoterapi keewɗo).

2. Ko waɗi ñawuuji ina njiya ko njiyataa no feewi so aɗa jogii Neutrophiles Zero¶

E neɗɗo mo reenngo mum woni no haanirta nii, ñawu nguu ina laaɓi sabu miliyoŋaaji miliyoŋaaji neutrophiles ina ndoga e nokku hee, ina maaya, ina mbaɗa ɓuuɓri ɓaleeri tiiɗndi, ɓalndu ɓuuɓndu boɗeeru, ɓuuɓri gonndi e daande, walla ɓuuɓri ɓaleeri denndaandi e rajo ɓalndu : - Alaa Neutrophiles = Alaa Pus e Alaa Maale Classique: E ñawɗo mo neutropenie mum tiiɗi: - Pneumonie bactérienne baawɗo warde ina waawi saabaade ɓuuɓri zero, ɓuuɓri zero, e rajo-X ɓalndu laaɓɗo no feewi, holliroowo tan ko nguleeki e fooftere yaawnde seeɗa. - Infection urinaire (urosepsis) tiiɗnde ina waawi saabaade ɓuuɓri zero nde ɓuuɓnata e hollirde zero ƴiiƴam ɓalejam (pyuria) e dow ɓuuɓri ƴiiƴam, tawa ina hollira tan ko ɓuuɓri. - Sellulit ɓalndu walla perirektal maayɗo saraaji reedu walla porto ƴiiƴam hakkundeejo ina waawi hollirde pus zero walla abscess fluctuant, tawa ina hollira tan ko nguleeki seeɗa, pinndi seeɗa, walla ɓuuɓri nokkuyankeeri e sara nguleeki. - Jeertinaango ko fayti e kortikosteroid maskoowo nguleeki: Ñawɓe kanseer heewɓe ina ƴetta ñalnde kala walla yontere kala deksametason walla prednison (ngam ɓuuɓri ngaandi, limfoma, myeloma keewɗo, batte immunoterapi, walla ɓuuɓri). Kortikosteroid ina haɗa termostaat hipotalamus ngaandi e doole mum. Nyawɗo ƴettuɗo deksametason ina waawi heɓde sepsis ƴiiƴam timmuɗo, mo nguleeki mum tolnii e 37,0$ (\(98,6^\circ\text{F}\)). E nder ñawɓe ƴettuɓe steroid, ƴeewto-ɗee e nokku mum ɓuuɓri diwtundi (rigorus), ɓuuɓri ɓuuɓndi, ɓuuɓndi no feewi tolno, walla ŋakkeende nguleeki les \(36,0^\circ\binndi{C}\) (\(96,8^\circ\binndi{F}\)).

3. "Kuulal antibiotik damal haa 60 minit".¶

So bakteriiji naatii e ƴiiƴam ñawɗo mo alaa neutrophiles (ina heewi kaɓirɗe Gram-negatif ko wayi no Escherichia coli, Klebsiella pneumoniae, walla Pseudomonas aeruginosa ina mbayloo e nder ƴiiƴam bonɗam e nder hunduko cocci** hono Staphylokoccus e Streptococcus ummoriiɗi e kateteruuji ƴiiƴam hakkundeeji), maayde ina ɓeydoo no feewi e kala waktu leelɗo. - Yamiroore opitaal hakkunde leyɗeele: Laabi ummoriiɗi e ASCO, IDSA, ESMO, kampaañ sepsis wuurɗo, e UK NICE (CG151) ina ɗaɓɓi nde kala departemaa toppitiiɗo ko fayti e safaara ina foti rokkude doosgal gadanal antibiyotik beta-laktam (suzobaktam-laktam** [Zosyn/Tazocin], walla meropenem**) e nder hojomaaji 60 caggal nde ñawɗo oo naati e damal suudu safrirdu, tawa o fadaani ngam ƴeewde limto ƴiiƴam ɓalejam (CBC) laboratuwaar so tawii ina tuumaa ina wondi e neutropenie. - Ko waɗata e ɗeen hojomaaji 60 gadani : Infirmiyee en ina ƴetta ɗoon e ɗoon seteeji ɗiɗi pinal ƴiiƴam (set gooto ina ƴetta e kala lummbirde ñawɗo oo Port-a-Cath, liggey PICC, walla kateter Hickman, e set gooto ina ƴetta e ƴiiƴam periferik e panneel Co.C). ƴiiƴam toɓɓere laktat, e fawde antibiotik IV ɗoon e ɗoon caggal nde ƴiiƴam ƴettaa. - **Triage mo Risk mawɗo vs (ko waɗɗii e mboros lewñere, mbayliigu ƴiiƴam, ɓuuɓri ƴiiƴam, ɓuuɓri ƴiiƴam, ɓuuɓri reedu, jiiɓru, walla mukositis tiiɗɗo) walla ina waawi waylude safaara ƴeewndotooɗo no feewi.

Feccere 2: Anndude Emergency Onkoloji joy goɗɗi gonɗi e nguurndam¶

Hay so ñawɗo kanseer oo alaa nguleeki, ñawu nguu ina jogii ñawu nguu e safaaraaji kanseer jamaanu (chimiothérapie, radiation, e inhibiteurs de checkpoint immunitaire) ina mbaawi jibinde caɗeele joy keertiiɗe to bannge mbaydi walla to bannge mbaylaandi, ɗe njiɗi ko toppitaade ko yaawi to departemaa :

Toppitagol ko adii safrirde ngol, e nder peewnugol Departemaa Emergency¶

Ɗatal 1: No ƴettirten nguleeki laaɓtuki e kisal e nder ñawɗo kemiterapi¶

1. Hutoro termometre oral (les ɗemngal), timpani (noppi), walla ƴiiƴam (tiinde) dijital.
2. So tawii ñawɗo oo yarii tan ko teewu ngulngu walla ndiyam ɓuuɓɗam, ɗaɓɓu 15 haa 20 minit hade mum ƴettude nguleeki hunduko mbele janngugol ngol waylaaka e fenaande.
3. Haɗaama no feewi: Hoto meeɗ huutoraade Termometre Rectal.
4. Simiterapi ina bonna ƴiye muusɗe peccitooje ko yaawi, ɗe ɓuuɓnata ɓalndu nduu fof gila e hunuko haa e reedu (mucositis). Puɗɗagol tippitagol termometre tiiɗngol (walla suppositoor, enema, walla tampon) e nder reedu ina waawi waɗde gonɗi mikroskoop e nder reedu ɓuuɓndu, ina addana miliyoŋaaji E. coli e bakteriiji ɓalndu anaerobik ngam naatde e ƴiiƴam ɗoon e ɗoon (bakterimiya) e saabaade ɓuuɓri perirektal bonndi walla ƴiiƴam ɗam waawataa haɓtaade so tawii ƴiiƴam ina famɗi (trombositopeni).

Ɗatal 2: Ƴeewto nokkuuji naatgol infection "Joy cuuɗiiɗi".¶

So aɗa haalda e infirmiyee onkoloji triage walla aɗa fadi jolngo, ƴeewto-ɗaa e gite maa ɗeeɗoo nokkuuje joy (woto meeɗ ɓuuɓnude, pop, walla ɓuuɓnude kala ɓuuɓri) e humpitaade ko njiy-ɗaa koo : 1. Kaɓirgal gonngal e ƴiiƴam hakkundeewal (Port-a-Cath, Line PICC, walla Catheter Hickman Tunnelled): Ƴeew ɓalndu dow porto ɓalndu walla ligne PICC junngo tawa aɗa ɓuuɓna ɓuuɓri laaɓtundi steril. Mbele ina woodi boɗewol, ɓuuɓngol, nguleeki, teddeendi, walla ɓuuɓri ɓaleeri e dow laawol tunnel ngol? Mbele nguleeki walla ɓuuɓri diƴƴe puɗɗiima e nder hojomaaji 30 haa 60 caggal nde ɓuuɓɗaa walla huutoriima porto? (Maande ɓooynde lumen kateter koloñaal; gollotooɓe safrirde ina poti ƴettude pine ƴiiƴam e nder porto ko adii nde ɓe ƴettata no ɗum safrirtee.) 2. Hunduko, Ɓoggi, e Gondu (Mucositis oral): Jalnude lampa telefoŋ nder hunduko. Mbele ina woodi ɓuuɓri boɗeeri mettundi, ɓuuɓri daneeri nanndundi e ɓuuɓri (thrush / candidiasis), ɓuuɓri ƴiiƴam, walla caɗeele muusde ndiyam ? 3. Fuɗɗude e Fooftere : Limtu no ñawɗo oo foofirta e nder leƴƴanɗe 60 e nder fooftere (foftere dow 20 haa 22 fooftere e nder hojomaaji ko maande jeertinaande ko yaawi e sepsis walla pneumonie hay so tawii ko ɓuuɓri) e ƴeewtaade pulse oximeter so ina woodi. 4. Reedu e nokku Perirectal: Naamndo ñawɗo oo so tawii ina wondi e ɓuuɓri reedu bannge ñaamo (tiflitis) walla kala ɓuuɓri, ɓuuɓri, walla ɓuuɓri saraaji reedu walla wutte so jooɗiima walla rewii e ɓuuɓri (cellulitis perianal ko ɓuuɓri keewndi, suuɗndi, ɓuuɓri grabite-ga-p e nder ñawɓe neutropenik). 5. Urin e ɓalndu: Naamndo so tawii urin ina nanndi e ɓuuɓri, ina nanndi e duule walla pinndi, walla ina usta no feewi e nder waktuuji 12 jawtuɗi ɗii.

Ɗatal 3 : Njuɓɓudi Trombositopeni (Plaquettes les) e sahaa gooto¶

Sabu kemiterapi ina suppita ƴiiƴam ɗam fof, ñawɗo mo ƴiiƴam ɗam ŋakkiraa (neutropenia) ina heewi no feewi heɓde ƴiiƴam ɗam ina famɗi no feewi (trombositopeni, haa teeŋti noon so ƴiiƴam ɗam ina ustoo les $10,000\text{ to }20,000 e$}me waktu e{xa:}mu) - Ƴeewto ɓalndu ƴiye, koyɗe, e juuɗe yeeso ngam yiytude toɓɓe tokoose boɗeeje walla boɗeeje ɗe ɓuuɓnataa so ɗe ɓuuɓnaama (petechiae), ɓuuɓri ɓaleeri ndi laaɓtaani (ecchymoses), walla ɓuuɓri ƴiiƴam nder hunduko (wet purpura). - So tawii ñawɗo oo ina wondi e ƴiiƴam nofru walla ƴiiƴam gonɗam e sara nguleeki, jooɗo-ɗaa ɗum en tiiɗɗi ina njuuroyoo yeeso, ɓuuɓna nofru les softundu nduu tawa ina jokki fotde hojomaaji 20 (ƴeew). ƴiiƴam nofru), e wiyde suudu safrirdu ɗoon e ɗoon nde tawnoo ina gasa tawa ina hatojini e ɓurtugol ƴiiƴam ko yaawi e sara antibiotik maɓɓe IV.

Ɗatal 4: Jeertinaango keeriiɗo wonande ñawɓe cellal CAR-T e antibiotikuuji ɗiɗi (CRS e ICANS)¶

So tawii ko ɓooyaani koo ñawɗo heɓi CAR-T cell therapy (terapi T-cell recepteur antigen chimérique) walla antibiotik bispecific T-cell engager ngam ñawu nguu, limfoma, walla myeloma keewɗo e nder yontereeji 4 jawtuɗi ɗii, nguleeki kiiɗki ina jogii caɗeele ɗiɗi nguurndam-thre e sahaa gooto: 1. Sepsis bakteriiji neutropenik (ina ɗaɓɓi antibiyotik IV ɗoon e ɗoon fotde hojomaaji 60), E 2. Sindoron ɓuuɓgol sitokin (CRS) e sindrom ɓuuɓɗo gonɗo e ƴiiƴam (ICANS): Ɓooygol ɓuuɓngol mawngol saabaade nguleeki mawki (\(>38,0^\circ\text{C}\) haa \(40,5^\circ\text{C}dde\)), ustude ƴiiƴam, ustude ƴiiƴam (dimmbagol, waylo-waylo binndol, caɗeele yiytude konngol, jiiɓru, walla ɓuuɓri). - Golle doosɗe: Waɗde sahaa kala hollir ñawɗo oo CAR-T / Kartal Wallet Bispecific e nder triage urgence ɗoon e ɗoon; ko jiidaa e antibiyotikaaji IV jaajɗi, ɓeeɗoo ñawɓe ina ɗaɓɓi ƴettugol ko yaawi tocilizumab e/walla kortikosteroid jokkondirɗo e nokku mum en safaara cellal.

Binndol jokkondiral laaɓtungol wonande 911 / 112 / 999 e Triage Emergency¶

Wiɗtooji kollitii wonde ñawɓe kanseer neutropenik ina keewi dañde caɗeele bonɗe e nder nokkuuji ɗo yimɓe heewɓe ngoni ɗoo, so wonaa tawa ñawɗo oo walla tergal galle oo ina hollita konnguɗi safaara "Sepsis neutropenik kemiterapi: windo antibiotik 60 minit" e jokkondiral gadanal ngal. Huutoro ndee binndol konngol e konngol:

• So a noddii 911 / 112 / 999 (so tawii ko ɓuuɓri, ɓuuɓri, ɓuuɓri fooftere, walla jiiɓru ina woodi):

  "Miɗo haani ambulance to [Adresse Exact] ngam tuumeede Sepsis Neutropenic. Ñawɗo oo ko [Duuɓi]-duuɓi [gorko/debbo] ina waɗa kimoterapi ngam [Nokku Kanser], e kimoterapi maɓɓe cakkitiiɗo ñalnde [ñalngu, balɗe X ɓennuɗe]. [O/O] ina jogii nguleeki C /O] ina wondi e [ɓuuɓri diwtundi / ɓuuɓri / ɓuuɓri foofaango / jiiɓru], kadi ina jogii [laayi PICC Port-a-Cath / junngo Min ndokkaani hay Tylenol walla ibuprofen gooto."

• So aɗa ƴetta haa to Departemaa Emergency Triage Desk (so aɗa ari e oto):

  "Oo ñawɗo ina woni e kimoterapi kuuɓtodinɗo (ñalngu [X] caggal ɓuuɓri, e nder windo nadir) ina jogii Feer Neutropenique [X.X°C / XXX.X°F]. Ko ɗoo [mo] Kartal Jeertinaango Sepsis Neutropenik Onkoloji. E les ASCO, IDhemedicines, e [NINI] ina ɗaɓɓi ndeenka isolation, pine ƴiiƴam periferik e Port-a-Cath, e dose gadano antibiotikuuji gonɗi e nder ƴiiƴam e nder hojomaaji 60 caggal triage."

• So tawii ñawɗo oo ina wondi e ñawu nguu (Inhibiteurs de contrôle) ko wayi no :

  "Teskorde teeŋtunde ngam Triage: Oo ñawɗo ina heɓa Immunoterapi kanseer ([Innde lekki]), wonaa tan kemiterapi aada. Maale mum en ina mbaawi wonde Keɓe bonɗe jowitiiɗe e immuno (irAE) ko wayi no pneumonitis autoimmune, kolitis, crisis miokarditis, walla kortikosteroids toowɗo ko jiidaa e kuulal ñawu nguu."

Ko nanngata e nder hojomaaji 2 ngam Go-Bag Departemaa Emergency¶

• "Kartal jeertinaango kaalis kemiterapi / immunoterapi" ñawɗo oo (hollitta ko njuɓɓudi leɗɗe laaɓtuɗe, ñalngu cirƴam cakkitiiɗam, pager/limoore telefoŋ onkolooji waktuuji 24, e sifaa porto).
• Kaayitaaji annditirɗi Port-a-Cath walla fob porto baawɗo innirde doole (ina haalana infirmiyee en so tawii porto ɓalndu ko "Power-Injectable" ngam ƴeewndaade CT scan e hol no njuuteendi ƴiiƴam Huber [\(3/4\text{-inch}\) vs. \(1\text{-inch}\)] foti e porto oo).
• Kirim ɓuuɓɗo (kirim ɓuuɓɗo lidocaine/prilocaine EMLA) so tawii ko yamiraa : waɗde dabbo kiri ɓuuɓɗo yamiraa e dow ɓalndu Port-a-Cath ɓuuɓnaaɗo e ɓuuɓri plastik tawa aɗa yaha e nder oto haa safrirde ina ɓuuɓna ɓalndu e nder hojomaaji 30 ko ɗum waɗi naatde e porto oo e ƴiiƴam Huber ina metti.
• Leɗɗe galleeji jooni ɗee kala (haa teeŋti e kala leɗɗe cafrorteeɗe ko wayi no levofloksasin walla trimetoprim-sulfametoksazol, leɗɗe cafrorteeɗe ko wayi no flukonazol/posakonazol, leɗɗe cafrorteeɗe ko wayi no asiklovir, leɗɗe cafrorteeɗe mawnugol ko wayi no pegfilgrastim [Negrastiusta]s, walla).
• Chargeur telefoŋ e mask spare laaɓɗo.

Haɓde e ñawu nguu ñalnde kala e nder Nadir Kimoterapi (Balɗe 7 haa 14)¶

So tawii hay feere wootere haɗataa 100 e nder teemedere ñawu nguu (sabu ko ɓuri heewde e ñawuuji ɗii ummorii ko e mborosaaji gonɗi e nder reedu ñawɗo oo), rewde ɗeeɗoo kuule tuugiiɗe e hujjaaji e nder balɗe maa ɗe limto-ɗaa seeɗa ina usta ɓuuɓri safrirde ndi waawataa haɗeede : 1. Toppitagol hunduko (Haɗde naatgol mukositis): Loowtu hunduko maa laabi 4 e ñalawma (caggal kala ñaamde e hade maa lelnude) e ɓuuɓri ɓuuɓndi \(1/2\text{ kaas}\) kafe e \(1/2\text{ kaas}\) soda (inved sodium \(\L2solbonate) m (\)8\binndol{ ons}$) ndiyam ngulɗam. Huutoro ɓuuɓri ɓuuɓri, reentoo ɓuuɓri njulaagu ndi alkol ina yoora, ina ɓuuɓna ɓuuɓri hunduko. 2. Haɗde ɓuuɓri e ɓuuɓri reedu: Kimoterapi e leɗɗe kaɓtorɗe ɓuuɓri (hono ondansetron/Zofran) ina addana ɓuuɓri tiiɗndi. Sosde ngam rewde ƴiiƴam tiiɗɗam ina ɓuuɓna ƴiiƴam ɗam (fissure anal), ina addana bakteriiji ɓalndu naatde e ƴiiƴam. Ƴettu ko yaawi softeende/laxatives ɗe onkolooji maa wasiyii, njaraa ndiyam keewɗam, kadi woto meeɗ huutoraade ɓuuɓri walla enemas. 3. Nyaamdu e laaɓal juuɗe: Lootde juuɗe e saabunde e ndiyam ngulɗam fotde leƴƴanɗe 20 hade ñaamde e caggal nde kuutorto-ɗaa lootorde. Sewnu kosam, colli, liɗɗi, e egguuji fof no moƴƴi haa nguleeki nder suudu kisal, loot ɓiɓɓe leɗɗe e leɗɗe ɓutte no moƴƴi, e reenaade kosam ɗam pasteurisaaka, ɓutte ɓutte, ɓutte ɓutte/sushi, e ñaamdu buffet jooɗiiɗo e nguleeki suudu. 4. Famde Pegfilgrastim (Neulasta) Nafoore ƴiye e Feere Goonga: Ñawɓe heewɓe ina keɓa ƴiiƴam ɓalejam (pegfilgrastim walla filgrastim, G-CSF) waktuuji 24 caggal nde ɓe keɓi safaara. No ƴiiƴam ɗam yaawi feewnude neutrophiles kesi e nder balɗe 2 haa 5 garooje ɗee nii, ñawɓe ɓee ina keewi tinde ɓuuɓri luggiɗndi e nder reedu mum en, e nder reedu mum en, e nder reedu mum en (ina heewi ustude ɗum e loratadine [Claritin] so tawii ko onkolooji jaɓi ɗum). Kono, woto meeɗ sikkude nguleeki \(38.0^\circ\text{C}\) (\(100.4^\circ\text{F}\)) walla ko ɓuri ɗum ko "tan e ƴiiƴam Neulasta": sahaa kala ƴeewto nguleeki maa, nodda onkoloji ɗoon e ɗoon ngam kala nguleeki.

Naamne keewɗe naamneede¶

Hol ko waɗi ƴettude Tylenol (asetaminofen / parasetamol) walla ibuprofen ngam ɓuuɓri seeɗa walla ɓuuɓri hoore ina bonna e nder safaara ?¶

So tawii kemikal (chimiothérapie) ina usta ƴiiƴam maa (neutrophiles), ɓanndu maa waawaa waɗde ɓuuɓri, ɓuuɓri, walla ɓuuɓri nokkuyankeewal so bakteriiji naatii, ko ɗum waɗi nguleeki ɓeydotooki ina heewi wonde maande jeertinaande TAN wonde ñawu nguu ina waawi warde nguurndam fuɗɗiima. Ƴettude asetaminofen, parasetamol, ibuprofen, walla aspiriin ina usta nguleeki maa artificiel fotde waktuuji keewɗi, ina suuɗa oon maande jeertinaango tawa bakteriiji ina keewi e nder ƴiiƴam maa no feewi. Hoto meeɗ ƴettude lekki ustooji nguleeki e nder safaara (chimiothérapie) tawa aɗa ƴeewtoo nguleeki maa ko adii, aɗa heɓa kadi seedantaagal laaɓtungal e fedde maa onkoloji.

Hol ko woni jaŋtol termometre tigi rigi limteteengol e nder safaara e nder sahaa kemiterapi ?¶

E fawaade e jamirooje onkoloji winndereeje (ASCO, IDSA, e ESMO), ɓuuɓri ɓuuɓri ko kala nguleeki hunduko gootol 38,3°C (101,0°F) walla ko ɓuri ɗum, WALLA nguleeki hunduko 38,0°C (100,4°F) walla ko ɓuri ɗum, duumotooɗo fotde balɗe 1 e nder suudu safrirdu janngugol gootol ko 38,0°C / 100,4°F). Yanti heen, so tawii ñawɗo kemikal ina wondi e ɓuuɓri diƴƴe (rigors), ɓuuɓri ƴiiƴam, ɓuuɓri ɓuuɓri, ɓuuɓri foofaango, walla nguleeki LOW no feewi les 36,0°C (96,8°F), ko ɗum huunde nde alaa ɗo haaɗi hay so tawii janngugol termometre toowngol alaa.

Hol ko waɗi jamirooje urgence ina kaɗa huutoraade termometre reedu walla ɓuuɓri reedu e ñawɗo kemikal ?¶

Simiterapi ina ɓuuɓna, ina leefna ƴiiƴam ɗam ɓuuɓɗam ɗam gonɗam e nder reedu e ɓalndu, tawa kadi ina usta ƴiiƴam ɓalejam kaɓtortooɗam ñawu nguu e ƴiiƴam ɗam ɓuuɓɗam. Naatde e termometre, walla ɓuuɓri, walla enema ina waawi ɓuuɓnude walla ɓuuɓnude ɓalndu nduu, tawa ina naatna miliyoŋaaji bakteriiji ɓalndu to bannge ƴiiƴam (ina addana ɗum sepsis Gram-negatif bonɗo) e saabaade ƴiiƴam ɓalndu tiiɗɗam.

Hol ko waɗi ɓuuɓri ɓalndu e ñawɗo kanseer ina ɗaɓɓi ƴeewndo yaawngo ngam anndude so tawii ko ɓuuɓri ɓalndu ?¶

Kanseer keewɗo (haa teeŋti e kanseer ɓernde, prostate, ɓuuɓri, ƴiiƴam, e myeloma multiple) ina mbaawi saabaade ƴiye ɓalndu. So tawii ɓuuɓri mawnii e nder reedu, maande adannde e nder ko ina tolnoo e 90% e ñawɓe ɓee ko ɓuuɓri kesiri walla ɓeydotoondi (ko ɓuri bonde so neɗɗo ina lelii e leeso walla ina ɓuuɓtoo) balɗe walla jonte hade koyɗe ɗee ɓuuɓde walla ɓuuɓde. Nanngude ɓuuɓri ɓalndu bonndi ko yaawi e MRI e doseeji toowɗi IV deksametason tawa ñawɗo oo ina waawi yahde haa jooni ina reena mbaawka maɓɓe yahde e jogaade ƴeewndo ɓuuɓri.

Fuɗɗoode ƴeewtaama¶

• Fedde Ameriknaare Onkoloji (ASCO) e Fedde Ameriknaare Ñawuuji Ɓooyɗi (IDSA, Dental Dowlaaji Amerik): Njuɓɓudi ñawbuuli e ɓuuɓri e nder mawɓe safrooɓe ñawu nguu: ASCO e IDSA Kesɗitingol Kuutorgal Kilinik Jo.)Clinikal OSA eClinikal Laabi gollorɗi ngam huutoraade ñawbuuli mborosaaji e nder ñawɓe neutropenik wonduɓe e kanseer (Freifeld et al.).
• Duɗal ngenndiwal toppitiingal cellal e toppitagol (NICE, Royaume-Uni): Sepsis neutropenic: haɗde e ƴellitde e nder yimɓe wonduɓe e kanseer (Kuulal safaara NICE CG151, yamiroore damal to antibiotik e nder hojomaaji 60) e *Njuɓɓudi ƴiiƴam gonndi e ƴiiƴam e nder mawɓe Laabi NG234).
• Fedde Oropnaare ngam Onkoloji Cafrirɗe (ESMO): Njuɓɓudi Neutropenie Febrile: Kuule kuutoragol ESMO e nder safaara (Klastersky et al., Annals de Oncologie) e Kuule ESMO ngam Njuɓɓudi Tookeeji ummoriiɗi e Immunoterapi.
• Reso ngenndiijo kuuɓtodinɗo kanseer (NCCN, Amerik): Laabi gollorɗi safaara NCCN e nder onkoloji: haɗde e safrude ñawuuji jowitiiɗi e kanseer e Njuɓɓudi tooke jowitiiɗe e inhibitor immune checkpoint.
• Fedde infirmiyeeji onkoloji (ONS) & Fedde infirmiyeeji onkoloji UK (UKONS): Laabi njuɓɓudi puɗɗagol onkoloji akut e kuutorɗe ƴeewndo jaawngo Triage waktuuji 24.

Ardiiɓe jokkondirɓe¶

• Sepsis e septik shock anndinde e jaabawol e nder sahaa
• Sindoron Cauda equina e ɓuuɓri ɓalndu ɓuuɓndi banngeeji boɗeeji
• Kiriis adrenal e ñawu Addison ina ɓuuɓna
• Emboli pulmonaire e trombose ƴiiƴam luggiɗɗam (DVT)
• Ƴiiƴam bonɗam nguurndam e dow ƴiiƴam ɓuuɓɗam walla e hemofili