Zazzabin Neutropenic A Lokacin Chemotherapy da Gaggawar Maganin Ciwon daji¶

Ga duk wanda ke karbar chemotherapy, maganin barnar kasusuwa da aka yi niyya, ko dashen kwayar halitta, ** zazzabi mai sauƙi ba shine "mura kawai" ba: gaggawa ce ta likita mai haɗari da ake kira Febrile Neutropenia (Zazzabin Neutropenic)**. Chemotherapy yana lalata ƙwayoyin farin jini masu saurin rarraba da aka sani da ** neutrophils **, sojojin da ke kan gaba a jiki don yakar kwayoyin cuta da fungi, musamman a lokacin taga "nadir" ($ 7\text{ to }14\text{ days}$ bayan jiko na chemotherapy). Lokacin da adadin neutrophil ya ragu zuwa sifili ko kusa-sifili, ƙwayoyin cuta marasa lahani waɗanda ke rayuwa ta zahiri a cikin baki, hanji, ko a kan fata a kusa da tashar tashar jijiya ta tsakiya za su iya mamaye jini kuma su ninka kowane minti 20 ba tare da haifar da kumburi, ja, ko tari ba. Idan ba a kula da shi ba a gida na ko da ƴan sa'o'i, zazzabin neutropenic yana ci gaba da sauri zuwa ci gaba. sepsis da septic shock. Rayuwa ya dogara da Dokar Zinariya "Kofa-zuwa-Antibiotic" *: kai ga sashen gaggawa nan da nan don haka maganin rigakafi masu yawa na cikin jini suna bazuwa ** cikin mintuna 60 na rarrabewa, kuma ba za su taɓa ɗaukar zazzabi mai tashi tare da kan-da-counter acetaminophen (paracetamol) ko ibuprofen kafin kiran ƙungiyar oncology.

Yi wannan yanzu¶

1. ** Bincika zafin baki (baki) ko tympanic / na ɗan lokaci nan da nan kuma a yi amfani da tsauraran \(38.3^\circ\rubutu{C}\) (\(101.0^\circ\rubu{F}\)) / \(38.0^\circ\rubutu{C}\) ($ 100.4^\circ\rubutu{F}$) mulkin Amurka. Oncology (ASCO), European Society for Medical Oncology (ESMO), da UK NICE jagororin, ** Neutropenic Fever ** an bayyana shi azaman:
2. Zazzabi guda ɗaya na baka na \(38.3^\circ\rubutu{C}\) (\(101.0^\circ\rubutu{F}\)) ko mafi girma, ** KO**
3. Zazzabi na baka na \(38.0^\circ\rubutu{C}\) (\(100.4^\circ\rubutu{F}\)) ko sama da haka wanda ke dawwama na awa 1 (ko ana auna sau biyu aƙalla awa 1 baya).
4. *(Lura: Yawancin amintattun NHS na Burtaniya da cibiyoyin ciwon daji suna amfani da madaidaicin madaidaicin madaidaicin karantawa ɗaya na \(38.0^\circ\rubutu{C}\) [\(100.4^\circ\rubutu{F}\)] sau ɗaya, ko *\(37.5^\circ\rubutu{C}\) [$ 99.5^\circ\” sa'a sau biyu a cikin sa'o'in ku na ci gaba da bibiyar sa'a guda biyu. mafi tsananin kati.)
5. Kira lambar gaggawa ta gida nan da nan idan majiyyaci na da sanyi/masu ƙarfi, juwa, ruɗe, ƙarancin numfashi, ko hawan jini. Buga lamba 911 a Amurka da Kanada, 112 a faɗin Tarayyar Turai, 999 a Ƙasar Ingila, ko duba duka. lambobin gaggawa idan majiyyaci yana da ** girgiza sanyi (rigors), yana jin suma lokacin da yake tsaye, yana da saurin bugun zuciya (\(>100\rubutu{bpm}\)), yana da hawan jini na systolic kasa da \(100\rubu{mmHg}\), ko yayi kodadde, mottled, ko dimuwa, koda kuwa ma'aunin zafi nasu ya karanta ** na al'ada ko kuma mara nauyi ($ 36text ($ ^ 36) \(<96.8^\circ\rubutu{F}\)), kamar yadda ciwon sanyi shine mafi hatsari nau'i na tashin hankali.
6. Idan baku da lafiya tare da zazzaɓi,kira layin gwajin Oncology na awa 24 nan da nan kuma ku je Ma'aikatar Gaggawa kai tsaye. Kada ku jira har zuwa lokutan ofis na safe. Ka sa wani ya tuƙi majiyyaci zuwa asibiti nan da nan, kuma ka tambayi likitan ciwon daji don ya kira gaba zuwa teburin dakin gaggawa don haka ** al'adun jini da maganin rigakafi na cikin jini suna shirye bayan isowa**.
7. **Kada a ba da kwayoyin da ke rage zazzaɓi (babu acetaminophen, paracetamol, ibuprofen, ko aspirin) kuma kada ku yi amfani da ma'aunin zafin jiki na dubura. fiye da karatun baka, don haka karatun karkashin hannu na \(37.8^\circ\rubutu{C}\) [\(100.0^\circ\rubutu{F}\)] daidai yake da zazzabin baka).
8. ** Sanya abin rufe fuska mai matse jiki ko N95/FFP2 abin rufe fuska a kan majiyyaci kafin shiga cikin dakin jira na Sashen Gaggawa.** Saboda majinyacin neutropenic ba shi da kariya ta kariya, zama ba a rufe a cikin cunkoson dakin jira na gaggawa kusa da marassa lafiya tari yana da hadari. Gabatar da "Chemotherapy Neutropenic Sepsis Alert Card" ga ma'aikacin jinya nan da nan kuma ka nemi a sanya shi a ** keɓe dakin jarrabawa ** nan take.
9. ** Bincika sauran Manyan Gaggawa na Oncologic guda huɗu.** Yayin da ake shirya don sufuri, allon da sauri don ** Malignant Spinal Cord Compression ** (sabon ciwon baya tare da rauni na ƙafafu, damuwa, ko matsalar mafitsara), ** Super Vena Cava (SVC) Ciwo ** (fuskar fuska / wuyansa da kuma rashin ƙarfi na numfashi), ** Tumor Lysis (Credit Syndrome) bugun jini a cikin kwanaki na fara chemo), da Hypercalcemia na Malignancy ( matsananciyar ƙishirwa, yawan fitsari, maƙarƙashiya, da rudani).

Bishiyar yanke shawara ta gaggawa da maganin cutar kansa¶

Yi amfani da wannan taswirar taswirar asibiti don tantance duk wata alama mai tsanani a cikin majiyyaci da ke fama da maganin cutar kansa ko cikin makonni 6 na chemotherapy.

flowchart TD
    Start["Marasa lafiya na Ciwon daji akan Chemotherapy, Immunotherapy, <br/> ko Radiation Yana Haɓaka Mummunan Alamu"] --> SepsisFlags{"Mataki 1: Duba Gaggawar Shock Septic / Rikicin Jajayen Tutoci <br/>1. Jijjiga sanyi (rigors), ko da ba tare da yawan zafin jiki ba?<br/>2. Hypothermia: Zazzabi <36.0°C (96.8°F)?<br/>3. Dizziness, suma, ruɗe, ko slured magana?<br/>4. Karancin numfashi, saurin numfashi, ko ciwon kirji?<br/>5. Ja, maƙaryaci, ko zafi akan layin Port-a-Cath / PICC / Hickman?"}

    SepsisFlags -->|"E: Kowa 1 kyauta"| Call911["MUHIMMAN CUTAR CUTAR CUTAR ONKOLOGIC SEPSIS / CRISIS: <br/>1. Kira 911 / 112 / 999 Nan da nan don Ambulance <br/>2. Bayyana 'Chemotherapy Neutropenic Sepsis Gaggawa'<br/>3. Ƙaddamar da Ƙofar-zuwa-IV-Antibiotic Target na Minti 60<br/>4. Ci gaba da kwance (ko a tsaye idan gajeriyar numfashi); NPO"]

    SepsisFlags -->|"A'A"| TempCheck{"Mataki na 2: Duba Yanayin Baki <br/>(KADA a yi amfani da ma'aunin zafin jiki na dubura) <br/>Shin yanayin zafi ne >= 38.3°C (101.0°F) Sau daya<br/> KO >= 38.0°C (100.4°F) na awa 1?"}

    TempCheck -->|"E: Ƙofar zazzabi ta hadu"| NeutFever["CIWON NEUTROPENIC GAGGAWA:<br/>1. KAR KA ba Tylenol/paracetamol, ibuprofen, ko aspirin<br/>2. Kira Layin Triage Oncology na awa 24 YANZU yayin da ake tashi<br/>3. Sanya abin rufe fuska a kan haƙuri; je Sashen Gaggawa YANZU<br/>4. Nuna Katin Faɗakarwa na Chemo a wurin rarrabewa: buƙatar keɓancewa + <br/> Al'adun Jini (Port + Peripheral) & Magungunan rigakafi na IV < 60 mins"]

    TempCheck -->|"A'a: Babu zazzabi ko alamun sepsis"| OncEmerg{"Mataki na 3: Bincika Gaggawar Ciwon Kankara Na Tsari & Metabolic:<br/>A. Sabon ciwon baya/ wuya + rauni na ƙafafu, ƙumburi, ko canjin mafitsara?<br/>B. Fuska mai kumbura/wuyansa/hannu + tari/magani mafi muni kwance?<br/>C. Chemo na baya-bayan nan (kwanaki 1-7) + ciwon ciki, tashin zuciya, fitsari mai duhu?<br/>D. Tsananin ƙishirwa, ruɗewa, maƙarƙashiya, ciwon kashi?"}

    OncEmerg -->|"A: Ciwon baya + alamun neuro"| MSCC["MATSALAR MALIGNANT NA KWANA: <br/> Gaggawa Spine MRI + High-Dose IV Dexamethasone YANZU"]

    OncEmerg -->|"B: kumburin fuska/wuyansa + dyspnea"| SVCS["DA ake zargi SUPERIOR VENA CAVA (SVC) SYNDROME: <br/> Zauna a tsaye (45-90 deg); Gaggawa Kirji CT + Kula da Oncology"]

    OncEmerg -->|"C ko D: Rikicin Metabolic"| Metabolic["TUMOMIN LYSIS KO HYPERCALCEMIA:<br/>Sashen Gaggawa YANZU don ECG, Electrolytes, & Fluids na IV"]

Sashe na 1: Fahimtar Zazzaɓin Neutropenic da Tagar Haɗari "Nadir".¶

1. Menene "Cikakken Ƙididdiga Neutrophil" (ANC) da Chemo Nadir?¶

Farin ƙwayoyin jini (leukocytes) sun haɗa da nau'ikan tantanin halitta da yawa, amma ** neutrophils ** sune farkon ƙwayoyin kashe ƙwayoyin cuta. Likitoci suna lissafin ** Cikakken Neutrophil Count (ANC)** ta hanyar ninka jimillar adadin farin jinin jini da kashi na neutrophils ("segs") da kuma makada mara girma: - Lafiya ta al'ada ANC: \(1,500\rubutu{zuwa}}8,000\rubutu{sel a kowace microliter}(\mu\rubutu{L})\) (ko \(1.5\rubutu{zuwa}}8.0 \ sau 10^9/\rubutu{L}\)). - Neutropenia: ANC kasa \(1,500\rubutu{sel}/\mu\rubutu{L}\) ($ <1.5 sau 10^9/\rubutu{L}\(). - **Mai tsananin Neutropenia (Hadarin Zazzabi):** ANC da ke ƙasa **\)500\rubutu{sel}/\mu\rubutu{L}\(** (\) <0.5 sau 10^9/ rubutu{L}$), ko ƙasa \(1,000 rubutu{sel}/mu\rubutu{L}\)04 ana sa ran saukewa a ƙasan \(5 hours. - **Babban Neutropenia (Mai Girman Haɗari):** ANC a ƙasa **\)100\rubutu{sel}/\mu\rubutu{L}\(** (\) <0.1 lokuta 10 ^ 9/ rubutu {L}$), na kowa a lokacin shigar da cutar sankarar bargo ko dashen kwayar halitta.

Yaushe ne "Nadir" ke faruwa? Bayan da aka shigar da daidaitaccen tsarin sake zagayowar chemotherapy a ranar 1, neutrophils da ke yawo a cikin jini suna rayuwa na ƴan kwanaki yayin da masana'antar kasusuwa ta cika da mamaki na ɗan lokaci. Sakamakon haka, adadin jinin jinin ya kai mafi ƙasƙancin dutsen ƙasa (** nadir ***) yawanci tsakanin **Ranar 7 da Rana ta 14 bayan chemotherapy ** (ko da yake yana iya faruwa a kowane lokaci a lokacin jiyya na baka na yau da kullun, radiation, ko ciwon daji na jini kamar cutar sankarar bargo, lymphoma, da mahara myeloma).

2. Me yasa cututtuka ke kallon gaba ɗaya ganuwa lokacin da kuke da sifili neutrophils¶

A cikin mutumin da ke da tsarin rigakafi na yau da kullun, kamuwa da cuta a bayyane yake saboda ** miliyoyin neutrophils suna ruga zuwa wurin kuma su mutu**, suna haifar da kauri mai launin rawaya, fata mai kumbura, raɗaɗi mai raɗaɗi, ko farar fata masu yawa akan X-ray na ƙirji: - Babu Neutrophils = Babu Pus kuma Babu Alamun Nau'a: A cikin majinyacin neutropenic mai tsanani: - Mummunan cutar ciwon huhu ** na iya haifar da ** tari, sifili phlegm, da cikakken haske mai x-ray na ƙirji*, yana nuna zazzabi kawai da ɗan saurin numfashi. - Ciwon fitsari mai tsanani (urosepsis)** na iya haifar da ** konewar sifili yayin yin fitsari** kuma ya nuna ** sifili fararen ƙwayoyin jini (pyuria) akan mashin fitsari**, yana nunawa da zazzaɓi kawai. - M fata ko cellulitis mai kisa a kusa da dubura ko tashar ruwa ta tsakiya na iya nuna ** zunzurutun majigi ko ƙurji mai jujjuyawa**, yana nunawa kawai tare da ɗumi mai ɗanɗano, raɗaɗin ruwan hoda, ko taushin wuri tare da zazzabi. - ** Gargaɗi akan Corticosteroids Masking Zazzabi:** Yawancin masu ciwon daji suna shan kullun ko mako-mako ** dexamethasone ko prednisone** (don kumburin kwakwalwa, lymphoma, myeloma mai yawa, illolin immunotherapy, ko tashin zuciya). Corticosteroids suna da karfi danne ma'aunin zafi na kwakwalwa na hypothalamus. Majinyaci da ke shan dexamethasone zai iya samun cikakken sepsis na neutropenic na jini tare da yawan zafin jiki na \(37.0^\circ\rubutu{C}\) (\(98.6^\circ\text{F}\)) \(36.0^\circ\rubutu{C}\) (\(96.8^\circ\rubutu{F}\))**.

3. "Dokar maganin rigakafi na Minti 60 Kofa zuwa Allura"¶

Da zarar kwayoyin cuta sun shiga cikin jinin majiyyaci ba tare da neutrophils ba (yawanci ** sandunan gram-negative ** kamar * Escherichia coli , * Klebsiella pneumoniae , ko * Pseudomonas aeruginosa * suna canzawa ta hanyar chemotherapy-lalacewa bakin ulcers [mucositis-kamar kumburin baki [mucositis] ko intestinal. Staphylococcus da Streptococcus daga tsakiyar venous catheters), mace-mace na karuwa sosai tare da kowane sa'a na jinkiri. - ** Umurnin Asibitin Kasa da Kasa: Sharuɗɗa daga ASCO, IDSA, ESMO, Kamfen ɗin Sepsis Surviving, da UK NICE (CG151) sun ba da umarni cewa kowane sashen gaggawa ya ba da kashi na farko na empiric anti-pseudomonal intravenous maganin rigakafi na beta-lactam ** (kamar ** cefepime, piperacillin) meropenem)*****************************************)))****,,** ba tareda jiran sakamakon gwajin gwajin jini ba, (CBC) zai dawo, idan ana zargin neutropenia. - Abin da ke faruwa a cikin waɗannan mintuna na 60 na farko: Nurses nan da nan zana ** nau'i biyu na al'adun jini ** (saitin daya zana ta kowane lumen na mai haƙuri ** Port-a-Cath, PICC line, ko Hickman catheter **, da kuma saitin daya zana daga jijiya na gefe), zana Cikakkar Jini Count (CBC, matakin jini da daban-daban). kwayoyin cuta nan da nan bayan zana jini. - High-Risk vs. Low-Risk Triage (The MASCC Score): Once the initial IV antibiotic dose is running, oncologists and emergency physicians calculate the Multinational Association for Supportive Care in Cancer (MASCC) Risk Index and CISNE score to determine whether the patient must stay in an inpatient isolation room (mandatory for leukemia, stem cell transplant, low blood pressure, ciwon huhu, ciwon ciki, rudani, ko mucositis mai tsanani) ko zai iya canzawa zuwa maganin kulawa sosai.

Sashe na 2: Gane Wasu Gaggawa Na Gaggawa Kan Rayuwa Biyar¶

Ko da lokacin da mai ciwon daji ba shi da zazzaɓi, mummunan aiki da kuma maganin ciwon daji na zamani (chemotherapy, radiation, da ** masu hana shinge na rigakafi ***) na iya haifar da rikice-rikice na tsari guda biyar ko na rayuwa waɗanda ke buƙatar kulawar gaggawa gaggawa:

Mataki-mataki kulawa kafin asibiti yayin shirye-shiryen Sashen Gaggawa¶

Mataki na 1: Yadda ake ɗaukar Madaidaicin Zazzabi Lafiya a cikin Majinyacin Chemotherapy¶

1. Yi amfani da na'urar baka ta dijital (a ƙarƙashin harshe), tympanic (kunne), ko jijiya na ɗan lokaci (goshi) ma'aunin zafi da sanyio.
2. Idan majiyyaci kawai ya sha shayi mai zafi ko ruwan ƙanƙara, jira ** 15 zuwa 20 mintuna ** kafin ɗaukar zafin jiki don kada a canza karatun.
3. Haramta Tsanani: Kar a taɓa amfani da Ma'aunin zafi da sanyio.
4. Chemotherapy yana lalata ƙwayoyin mucosal masu rarraba cikin sauri wanda ke rufe dukkan sassan gastrointestinal daga baki zuwa dubura (mucositis). Tura ma'aunin ma'aunin zafi da sanyio (ko suppository, enema, ko tampon) a cikin dubura na iya haifar da tsagewar da ba a iya gani ba a cikin rufin dubura mai rauni, yana barin miliyoyin E. coli da anaerobic gut kwayoyin cuta don shiga cikin jini nan take (kwayoyin cuta) da kuma haifar da kumburin hanji mai haɗari ko zubar jini wanda ba za a iya sarrafawa ba idan platelets sun yi ƙasa (thrombocytopenia).

Mataki na 2: Bincika Shafukan Shigar Cutar Cutar “Booye Biyar¶

Yayin da yake magana da ma'aikaciyar jinya ko jiran jigilar kaya, duba waɗannan tabo guda biyar (kada ku taɓa matsi, fashe, ko buga wani ciwo) kuma ku ba da rahoton abin da kuke gani: 1. ** Na'urar Samun Hannu ta Tsakiya (Port-a-Cath, Layin PICC, ko Hickman Tunnelled Catheter):** Dubi fatar da ke saman tashar tashar ƙirji ko layin PICC na hannu ba tare da bare suturar da ba ta dace ba. Akwai wani ja, kumburi, dumi, taushi, ko rawaya ɓawon burodi tare da hanyar rami? Shin zazzabi ko girgizar sanyi ya fara ** cikin mintuna 30 zuwa 60 bayan an yi ruwa ko amfani da tashar jiragen ruwa**? ( Alamar al'ada ta lumen catheter, dole ne ma'aikatan asibiti su zana al'adun jini daga tashar jiragen ruwa * kafin * yanke shawarar yadda za a bi da shi.) 2. Baki, Gums, da Maƙogwaro (Oral Mucositis): Hana hasken waya a cikin baki. Akwai jajayen miki mai raɗaɗi, fari kamar faci (thrush/candidiasis), ciwon gumi, ko wahalar hadiye ruwa? 3. Huhun Huhu da Numfasawa: Kidaya yawan numfashin da majiyyaci ya dauka cikin dakika 60 a hutawa (yawan numfashi ** sama da numfashi 20 zuwa 22 a cikin minti daya** alamar gargadin farko na sepsis ko ciwon huhu ko da ba tari ba) sannan a duba bugun bugun jini idan akwai. 4. Cikin Ciki da Wuta: Tambayi majiyyaci idan suna da ciwon ciki na gefen dama (typhlitis) ko ** duk wani ciwo, konewa, ko taushi a kusa da dubura ko kashin wutsiya lokacin zaune ko wucewar stool** (perianal cellulitis shine sau da yawa, tushen ɓoye na masu barazanar rai masu barazanar Gram-negative da anaubice). 5. Fitsari da fata: Tambayi idan fitsari ba ya jin daɗi, yayi kama da gajimare ko ruwan hoda, ko kuma ya ragu sosai a ƙara a cikin awanni 12 da suka gabata.

Mataki 3: Sarrafa Thrombocytopenia (Ƙananan Platelets) lokaci guda¶

Saboda ilimin chemotherapy yana kashe maƙarar kasusuwa gabaɗaya, majiyyaci mai ƙarancin farin jini (neutropenia) sau da yawa yana da ƙarancin platelet na jini mai haɗari (** thrombocytopenia **, musamman lokacin da platelet ɗin ya faɗi ƙasa da \(10,000» rubutu zuwa } 20,000 / mu \ rubutu {L}\)) a daidai lokaci guda: - Bincika fatar shinshina, idon sawu, da gaban gaba don ƴan ƙaramar ɗigo ja ko shuɗi waɗanda basa dushewa idan an danna (petechiae), ƙumburi mai duhu da ba a bayyana ba (ecchymoses), ko kumburin jini a cikin baki (wet purpura). - Idan majiyyaci yana zubar da jinin hanci ko danko tare da zazzaɓi, zaunar da su tsaye yana jingina gaba, daƙasa hancin ƙasa mai laushi na tsawon mintuna 20 (duba) zubar jini), kuma ku gaya wa dakin gaggawa nan da nan saboda suna iya buƙatar gaggawar bugun jini na platelet ** tare da maganin rigakafi na IV.

Mataki na 4: Faɗakarwar Gaggawa ta Musamman don CAR-T Cell da Bispecific Antibody Patients (CRS da ICANS)¶

Idan mara lafiya kwanan nan ya sami ** CAR-T cell therapy ** (chimeric antigen receptor T-cell therapy) ko ** bispecific T-cell engager antibody ** don cutar sankarar bargo, lymphoma, ko myeloma da yawa a cikin makonni 4 da suka gabata, zazzaɓi kwatsam yana da dalilai guda biyu masu barazanar rayuwa: 1. ** Neutropenic Bacterial Sepsis ** (yana buƙatar maganin rigakafi na 60-minti IV nan da nan), DA 2. ** Ciwon Sakin Cytokine (CRS) da Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS):** Babban kunnawa na rigakafi wanda ke haifar da zazzaɓi mai zafi ($> 38.0 ^ cir rubutu {C} $ zuwa $ 40.5 ^ cir\rubu {C}$), faduwawar jini, ƙarancin iskar oxygen, canjin yanayi mai wuya, canjin yanayi mai wuyar gaske, canjin yanayi mai wuyar gaske, canjin yanayi mai wuyar gaske. rudani, ko tashin hankali). - Aikin tilas: Koyaushe nuna majiyyaci CAR-T/Katin Wallet Bispecific a lokacin gaggawar gaggawa; Bugu da ƙari ga maganin rigakafi na IV mai fadi, waɗannan marasa lafiya suna buƙatar gudanar da gaggawa na mai karɓar mai karɓar mai karɓa na interleukin-6 **tocilizumab ** da / ko ** corticosteroids ** hade tare da cibiyar maganin salula.

Madaidaicin rubutun sadarwa na 911/112/999 da kuma Tashin Gaggawa¶

Nazarin ya nuna cewa masu ciwon daji na neutropenic akai-akai suna fama da jinkiri mai haɗari a cikin cunkoson wuraren jira na dakin gaggawa sai dai idan mai haƙuri ko memba na iyali ya faɗi kalmomin asibiti "Chemotherapy Neutropenic Sepsis: Window Antibiotic 60-Minute" a farkon tuntuɓar. Yi amfani da wannan rubutun kalma don kalma:

• ** Lokacin kiran 911/112/999 (idan sanyi, dizziness, shortness na numfashi, ko rudani sun kasance):**

  • "Ina buƙatar motar asibiti a [Adireshin Daidai] don wanda ake zargin Neutropenic Sepsis. Mai haƙuri shine [Shekaru] mai shekaru [namiji / mace] yana jurewa chemotherapy don [Nau'in Ciwon daji], tare da jiko na chemotherapy na ƙarshe akan [ Kwanan wata, X days ago]. Ba mu ba wani Tylenol ko ibuprofen ba."*

• Lokacin da aka haura zuwa Tebur ɗin Sashen Gaggawa (idan ya zo da mota):

  *"Wannan mara lafiya yana kan aikin chemotherapy mai aiki (Ranar [X] bayan jiko, a cikin taga nadir) kuma yana da ** Neutropenic Fever na [X.X ° C / XXX.X ° F] **. Anan [nasa] Oncology Neutropenic Sepsis Alert Card. A karkashin ASCO, IDSA, da NICE jagororin, al'adun karewa na gaggawa, [shi / she] - yana buƙatar jagororin kariyar jini. da ** na farko-kashi na farko na maganin rigakafi mai fa'ida a cikin jijiyoyi a cikin mintuna 60 na rarrabewa **."

• ** Idan mai haƙuri yana kan Immunotherapy (Masu hana masu hanawa kamar Pembrolizumab/Keytruda, Nivolumab/Opdivo, ko Ipilimumab/Yervoy):**

  "Muhimmiyar Bayani don Ƙirar: Wannan majiyyaci yana karɓar Cancer Immunotherapy ([Sunan Drug]), ba kawai maganin chemotherapy na al'ada ba. Alamun su na iya zama wani abin da ya faru na rashin lafiyar jiki (irAE)* irin su autoimmune pneumonitis, colitis, myocarditis, ko adrenal rikicin, wanda ke buƙatar tuntuɓar corticosteroids nan da nan. maganin kamuwa da cuta.*

Abin da za a ɗauka a cikin mintuna 2 don Jakar Go-Bag na Sashen Gaggawa¶

• Katin Jijjiga Wallet Wallet na majiyyaci (yana nuna ainihin tsarin magani, kwanan wata sake zagayowar ƙarshe, shafi na awa 24 / lambar waya, da nau'in tashar jiragen ruwa).
• ** Katin shaida na Port-a-Cath ko tashar jiragen ruwa mai allurar wuta ** (yana gaya wa ma'aikatan jinya na gaggawa ko tashar kirjin "Power-Injectable" don bambancin CT scan da wane girman allurar Huber [$ ¾ rubutu {-inch} $ vs. $ 1 rubutu {-inch} $] ya dace da tashar jiragen ruwa).
• ** Cream din numbing (lidocaine/prilocaine EMLA cream)** idan an wajabta shi: shafan dab na kirim ɗin da aka tsara na numbing akan kirjin Port-a-Cath da aka rufe da filastik yayin hawa a cikin mota zuwa asibiti yana lalata fata a cikin mintuna 30 don haka samun tashar tashar jiragen ruwa tare da allurar Huber ba shi da zafi.
• ** Duk magungunan gida na yanzu *** (musamman duk wani maganin rigakafi kamar levofloxacin ko trimethoprim-sulfamethoxazole, antifungals kamar fluconazole/posaconazole, antivirals kamar acyclovir, ci gaban factor injections kamar ** pegfilgrastim [Neulasta] ko filgrastim [Neupogen]**, da kuma jini thinners).
• ** Caja waya da abin rufe fuska mai tsabta.**

Rigakafin kamuwa da cuta na yau da kullun yayin Chemotherapy Nadir (Kwanaki 7 zuwa 14)¶

Duk da yake babu wani taka tsantsan da ke hana kashi 100 na zazzabin neutropenic (saboda yawancin cututtuka sun fito ne daga flora na majiyyaci na al'ada na marasa lafiya), bin waɗannan ka'idodin tushen shaida yayin kwanakin ƙarancin ku yana rage hanawa asibiti: 1. ** Kulawar Baki (Hana Shigar Mucositis):** Kurkure bakinku sau 4 a rana (bayan kowane abinci da kafin kwanciya) tare da maganin mara kyau na \(1/2\rubu{ teaspoon}\) gishiri da \(1/2\rubu{ teaspoon}\) baking soda (sodium bicarbonate) narkar da \(240\ounce{mL}\) $8\s ruwan dumi. Yi amfani da buroshin hakori mai laushi mai laushi, kuma guje wa wanke baki na kasuwanci na barasa wanda ke bushewa da fashe murfin baki. 2. Hana Maƙarƙashiya & Ciwon Zuciya: Chemotherapy da magungunan tashin zuciya (kamar ondansetron/Zofran) suna haifar da maƙarƙashiya mai tsanani. Matsewa don wucewar stool mai ƙarfi yana yayyage murfin tsuliya mai rauni ( fissure ta dubura**), yana samar da hanyar kai tsaye don ƙwayoyin hanji su shiga cikin jini. Ɗauki masu tausasawa/maganin stool da likitan likitan ku ya ba ku da wuri, ku sha ruwa mai yawa, kuma kada ku taɓa amfani da suppositories ko enemas. 3. Tsaftar Abinci & Hannu: A wanke hannu da sabulu da ruwan dumi na tsawon dakika 20 kafin cin abinci da bayan wanka. Dafa duk nama, kaji, kifi, da ƙwai sosai zuwa yanayin zafi na ciki, wanke ɗanyen ƴaƴan ƴaƴan ƴaƴan ganyaye a hankali, kuma a guji kiwo da ba a daɗe ba, ɗanyen tsiro, ɗanyen shellfish/sushi, da abincin buffet wanda ya zauna a ɗaki. 4. ** Fahimtar Pegfilgrastim (Neulasta) Ciwon Kashi vs. Zazzaɓi na Gaskiya:** Yawancin marasa lafiya suna karɓar allura mai haɓaka farin-jini (pegfilgrastim ko filgrastim, G-CSF) awanni 24 bayan chemotherapy. Kamar yadda kasusuwan kasusuwa da sauri ke samar da sababbin neutrophils a cikin kwanaki 2 zuwa 5 na gaba, marasa lafiya sukan ji zafi mai zafi a cikin kwatangwalo, kashin nono, da ƙananan baya (sau da yawa loratadine [Claritin) ya sami sauƙi idan likitan oncologist ya yarda da shi). Duk da haka, kada ku ɗauka zazzaɓi na \(38.0^\circ\rubutu{C}\) (\(100.4^\circ\rubutu{F}\)) ko mafi girma shine "kawai daga harbin Neulasta": koyaushe duba yanayin ku kuma ku kira likitan ku nan da nan don kowane zazzabi.

Tambayoyin da ake yawan yi¶

Me yasa shan Tylenol (acetaminophen / paracetamol) ko ibuprofen don zazzabi mai sauƙi ko ciwon kai yana da haɗari yayin maganin cutar sankara?¶

Lokacin da chemotherapy ya rage farin jinin ku (neutrophils), jikin ku ba zai iya yin kumburi, ja, ko kumburi a cikin gida lokacin da ƙwayoyin cuta suka mamaye ba, don haka zazzabi mai tasowa shine kawai alamar gargaɗin cewa kamuwa da cuta mai barazana ga rayuwa ya fara. Shan acetaminophen, paracetamol, ibuprofen, ko aspirin yana rage zafin jikin ku ta hanyar wucin gadi na tsawon sa'o'i da yawa kuma yana ɓoye alamar gargaɗin yayin da ƙwayoyin cuta ke ƙaruwa cikin sauri a cikin jinin ku. Kada ku taɓa shan wani magani mai rage zazzaɓi yayin chemotherapy ba tare da fara bincika yanayin zafin ku ba da kuma samun bayyananniyar izini daga ƙungiyar likitan ku.

Menene ainihin karatun ma'aunin zafi da sanyio ya ƙidaya azaman gaggawar likita yayin chemotherapy?¶

Dangane da jagororin ilimin cututtukan daji na duniya (ASCO, IDSA, da ESMO), gaggawar zazzabin neutropenic shine kowane zafin baki guda ɗaya na 38.3°C (101.0°F) ko mafi girma, KO zazzabi na baka na 38.0°C (100.4°F) ko mafi girma wanda ke ɗaukar tsawon sa’a 1 cikakke (yawancin asibitocin NHS na UK suna amfani da ƙaƙƙarfan ƙaƙƙarfan 38°C. 100.4°F). Bugu da kari, idan majinyacin chemotherapy yana da rawar jiki (rigors), dizziness, rudani, gajeriyar numfashi, ko yanayin zafi da ke ƙasa da 36.0°C (96.8°F), gaggawa ce ta gaggawa ko da ba tare da karatun ma'aunin zafin jiki ba.

Me yasa jagororin gaggawa suka hana yin amfani da ma'aunin zafi da sanyio na dubura ko suppository na dubura a majinyatan chemotherapy?¶

Chemotherapy yana yin bakin ciki kuma yana raunana lallausan mucosa mai laushi da ke rufe dubura da hanji yayin da lokaci guda ya rage duka biyun kamuwa da cuta-yakar fararen jini da kuma platelets masu zubar jini. Shigar da ma'aunin zafi da sanyio na dubura, ko ma'aunin zafi da sanyio, ko enema cikin sauki zai iya tona ko yaga bangon dubura mai rauni, shigar da miliyoyin kwayoyin cuta na hanji kai tsaye zuwa cikin jini (wanda ke haifar da muguwar kwayar cutar Gram-negative sepsis) da haifar da zub da jini mai tsanani.

Me yasa ciwon baya a cikin mai ciwon daji yana buƙatar duba gaggawa don matsawa na kashin baya?¶

Yawancin ciwon daji na yau da kullum (musamman nono, prostate, huhu, koda, da kuma myeloma mai yawa) na iya yadawa zuwa kasusuwa na kashin baya. Idan ajiyar ƙwayar cuta ta girma a cikin canal na kashin baya, alamar farko a cikin sama da kashi 90 cikin dari na marasa lafiya sabo ne ko daɗaɗɗen baya ko wuyan wuyansa (muni mafi muni lokacin kwanta barci a kan gado ko tari) kwanaki ko makonni kafin kafafu su yi rauni ko suma. Kama matsi na kashin baya da wuri tare da MRI na gaggawa da babban adadin dexamethasone na IV yayin da mai haƙuri zai iya tafiya yana kiyaye ikon su na tafiya da kula da mafitsara.

An duba tushe¶

• American Society of Clinical Oncology (ASCO) and Infectious Diseases Society of America (IDSA, United States): Outpatient Management of Fever and Neutropenia in Adults Treated for Malignancy: ASCO and IDSA Clinical Practice Guideline Update (Taplitz et al., Journal of Clinical Oncology) and *IDSA Clinical Practice Guideline for the Use of Antimicrobial Ma'aikata a cikin Marasa lafiya Neutropenic tare da Ciwon daji * (Freifeld et al.).
• ** Cibiyar Kula da Lafiya da Kula da Lafiya ta Kasa (NICE, United Kingdom): ** * Neutropenic Sepsis: Rigakafin da Gudanarwa a cikin Mutanen da ke fama da Ciwon daji * (NICE Clinical Guideline CG151, umarnin 60-minti-zuwa maganin rigakafi) da * Metastatic Spinal Cord Compression a Adults: Risk Assessment, NG Diagnosis and Management.
• ** Ƙungiyar Turai don Magungunan Oncology (ESMO): *** Gudanar da Febrile Neutropenia: ESMO Clinical Practice Guidelines * (Klastersky et al., * Annals of Oncology *) da * ESMO Sharuɗɗa akan Gudanar da Guba daga Immunotherapy *.
• National Comprehensive Cancer Network (NCCN, United States): * NCCN Dokokin Ayyuka na Clinical a Kan Oncology: Rigakafi da Maganin Ciwon Ciwon daji* da kuma * Sarrafa Maganin Ciwon Cutar Kankara mai Alaƙa *.
• Oncology Nursing Society (ONS) & UK Oncology Nursing Society (UKONS): Acute Oncology Initial Management Guidelines and 24-Hour Triage Rapid Assessment Toolkit.

Jagora masu alaƙa¶

• Sepsis da Septic shock ganewa da amsa gaggawa
• Cauda equina ciwo da m kashin baya matsawa ja tutoci
• Rikicin adrenal da cutar Addison ta gaggawa allurar
• Cutar kumburin huhu da thrombosis mai zurfi (DVT)
• Zubar da jini mai barazana ga rayuwa akan masu rage jini ko a hemophilia