I-Neutropenic Fever Ngexesha le-Chemotherapy kunye ne-Cancer Treatment Emergency¶

Nabani na ofumana unyango lwekhemotherapy, unyango lomongo ojoliswe kuwo, okanye uqhaqho-fakelo lwe-stem cell, umkhuhlane olula awukhe ube "njengomkhuhlane nje": yimeko engxamisekileyo yezonyango ebizwa ngokuba yi-Febrile Neutropenia (Neutropenic Fever). I-Chemotherapy itshabalalisa ngokukhawuleza ukwahlula iiseli ezimhlophe zegazi ezaziwa njenge neutrophils, i-infantry yomzimba ejongene neebhaktheriya kunye nomngundo, ngakumbi ngexesha le-"nadir" yefestile ($ 7\text{ ukuya }14\text{day}$ emva kokufakwa kwechemotherapy). Xa izibalo ze-neutrophil zehla ziye ku-zero okanye kufutshane no-zero, iibhaktheriya ezingenabungozi ezihlala ngokwemvelo emlonyeni, emathunjini, okanye eluswini olujikeleze izibuko le-venous esembindini zinokuhlasela umsinga wegazi kwaye ziphindeke kabini rhoqo ngemizuzu engama-20 ngaphandle kokuvelisa ubovu, ububomvu, okanye ukukhohlela. Ukushiywa kungaphathwanga ekhaya kangangeeyure ezimbalwa, umkhuhlane we-neutropenic uqhubela phambili ngokukhawuleza. i-sepsis kunye ne-septic shock. Ukusinda kuxhomekeke kwi-Iyure yeGolden "Door-to-Antibiotic" Rule*: ukufikelela kwisebe likaxakeka ngokukhawuleza ngoko ke i-intravenous wide-spectrum antibiotics ifaka ** ngaphakathi kwemizuzu ye-60 ye-triage **, kwaye ungalokothi ugqume umkhuhlane okhulayo kunye ne-acetaminophen engaphezulu kwe-counter (i-paracetamol) okanye i-ibuprofen ngaphambi kokubiza iqela le-oncology.

Yenza oku ngoku¶

1. Khangela ubushushu bomlomo (umlomo) okanye i-tympanic/yexeshana ngoko nangoko kwaye usebenzise umgaqo ongqongqo we-\(38.3^\circ\text{C}\) (\(101.0^\circ\text{F}\)) / \(38.0^\circ\text{C}\) (\(100.4^\circ\text{F}\)) umgaqo. (I-ID ye-American Clinical Society Infect of the American Disease Society). I-Oncology (ASCO), i-European Society for Medical Oncology (ESMO), kunye ne-UK NICE izikhokelo, ** I-Neutropenic Fever ** ichazwa ngolu hlobo:
2. Ubushushu bomlomo obunye be-\(38.3^\circ\text{C}\) (\(101.0^\circ\text{F}\)) okanye ngaphezulu, OKANYE
3. Iqondo lobushushu lomlomo le-\(38.0^\circ\text{C}\) (\(100.4^\circ\text{F}\)) okanye ngaphezulu eliqhubekayo kangangeyure eyi-1 (okanye lilinganiswa kabini ubuncinane ngeyure enye).
4. (Qaphela: Iitrust ezininzi zase-UK ze-NHS kunye namaziko omhlaza asebenzisa umyinge ongqongqo wokufunda omnye \(38.0^\circ\text{C}\) [\(100.4^\circ\text{F}\)] kanye, okanye \(37.5^\circ\text{C}\) [\(99.5^}\)1 iyure yonke ilandela iziko lomhlaza' rhoqo iyure enye owona mda wekhadi ungqongqo.)*
5. Fowunela inombolo yakho yexesha likaxakeka ngoko nangoko ukuba isigulana sigodola/ukuqaqanjelwa, isiyezi, ukubhideka, ukuphefumla nzima, okanye uxinzelelo lwegazi oluphantsi. Cofa u-911 eUnited States naseKhanada, 112 ngapha kweEuropean Union, 999 eUnited Kingdom, okanye ubone zonke amanani kaxakeka ukuba isigulana sine ukungcangcazela kwengqele (rigors), siziva sityhafile xa simile, sinesantya sentliziyo esikhawulezayo (\(>100\text{ bpm}\)), sinegazi le-systolic elingaphantsi kwe-\(100\text{ mmHg}\), okanye likhangeleka liphaphathekile, linamabala, okanye libhidekile, nokuba ithemometha ifundeka eqhelekileyo okanye engaqhelekanga okanye isezantsi ngokungaqhelekanga. \(<96.8^\circ\text{F}\)), njengoko i-sepsis ebandayo iyeyona ndlela iyingozi yokutshatyalaliswa kwe-septic.
6. Ukuba uzinzile unomkhuhlane, tsalela umnxeba wakho weeyure ezingama-24 ngoko nangoko kwaye uye ngqo kwiSebe lezoNgxamiseko. Sukulinda de kube ziiyure zokusebenza kwasekuseni. Cela umntu aqhubele isigulana esibhedlele ngokukhawuleza, kwaye ucele i-on-callologist ukuba ibize ngaphambili kwidesika yovavanyo lwegumbi likaxakeka ukuze iinkcubeko zegazi kunye ne-antibiotics emithanjeni zilungile ekufikeni kwakho.
7. MUSA ukunika naziphi na iipilisi zokunciphisa umkhuhlane (akukho acetaminophen, paracetamol, ibuprofen, okanye aspirin) kwaye ungaze usebenzise ithemometha ekwirectal. Linganisa ubushushu phantsi kolwimi (oral) okanye phantsi kwengalo (axillary; qaphela ukuba i-axillary readings ibaleka malunga ne-\(0.5\c}^\circ\text\)0.5\c^{\circ\text\(0. ngaphantsi kokufundwa komlomo, ngoko ke ukufunda ngaphantsi kwekhwapha **\)37.8}\circ\text{C}$ [\(100.0^\circ\text{F}\)]** ilingana nomkhuhlane womlomo).
8. Faka imaski yoqhaqho eqinileyo okanye i-N95/FFP2 kwisigulana phambi kokuba ungene kwigumbi lokulinda leSebe likaNgxamiseko. Kuba isigulana esine-neutropenic siphantse saziro zokhuselo lomzimba, ukuhlala singagqunywanga kwigumbi lokulinda likaxakeka elixineneyo ecaleni kwezigulana ezikhohlelayo kuyingozi. Bonisa "iKhadi leSilumkiso seChemotherapy Neutropenic Sepsis" kumongikazi wovavanyo ngoko nangoko kwaye ucele ukuba abekwe kwigumbi leemviwo elikwanti ngoko nangoko.
9. ** Khangela ezinye iiNgxaki eziNgxamisekileyo ze-Oncologic ezine eziNgxamisekileyo.** Ngelixa ulungiselela ukuthutha, isikrini ngokukhawuleza ** I-Malignant Spinal Cord Compression ** (intlungu entsha yomqolo enobuthakathaka bomlenze, ukuphazamiseka, okanye ingxaki yesinye), *I-Superior Vena Cava (SVC) Syndrome ** (ukudumba kobuso / intamo kunye nokuphefumula okufutshane), ** I-Tumor, i-Lymus Syndrome, i-Lymus Syndrome ukubetha kwentliziyo ngaphakathi kweentsuku zokuqalisa i-chemo), kunye ** I-Hypercalcemia ye-Malignancy ** (unxano olugqithisileyo, ukuchama rhoqo, ukuqhina, kunye nokudideka).

Uvavanyo olungxamisekileyo kunye nomthi wesigqibo sonyango lomhlaza¶

Sebenzisa le tshati yekliniki ukuvavanya naziphi na iimpawu ezibukhali kwisigulana esifumana unyango olusebenzayo lomhlaza okanye kwiiveki ezi-6 zechemotherapy.

flowchart TD
    Start["Isigulana soMhlaza kwiChemotherapy, Immunotherapy,<br/>okanye iRadiation iphuhlisa iimpawu ezibukhali"] --> SepsisFlags{"INyathelo 1: Jonga Ukothuka ngoko nangoko kweSeptic / IiFlegi eziBomvu zeNgxaki <br/>1. Ukuqhaqhazela ingqele (i-rigors), nangaphandle kobushushu obuphezulu?<br/>2. IHypothermia: Ubushushu obungaphantsi kwe-36.0°C (96.8°F)?<br/>3. Unesiyezi, isiyezi, ukubhideka, okanye intetho engacacanga?<br/>4. Ukuphefumla nzima, ukuphefumla ngokukhawuleza, okanye intlungu yesifuba?<br/>5. Ububomvu, ubovu, okanye intlungu phezu kwePort-a-Cath / PICC / Hickman line?"}

    SepsisFlags -->|"EWE: Nawuphi na um-1 okhoyo"| Call911["I-SEPSIS YE-ONCOLOGIC EBALULEKILEYO / INGXAKI:<br/>1. Fowunela u-911/112/999 Ngoko nangoko kwi-Ambulensi<br/>2. Ukubhengeza 'I-Chemotherapy Neutropenic Sepsis Emergency'<br/>3. Ukunyanzelisa i-60-Minute ye-Door-to-IV-Antibiotic Target <br/>4. Hlala ulele (okanye uthe nkqo ukuba uphefumla kancinci); NPO"]

    SepsisFlags -->|"HAYI"| TempCheck{"Inyathelo lesi-2: Jonga iTemperature yoMlomo<br/>(UNGAZE usebenzise ithermometer yerectal)<br/>Is temp >= 38.3°C (101.0°F) KANYE<br/>OR >= 38.0°C (100.4°F) ngeyure eyi-1?"}

    TempCheck -->|"EWE: Umda womkhuhlane udibene"| NeutFever["INGXAKEKA YE-NEUTROPENIC Fever:<br/>1. MUSA ukunika iTylenol/paracetamol, ibuprofen, okanye iaspirin<br/>2. Tsalela umnxeba weeyure ezingama-24 zeOncology Triage Line NGOKU ngelixa uhamba<br/>3. Beka imaski kwisigulana; yiya kwiSebe likaNgxamiseko NGOKU<br/>4. Bonisa iKhadi le-Chemo Alert at triage: isicelo sokuhlukaniswa +<br/> Iinkcubeko zeGazi (i-Port + Peripheral) kunye ne-IV Antibiotics < 60 mins"]

    TempCheck -->|"HAYI: Akukho mkhuhlane okanye iimpawu ze-sepsis"| OncEmerg{"Inyathelo lesi-3: Qwalasela iiNgxaki zoMhlaza woLwakhiwo kunye neMetabolic:<br/>A. Intlungu entsha yomqolo/yentamo + ubuthathaka bomlenze, ukuba ndindisholo, okanye utshintsho lwesinyi?<br/>B. Ukudumba kobuso/intamo/iingalo + ukukhohlela/ukuphelelwa umoya kubi ngakumbi ukungqengqa?<br/>C. I-chemo yakutsha nje (iintsuku ezi-1-7) + iicramps, isicaphucaphu, umchamo omnyama?<br/>D. Unxano olugqithisileyo, ukudideka, ukuqhina, iintlungu zamathambo?"}

    OncEmerg -->|"A: Iintlungu zangasemva + iimpawu ze-neuro"| MSCC["UXINEZELEKILEYO UXINEZELEKO LOMNQOBO WOKUMKHUMBA OKUBI:<br/>I-MRI ye-Emergency Spine + High-Dose IV Dexamethasone NGOKU"]

    OncEmerg -->|"B: Ubuso / intamo ukudumba + dyspnea"| SVCS["I-SUPERIOR SUPERIOR VENA CAVA (SVC) SYNDROME:<br/>Hlala ngokuthe tye (45-90 deg); Isifuba esiNgxamisekileyo CT + Ukhathalelo lweOncology"]

    OncEmerg -->|"C okanye D: Ingxaki yeMetabolic"| Metabolic["OKUTHINELEKELELWAYO I-TUMOR LYSIS OKANYE I-HYPERCALCEMIA:<br/>ISebe eliNgxamisekileyo NGOKU le-ECG, i-Electrolytes, kunye ne-IV Fluids"]

Icandelo 1: Ukuqonda i-Neutropenic Fever kunye ne "Nadir" yefestile yengozi¶

1. Yintoni i-"Absolute Neutrophil Count" (ANC) kunye neChemo Nadir?¶

Iiseli zegazi ezimhlophe (i-leukocytes) zibandakanya iindidi ezininzi zeeseli, kodwa i-neutrophils zezona iiseli ezibulala iibhaktheriya. Oogqirha babala i-Absolute Neutrophil Count (ANC) ngokuphinda-phinda inani lilonke leseli emhlophe yegazi ngepesenti yeeneutrophils ezicandiweyo ("iisegi") kunye neebhendi ezingekavuthwa: - Normal Healthy ANC: \(1,500\text{ ukuya }8,000\text{ iiseli microliter nganye }(\mu\text{L})\) (okanye \(1.5\text{ ukuya }8.0 \ amaxesha 10^9/\text{L}\)). - Neutropenia: ANC ngezantsi \(1,500\text{ cells}/\mu\text{L}\) (\(<1.5 \ amaxesha 10^9/\text{L}\)). - I-Neutropenia eMandundu (Umngcipheko weFiva oPhezulu): ANC ngezantsi \(500\text{ cells}/\mu\text{L}\) (\(<0.5 \ amaxesha 10^9/\text{L}\)), okanye Ngaphantsi kwe-\(1,000\text{ cells}/\mu\text{L}\) ilindeleke ukuba yehle ngaphantsi kwe-\(500\) yeeyure. - I-Neutropenia enzulu (iMngcipheko omkhulu): ANC ngezantsi \(100\text{ cells}/\mu\text{L}\) (\(<0.1 \ amaxesha 10^9/\text{L}\)), ixhaphake ngexesha lokungeniswa kwe-leukemia ebukhali okanye i-stem cell transplantation.

Yenzeka nini i"Nadir"? Emva kokuba umjikelo oqhelekileyo we-chemotherapy we-intravenous ufakwe ngoSuku loku-1, i-neutrophils esele ijikeleza egazini ihlala iintsuku ezimbalwa ngelixa umzi-mveliso womongo wethambo uphazamisekile okwethutyana. Ngenxa yoko, inani leeseli ezimhlophe zegazi lifika kwindawo esezantsi yelitye (** i-nadir ) ngokuqhelekileyo phakathi kwe- Usuku lwe-7 kunye noSuku lwe-14 emva kwe-chemotherapy ** (nangona ingenzeka nanini na ngexesha lemihla ngemihla yonyango ekujoliswe kuyo ngomlomo, i-radiation, okanye i-hematologic cancers efana ne-leukemia, i-lymphoma, kunye ne-myeloma eninzi).

2. Kutheni usulelo lujongeka lungabonakali ngokupheleleyo xa uneZero Neutrophils¶

Kumntu onesistim somzimba esiqhelekileyo, usulelo luyabonakala kuba izigidi ze-neutrophils zibaleka ukuya kwindawo kwaye zife , zenza ubovu olutyheli olutyheli, ulusu olubomvu oludumbileyo, i-exudates yomqala ebuhlungu, okanye amabala amhlophe ashinyeneyo kwi-X-ray yesifuba: - Akukho Neutrophils = Akukho Pus kwaye Akukho ziMpawu zeClassic: Kwisigulane esine-neutropenic enzima: - Inyumoniya ebulalayo** isenokubangela ukhohlokhohlo, zero phlegm, kunye neX-reyi yesifuba ecace gca, ebonisa kuphela umkhuhlane kunye nokuphefumla ngokukhawuleza. - Usulelo olumandla lomgudu womchamo (urosepsis) lunokubangela ukutshisa kungabikho xa uchama kwaye kubonise akukho iiseli ezimhlophe zegazi (pyuria) kwidipstick yomchamo, ezibonisa umkhuhlane kuphela. - Isikhumba esibulalayo ** okanye i-perirectal cellulitis* ejikeleze umngxuma wokukhupha ilindle okanye izibuko le-venous esembindini inokubonisa ubovu obungenaziro okanye ithumba eliguquguqukayo, libonisa kuphela ubushushu obufihlakeleyo, ubupinki obufiphele, okanye ukuthamba okuhlala kwindawo ecaleni komkhuhlane. - Isilumkiso ngeCorticosteroids Masking the Fever: Izigulana ezininzi ezinomhlaza zithatha yonke imihla okanye ngeveki idexamethasone okanye iprednisone (yokudumba kwengqondo, i-lymphoma, i-myeloma emininzi, iziphumo ebezingalindelekanga ze-immunotherapy, okanye isicaphucaphu). ICorticosteroids icinezela ngamandla i-hypothalamus thermostat yobuchopho. Isigulane esithatha i-dexamethasone sinokuba ne-neutropenic bloodstream sepsis egcwele ngokupheleleyo enobushushu obuqhelekileyo be-\(37.0^\circ\text{C}\) (\(98.6^\circ\text{F}\)). Kwizigulana ezikwi-steroids, jonga endaweni yoko ukuqhaqhazela (iingqele), ukudinwa ngequbuliso, isiyezi, ukwehla kweqondo lobushushu, isiyezi, ukwehla kweqondo lobushushu, isiyezi, ukudideka okuncinci \(36.0^\circ\text{C}\) (\(96.8^\circ\text{F}\)).

3. Umthetho we-"60-Minute Door-to-Needle Antibiotic Rule"¶

Nje ukuba ibhaktheriya ingene egazini lesigulane esingenayo i-neutrophils (rhoqo i-Gram-negative rods njenge Escherichia coli, Klebsiella pneumoniae, okanye i-Pseudomonas aeruginosa idlulisa kwizilonda zomlomo ezonakeleyo ngechemotherapy [mucositis-] okanye i-cositis***-) okanye i-cositis I-Staphylococcus kunye ne-Streptococcus ezisuka kumbindi we-venous catheters), ukusweleka kwabantu kukhula ngokukhawuleza ngeyure nganye yokulibaziseka. - Ugunyaziso lweSibhedlele saMazwe ngaMazwe: Izikhokelo ezivela kwi-ASCO, IDSA, ESMO, i-Surviving Sepsis Campaign, kunye ne-UK NICE (CG151) zigunyazisa ukuba isebe ngalinye likaxakeka lilawule umthamo wokuqala ye-empiric anti-pseudomonal intravenous beta-lactam antibiotic (efana ne ctacefepime, piperacill, piperacill/Zomaracill] meropenem) kwimizuzu engama-60 isigulana singene kumnyango wesibhedlele, ngaphandle kokulinda ukuba isiphumo selabhoratri yeseli emhlophe yegazi (CBC) sibuye ukuba kukrokrelwa i-neutropenia. - Kwenzeka ntoni kuloo mizuzu yokuqala ye-60: Abahlengikazi ngokukhawuleza bazoba ** iiseti ezimbini zeenkcubeko zegazi ** (iseti enye izotywe kwi-lumen nganye yesigulana esifakwe kwi-*Port-a-Cath, umgca we-PICC, okanye i-catheter ye-Hickman , kunye neseti enye etsalwe kwi-peripheral arm vein), zoba i-Complete Blood Count (i-Ccta, ipaneli ye-metabolic ngokukhawuleza kunye ne-antibiotiki) emva kokutsalwa kwegazi. - ** Umngcipheko ophezulu vs. Umngcipheko ophantsi (i-MASCC Score): ** Emva kokuba i-IV yokuqala ye-antibiotic dose iqhuba, i-oncologists kunye noogqirha bexakeka babala ** Umbutho we-Multinational for Supporting Care in Cancer (MASCC) I-Risk Index ** kunye ne- inqaku le-CISNE ** ukujonga ukuba isigulane kufuneka sihlale kwi-inpatient isolation room (isinyanzelo, i-leukemia, i-cell stem, i-blood pressure, i-blood pressure, i-blood pressure, i-contraindications, i-blood blood pressure, i-blood pressure, i-blood pressure, i-blood pressure, i-blood pressure, i-leukemia, i-blood pressure, i-blood pressure, i-blood pressure, i-blood pressure, i-blood pressure, i-leukemia, i-blood pressure, i-blood pressure. okanye i-mucositis enzima) okanye inokutshintshela kunyango olujongwe ngokusondeleyo.

Icandelo lesi-2: Ukuqaphela ezinye eziHlanu eziMngcipheko zoNgxamiseko lweOncologic¶

Nokuba isigulana somhlaza singenawo umkhuhlane, ubulwelwe obusebenzayo kunye nonyango lwangoku lomhlaza (i-chemotherapy, i-radiation, kunye ** ne-immune checkpoint inhibitors **) inokubangela iingxaki ezintlanu zesakhiwo okanye zemetabolism ezifuna ukhathalelo olungxamisekileyo lwesebe:

Inyathelo ngenyathelo lokhathalelo lwangaphambi kwesibhedlele ngelixa ulungiselela iSebe likaNgxamiseko¶

Inyathelo loku-1: Ungalithatha njani iqondo lobushushu elichanekileyo ngokukhuselekileyo kwiSigulana seChemotherapy¶

1. Sebenzisa i-digital oral (phantsi kolwimi), i-tympanic (indlebe), okanye i-temporal artery (ebunzi) ithemometha.
2. Ukuba isigulane sisele nje iti eshushu okanye amanzi e-ice, linda ** 15 ukuya kwimizuzu engama-20 ** ngaphambi kokuba uthathe iqondo lokushisa lomlomo ukuze ukufundwa kungatshintshwa ngobuxoki.
3. Yalelwe Ngokungqongqo: Ungaze usebenzise iThermometer yeRectal.
4. I-Chemotherapy iyonakalisa iiseli ze-mucosal ezahlula ngokukhawuleza ezidibanisa yonke i-gastrointestinal tract ukusuka emlonyeni ukuya kwi-anus (**mucositis *). Ukutyhala incam yethemometha eqinile (okanye i-suppository, enema, okanye i-tampon) kwi-rectum kunokudala ukukrazuka kwe-microscopic kumbane oethe-ethe we-rectal, okuvumela izigidi ze-E. coli * kunye neebhaktheriya ze-anaerobic gut ukungena egazini ngokukhawuleza ( i-bacteremia ) kwaye ibangele i-abscess ye-perirectal eyingozi okanye ukopha okungalawulekiyo ukuba iiplatelet ziphantsi ( thrombocytopenia **).

Inyathelo lesi-2: Jonga indawo yokuNgena "eZintlanu ezifihlakeleyo".¶

Ngelixa uthetha nomongikazi we-oncology triage okanye ulinde isithuthi, jonga ezi ndawo zintlanu (ungaze ucinezele, uqhaqhe, okanye uhlabe nasiphi na isilonda) kwaye uxele into oyibonayo: 1. Isixhobo soFikelelo esiseMbindini (i-Port-a-Cath, i-PICC Line, okanye i-Hickman Tunnelled Catheter): Jonga ulusu olungaphaya kwezibuko lesifuba okanye umgca we-PICC wengalo ngaphandle kokuxobula isinxibo esingenazintsholongwane. Ngaba kukhoubomvu, ukudumba, ubushushu, ukuthamba, okanye ukuqwenga okutyheli ecaleni kwendlela yetonela? Ingaba umkhuhlane okanye ukungcangcazela yingqele kuqale kwimizuzu engama-30 ukuya kuma-60 emva kokugungxulwa okanye ukusebenzisa izibuko? (Uphawu oluqhelekileyo lwelumen yecatheter; abasebenzi basesibhedlele kufuneka batsale amasiko egazi kwizibuko phambi kokuba bagqibe ngendlela yokuyinyanga.) 2. Umlomo, Iintsini, kunye noMqala (Oral Mucositis): Khanyisa ukukhanya kwefowuni ngaphakathi emlonyeni. Ngaba kukho izilonda ezibomvu ezibuhlungu, amabala amhlophe afana necurd (thrush / candidiasis), ukopha kweentsini, okanye ubunzima bokuginya ulwelo? 3. Imiphunga nokuphefumla: Bala ukuba mingaphi imiphefumlo isigulana esiyiphefumlayo kwimizuzwana engama-60 xa siphumle (umlinganiselo wokuphefumla ngaphezu kokuphefumla okungama-20 ukuya kwangama-22 ngomzuzu luphawu olusisilumkiso kwangethuba lwesepsis okanye inyumoniya nangaphandle kokukhohlela) kwaye ujonge i-oximeter yomnwe ukuba ikhona. 4. Isisu kunye nommandla wePerirectal: Buza isigulane ukuba ngaba banayo nayiphi na intlungu yesisu esingakwesokudla (typhlitis) okanye **naziphi na iintlungu, ukutshisa, okanye ububele obujikeleze i-anus okanye umsila xa uhleli okanye udlula isitulo ** (i-perianal cellulitis yinto eqhelekileyo, efihliweyo yomthombo wobomi kwizigulane ze-neaerobic kunye ne-annutropnegasis) 5. Umchamo kunye noLusu: Buza ukuba ukuchama kuvakala kungakhululekanga na, kujongeka kukho amafu okanye okupinki, okanye kwehle kakhulu umthamo wevolumu kwiiyure ezili-12 ezidlulileyo.

Inyathelo lesi-3: Lawula i-Thrombocytopenia (iiPlatelets eziphantsi) ngaxeshanye¶

Ngenxa yokuba ichemotherapy icinezela wonke umongo wethambo, isigulana esineeseli zegazi ezimhlophe ezisezantsi (neutropenia) zihlala zineeplatelet zegazi ezisezantsi eziyingozi (thrombocytopenia, ngakumbi xa iiplatelets ziwela ngaphantsi kwe-\(10,000\text{ ukuya ku}20,000/\mu\text{L}\)) ngaxeshanye: - Khangela ulusu lwee-shins, ama-ankle, kunye neengalo zangaphambili ze-pinpoint ezincinci ezibomvu okanye ezimfusa ezingabonakali xa zicinezelekile (** petechiae ), imivumbo emnyama engabonakaliyo ( ecchymoses ), okanye i-blood blisters ngaphakathi emlonyeni ( wet purpura ). - Ukuba isigulana sopha impumlo okanye intsini yopha ecaleni komkhuhlane, zihlalise nkqo ungqiyame phambili, cinezela impumlo ethambileyo esezantsi ngokuqhubekayo kangangemizuzu engama-20 (bona ukopha ngeempumlo), kwaye uxelele igumbi likaxakeka ngoko nangoko njengoko banokufuna utofelo-gazi olungxamisekileyo* ecaleni kwe-IV yabo yokubulala iintsholongwane.

Inyathelo lesi-4: Isilumkiso esiNgxamisekileyo esiKhethekileyo se-CAR-T Cell kunye neBispecific Antibody Patients (CRS kunye ne-ICANS)¶

Ukuba isigulane sisanda kufumana ** i-CAR-T ye-cell therapy ** (i-chimeric antigen receptor T-cell therapy) okanye i- ** bispecific T-cell engager antibody ** ye-leukemia, i-lymphoma, okanye i-myeloma eninzi kwiiveki ezi-4 ezidlulileyo, umkhuhlane wequbuliso unezizathu ezibini ezisongela ubomi ngaxeshanye: 1. ** I-Neutropenic Bacterial Sepsis ** (ifuna i-antibiotics ye-IV yemizuzu engama-60 ngokukhawuleza), ** KUNYE ** 2. Cytokine Release Syndrome (CRS) kunye ne-Immune Effector Cell-Associated Neurotoxicity Syndrome (ICANS): Ukusebenza okukhulu komzimba okubangela umkhuhlane ophezulu (\(>>38.0 ^\circ\text{C}\) ukuya kwi-\(40.5^\circ\text{C}\)), ukuwisa uxinzelelo lwegazi, ukutshintshwa kwe-neurological, i-oxygen ephantsi, i-oxygen eguquka ngokukhawuleza ubunzima, ukudideka, okanye ukuxhuzula). - Isenzo esiSinyanzelo: Soloko ubonisa iKhadi le-CAR-T / Bispecific Wallet* yesigulana kuvavanyo olungxamisekileyo ngoko nangoko; ukongeza kwi-antibiotics ye-IV ebanzi, ezi zigulana zifuna ukulawulwa ngokukhawuleza kwe-interleukin-6 receptor antagonist ** tocilizumab ** kunye / okanye ** i-corticosteroids ** eququzelelwe kunye neziko labo lonyango lweselula.

Iskripthi sonxibelelwano esichanekileyo se-911 / 112 / 999 kunye ne-Emergency Triage¶

Uphononongo lubonisa ukuba izigulana zomhlaza we-neutropenic zihlala zinengxaki yokulibaziseka kwiindawo zokulinda ezixineneyo zegumbi likaxakeka ngaphandle kokuba isigulana okanye ilungu losapho litsho amagama ekliniki "Chemotherapy Neutropenic Sepsis: Ifestile yeMinute ye-Antibiotic eyi-60" kuqhagamshelwano lokuqala. Sebenzisa eli gama leskripthi ngegama:

• Xa ufowunela 911/112/999 (ukuba kukho iingqele, isiyezi, ukuphelelwa ngumphefumlo, okanye ukubhideka):

  "Ndidinga i-ambulensi [Eyona dilesi] ye-Neutropenic Sepsis ekrokrelekayo. Isigulana sineminyaka [Yobudala] ubudala [indoda/ibhinqa] sifumana unyango lwechemotherapy [Uhlobo loMhlaza], kunye nonyango lwazo lokugqibela lwechemotherapy [Umhla, kwiintsuku eziyi-X ezidlulileyo]. ukubhideka], kwaye unento efakiweyo [isifuba Port-a-Cath / ingalo PICC line] ASIyinikanga nayiphi na iTylenol okanye ibuprofen."

• Xa unyukela kwiDesika yokuThatha iSebe likaxakeka (ukuba ufika ngemoto):

  *"Esi sigulana sikwi-chemotherapy esebenzayo (i-Day [X] post-infusion, ngaphakathi kwefestile ye-nadir) kwaye ine- Neutropenic Fever ye [X.X°C / XXX.X°F]. Nantsi [yakhe] I-Oncology Neutropenic Sepsis Alert Card. Ngaphantsi kwe-ASCO, i-IDSA, kunye ne-NICEsheral guidelines, i-isopheral / i-imediatesheral guidelines Iinkcubeko zegazi lasePort-a-Cath, kunye **idosi yokuqala ye-intravenous broad-spectrum antibiotics ngaphakathi kwemizuzu engama-60 yokuzama *."

• Ukuba isigulane sikwi-Immunotherapy (I-Checkpoint Inhibitors njenge-Pembrolizumab/Keytruda, i-Nivolumab/Opdivo, okanye i-Ipilimumab/Yervoy):

  *"Inqaku Elibalulekileyo Lovavanyo: Esi sigulana sifumana I-Cancer Immunotherapy ([Igama Leziyobisi]), hayi nje ichemotherapy yesintu. Iimpawu zabo zisenokuba Isigigaba esiNxulumene ne-Immune-Related Adverse (irAE) esifana ne-autoimmune pneumonitis, colitis, myocarditis, okanye i-adrenal crisis, efuna ukuxilongwa ngokukhawuleza kwe-infectionalcosteroids umthetho ngaphandle."

Yintoni omawuyibambe ngemizuzu emi-2 yeGo-Bag yeSebe likaNgxamiseko¶

• I-"Chemotherapy / Immunotherapy Wallet Alert Card" yesigulana (ibonisa irejimeni yeziyobisi echanekileyo, umhla womjikelo wokugqibela, i-oncologist yeeyure ezingama-24 / inombolo yefowuni, kunye nohlobo lwe-port).
• Ikhadi lokuchonga lePort-a-Cath okanye i-port-injectable port fob (ixelela abongikazi bengxakeko ukuba izibuko lesifuba liyi-"Power-Injectable" ye-CT scan scan kunye nobungakanani benaliti ye-Huber [$ ¾\text{-inch}$ vs. \(1\text{-inch}\)] ingena kwizibuko).
• ** I-cream cream (i-lidocaine / prilocaine EMLA cream) ** ukuba imiselwe: ukusebenzisa i-dab ye-numbing cream emiselweyo phezu kwesifuba I-Port-a-Cath egqunywe ngeplastiki xa ukhwele kwimoto ukuya esibhedlele unciphisa ulusu kwimizuzu engama-30 ukuze ukufikelela kwi-port kunye nenaliti ye-Huber kubuhlungu.
• Onke amayeza akhoyo asekhaya (ingakumbi nawaphi na amayeza okubulala iintsholongwane afana ne-levofloxacin okanye i-trimethoprim-sulfamethoxazole, i-antifungals efana ne-fluconazole/posaconazole, ii-antivirals ezifana ne-acyclovir, iinaliti ze-pegfilgrastim [Neulasta] okanye i-filgrastim [Neupogen])*, kunye ne-blood thinners).
• Itshaja yefowuni kunye nemaski esecaleni ecocekileyo.

Ukuthintela ukusuleleka kwimihla ngemihla ngexesha le-Chemotherapy Nadir (Iintsuku ezisi-7 ukuya kwe-14)¶

Ngelixa akukho luthintelo luthintela i-100 yepesenti ye-neutropenic fevers (kuba uninzi lwezifo zivela kwi-digestive tract flora yesigulana), ukulandela le mithetho esekelwe kubungqina ngexesha leentsuku zakho ezisezantsi kunciphisa ukulaliswa esibhedlele okunokuthinteleka: 1. Ukhathalelo lomlomo (Ukuthintela Ukungena kwe-Mucositis): Hlanza umlomo wakho amaxesha e-4 ngosuku (emva kwesidlo ngasinye nangaphambi kokulala) kunye nesisombululo esingenanto se- ** $ ½ umbhalo { teaspoon} ityuwa ye-$ kunye ne-$ ½ umbhalo { teaspoon} $ i-soda yokubhaka (i-sodium bicarbonate) echithwe kwi-$ 240 umbhalo { mL} $ ( $ 8 text){ Sebenzisa ibhrashi yamazinyo ethambileyo kakhulu, kwaye uphephe imilomo yorhwebo esekwe etywaleni eyomileyo kwaye iqhekeze intambo yomlomo. 2. Ukuthintela Ukuqunjelwa kunye ne-Anal Fissures: I-Chemotherapy kunye namayeza okulwa nesicaphucaphu (njenge-ondansetron/Zofran) abangela ukuqunjelwa okukhulu. Ukuzabalazela ukudlula ilindle eliqinileyo kukrazula ulwenja oluethe-ethe lwempundu (umngxuma wokukhupha umngxuma), idala indawo ethe ngqo yebhaktiriya emathunjini ukuba ingene egazini. Thatha izithambisi/izithontsi zomlomo ezicetyiswa ngugqirha we-oncologist kwangoko, sela ulwelo oluninzi, kwaye ungaze usebenzise ii-rectal suppositories okanye i-enema. 3. Ukutya & Nococeko lwezandla: Hlamba izandla ngesepha namanzi ashushu imizuzwana engama-20 phambi kokutya nasemva kokusebenzisa igumbi lokuhlambela. Pheka yonke inyama, inkukhu, intlanzi namaqanda ngokucokisekileyo ukuze ube nobushushu bangaphakathi obukhuselekileyo, uhlambe iziqhamo nemifuno ekrwada ngononophelo, kwaye uphephe ubisi olungacolwanga, amahlumelo akrwada, oonokrwece/isushi ekrwada, nokutya okuthe kwahlala kwiqondo lobushushu. 4. Ukuqonda i-Pegfilgrastim (Neulasta) Iintlungu Zamathambo vs. I-True Fever: Izigulane ezininzi zifumana inaliti ye-white-blood-boosting injection (**pegfilgrastim okanye filgrastim **, G-CSF) kwiiyure ezingama-24 emva kwechemotherapy. Njengoko umongo wethambo uvelisa ngokukhawuleza i-neutrophils entsha kwiintsuku ezi-2 ukuya kwezi-5 ezilandelayo, izigulane zihlala ziva intlungu ebuhlungu ezinqeni zabo, isifuba, kunye nomqolo ophantsi (udla ngokukhululeka yi-loratadine [Claritin] ukuba ivunywe yi-oncologist). Nangona kunjalo, ungaze ucinge ukuba ngumkhuhlane we-\(38.0^\circ\text{C}\) (\(100.4^\circ\text{F}\)) okanye ngaphezulu "kusuka kwi-Neulasta shot": soloko ujonga ubushushu bakho kwaye ufowunele i-oncology ngoko nangoko ngayo nayiphi na ifiva.

Imibuzo edla ngokubuzwa¶

Kutheni ukuthatha iTylenol (i-acetaminophen / i-paracetamol) okanye i-ibuprofen yomkhuhlane omncinci okanye intloko ebuhlungu iyingozi kakhulu ngexesha le-chemotherapy?¶

Xa ichemotherapy ithoba iiseli zakho zegazi ezimhlophe (neutrophils), umzimba wakho awukwazi ukwenza ubovu, ububomvu, okanye ukudumba kwendawo xa iibhaktheriya zihlasela, ngoko ke umkhuhlane okhulayo udla ngokuba luphawu KUPHELA olulumkisayo ukuba usulelo lwegazi olusongela ubomi luqalile. Ukuthatha i-acetaminophen, i-paracetamol, ibuprofen, okanye i-aspirin yehlisa ubushushu bakho ngokuzenzela iiyure ezininzi kwaye ifihla uphawu lwesilumkiso ngelixa iintsholongwane ziphindaphindeka ngokukhawuleza egazini lakho. Ungaze uthathe naliphi na iyeza lokunciphisa umkhuhlane ngexesha le-chemotherapy ngaphandle kokujonga ubushushu bakho kuqala kwaye ufumane imvume ecacileyo kwiqela lakho le-oncology.

Yeyiphi eyona thermometer ibalwa njengengxamisekileyo yonyango ngexesha lechemotherapy?¶

Ngokwezikhokelo ze-oncology zamazwe ngamazwe (i-ASCO, i-IDSA, kunye ne-ESMO), i-neutropenic fever engxamisekileyo yiyiphi na iqondo lokushisa lomlomo elilodwa le-38.3 ° C (101.0 ° F) okanye ngaphezulu, OKANYE iqondo lokushisa lomlomo le-38.0 ° C (100.4 ° F) okanye elingaphezulu elihlala kwi-1 iyure epheleleyo (ezininzi ze-UK NHS imithetho ye-3 ye-3 yokufunda engqongqo. 100.4°F). Ukongeza, ukuba umguli wekhemotherapy uba neengqele ezingcangcazelayo, ukuba nesiyezi, ukubhideka, ukuphefumla nzima, okanye ubushushu obungaphantsi kwe-36.0°C (96.8°F) ngokungaqhelekanga, yingxakeko ekhawulezileyo nangaphandle kokufundwa kwethemometha ephezulu.

Kutheni izikhokelo zikaxakeka zikwalela ukusebenzisa ithemometha ye-rectal okanye i-rectal suppository kwisigulana se-chemotherapy?¶

I-Chemotherapy iyancipha kwaye yenze buthathaka inwebu ethambileyo ye-mucous ejikeleze i-rectum kunye namathumbu ngelixa ngaxeshanye isehlisa zombini iiseli ezimhlophe zegazi ezilwa nosulelo kunye neeplatelet zegazi. Ukufaka ithemometha yomlomo, i-suppository, okanye i-enema kunokukrwela okanye ukukrazula lula udonga oluethe-ethe lwe-rectal, lungenise izigidi zeebhaktheriya zamathumbu ngqo egazini (okubangela ukufa kwe-Gram-negative sepsis) kwaye kubangela ukopha okukhulu kwi-rectal.

Kutheni le nto iintlungu zangasemva kwisigulane somhlaza zifuna isheke engxamisekileyo yoxinzelelo lomqolo?¶

Uninzi lwee-cancer eziqhelekileyo (ingakumbi ibele, i-prostate, imiphunga, izintso, kunye ne-myeloma eninzi) inokusasazeka kumathambo omqolo. Ukuba idiphozithi ye-tumor ikhula kwi-canal yomgogodla, uphawu lokuqala olungaphezulu kweepesenti ze-90 zezigulane zintsha okanye zibuhlungu kakhulu emva okanye intlungu yentamo (ibi kakhulu xa ulele phantsi ebhedini okanye ukhohlela) iintsuku okanye iiveki ngaphambi kokuba imilenze ibe buthathaka okanye ibe ndindis. Ukubamba ukunyanzeliswa kwentambo yomgogodla kwangoko nge-MRI engxamisekileyo kunye ne-dexamethasone ye-IV ephezulu ngelixa isigulane sisakwazi ukuhamba sigcina amandla abo okuhamba kunye nokugcina ulawulo lwesinyi.

Imithombo ijongiwe¶

• ** I-American Society ye-Clinical Oncology (ASCO) kunye ne-Infectious Diseases Society of America (IDSA, eUnited States): ** * Ukulawulwa kwezigulane eziphuma ngaphandle kweFever kunye ne-Neutropenia kubantu abadala abaNyangelwe i-Malignancy: i-ASCO kunye ne-IDSA ye-Clinical Practice Guideline Update Update * (Taplitz et al., * I-Journal ye-Clinical Oncology ye-Agency Practice ye-Antimicrobies ye-ID ye-Antimicrobies ye-ID Izigulana zeNeutropenic ezinoMhlaza * (Freifeld et al.).
• ** Iziko leSizwe leMpilo kunye noNonophelo olugqwesileyo (i-NICE, e-United Kingdom): ** * I-Neutropenic Sepsis: uThintelo kunye noLawulo kuBantu abaneCancer * (I-NICE Clinical Guideline CG151, i-60-minute-minute-door-to-antibiotic mandate) kunye * ne-Metastatic Spinal Cord Compression kuBantu abadala: Uvavanyo loMngcipheko, iSikhokelo se-NICE3 kunye noLawulo lweNgcaciso * .
• ** Umbutho waseYurophu we-Oncology yezoNyango (ESMO): ** * Ulawulo lwe-Febrile Neutropenia: Izikhokelo ze-ESMO Clinical Practice * (Klastersky et al., *Anals of Oncology *) kunye * Izikhokelo ze-ESMO kuLawulo lwe-Toxicities kwi-Immunotherapy *.
• ** I-National Comprehensive Cancer Network (NCCN, eUnited States): ** *Izikhokelo ze-NCCN zokuSebenza kwezonyango kwi-Oncology: uThintelo kunye noNyango lweZifo eziNxulumene neCancer * kunye * noLawulo lwe-Immune Checkpoint Inhibitor-Related Toxicities *.
• I-Oncology Nursing Society (ONS) kunye ne-UK Oncology Nursing Society (UKONS): Izikhokelo ze-Acute Oncology Initial Management kunye ne-24-Hour Triage Rapid Assessment Toolkit.

Izikhokelo ezinxulumeneyo¶

• I-Sepsis kunye ne-septic shock kunye nokuphendula ngokukhawuleza
• I-Cauda equina syndrome kunye neeflegi ezibomvu zoxinzelelo lwe-spinal cord
• Ingxaki yeAdrenal kunye nesifo sikaAddison sikaxakeka inaliti
• I-pulmonary embolism kunye ne-deep vein thrombosis (DVT)
• Ukopha okusongela ubomi kwiincindi zegazi okanye kwi-hemophilia