Acute Oncology Case study 28/01/2014

A 64 year old patient with a stage 4 squamous cell lung cancer attends the A&E department at 22.00 hrs with a history of an increase in SOB over the last 2 days, some left sided pleuritic type chest pain and a pyrexia of 38.3 degrees for which he has taken some Paracetamol while he was at home. He received his first cycle of intravenous chemotherapy 10 days ago. The drugs he received were Gemcitibine and Carboplatin.

Obs on arrival -  temp 36.1 degrees, pulse 98 bpm and BP 110/60, 02 sats 91% on air

PMH – nil to note other than lung cancer

Medications – metoclopramide 10mgs prn,  Zomorph 10mg bd and Oromorph 5mg prn.

Examination- Crackles on left side with some reduced air entry, pulse regular, able to speak in full sentences. Does not look distressed.

 

Questions

  • What are the differential diagnoses?
  • What does your initial assessment consist of (include all investigations you would include in your plan)?
  • What does your initial management plan consist of within the first hour of arrival into the department (please be specific regarding any drugs that you would prescribe to be administered)
  • What might be included in your subsequent plan of care?
  • If you were not sure regarding patient management especially relating to any oncology aspects who would you contact for support considering that this was an out of hours situation?