GuidelinesEML (Adult Hospital STG)
Structural Emergencies
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 Edition
Epidural Spinal Cord Compression
Malignant Pericardial Effusion
EPIDURAL SPINAL CORD COMPRESSION
ICD-10 Code: G95.2
DESCRIPTION
- Seen in breast, lung and prostate cancers, as well as multiple myeloma.
- Patients present with new back pain that worsens when lying down, late paraparesis, late incontinence, and loss of sensory function.
GENERAL MEASURES
- To evaluate level of neurologic function, perform a spinal x-ray or MRI if available.
MEDICINE TREATMENT
- Dexamethasone, IV, 16 mg immediately as a single dose.
- Followed by 4 mg 6 hourly, until transfer.
REFERRAL
- Urgent referral to tertiary services with oncology or neurosurgery services.
MALIGNANT PERICARDIAL EFFUSION
ICD-10 Code: I31.3
DESCRIPTION
- Seen in metastatic lung and breast cancer, melanoma, leukaemia, and lymphoma.
- Patients present with dyspnoea, fatigue, distended neck veins, distant heart sounds, tachycardia, orthopnoea, narrow pulse pressure, pulsus paradoxus or water-bottle heart.
Investigation
- Trans-thoracic echocardiography.
GENERAL MEASURES
- Management is dependent on the underlying aetiology and symptom progression.
- Diagnostic and therapeutic pericardiocentesis:
- Immediate pericardiocentesis is mandatory for patients with tamponade.
- Send some of the fluid drained for microbiology and cytology.
REFERRAL
- All patients for definitive therapy.
SUPERIOR VENA CAVA SYNDROME
ICD-10 Code: I87.1
DESCRIPTION
- Superior Vena Cava (SVC) obstruction may be seen in lung cancer, germ cell tumours, lymphomas, thyroid carcinomas, and metastatic mediastinal tumours.
- Indwelling central venous catheters may cause SVC syndrome due to venous thrombosis.
- Patients present with: cough, dyspnea, dysphagia, facial oedema, or upper extremity swelling or discolouration, with development of collateral venous circulation.
GENERAL MEASURES
- Histological diagnosis is essential for definitive management.
- Head elevation and supplementary oxygen.
MEDICINE TREATMENT
Maintain normovolaemia.
- Sodium chloride 0.9%, IV, 1000 mL 8 hourly.
- Corticosteroids may be considered in consultation with a specialist.
REFERRAL
- Refer for histological diagnosis, and further management.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2024 Edition