Adult Medical Emergency Handbook - Scottish Intensive Care Society

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Chapter 9
EMEGENCIES IN HAEMATOLOGY , ONCOLOGY
& PALLIATIVE CARE
1. NEUTROPENIC SEPSIS
Definitions
Neutropenia: neutrophil count of less than 1.0 x 109 /l.
Fever: isolated temperature greater than 38.5oC or 2 recordings greater
than 38.0oC two hours apart. (NOTE: patients may be neutropenic and
septic with a normal/low temperature. If recent chemotherapy and
unwell then assume neutropenic sepsis until proven otherwise).
Presenting features
• Generalised constitutional symptoms are common (lethargy,
rigors, confusion). Patients can go from being well to being in
life threatening septic shock in just a few hours. Neutropenia
markedly alters the host’s immune response and makes infection
more difficult to detect.
• Ask about respiratory, urinary, oropharyngeal and lower GI
symptoms. Enquire about recent instrumentation/dental work.
• Does the patient have a Hickman Line? Ask about recent line use
and whether there is pain around the line.
Patients with febrile neutropenia MUST receive antibiotics
even if there are no localising signs of infection.
Assessment
Look for:
• Signs of shock e.g. tachypnoea, tachycardia, hypotension, altered
mental state.
• Fever
• Detailed examination for any localising signs of infection.
Management
AIM FOR FIRST DOSE OF IV ANTIBIOTICS AS SOON AS POSSIBLE
BUT AT THE LATEST WITHIN 1 HOUR OF ADMISSION – if septic following
chemotherapy then confirmation of neutropenia is not needed
before first antibiotics
• Assess ABCDE. Treat as in Chapter 2.
• Give high concentration oxygen by mask.
242 adult medical emergencies handbook | NHS LOTHIAN: UNIVERSITY HOSPITALS DIVISION | 2009/11