Transcript EMS and Chemothrapy

EMS and Chemotherapy
Jerry Myers, EMT-P/EMS-I
Lieutenant, Ambulance Supervisor
Ridgefield Fire Department
[email protected]
What we will talk about
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What is Cancer
What causes Cancer
How is it treated
What is Chemotherapy
Assessment tips for chemotherapy patients
Treating chemotherapy patients
What is Cancer?
Cancer is what happens when part of your body grows in an
uncontrollable way and damages healthy parts.
Cancer cells grow and multiply when they should not.
Cancer cells are capable of crossing the normal boundaries of the
tissue they start in.
Cancer cells can get in to the bloodstream or other means of travel.
Cancer cells can establish secondary tumors at distant areas.
Cancer cells may produce substances that interfere with normal
body functions.
Some Scary Numbers
• Since 1990 there have been 17 million cases
of cancer diagnosed in the US.
• In 2003 there were 1,334,100 new cases of
cancer diagnosed in the US.
• 556,500 will die annually. This amounts to
1,500 a day!
• 1 in 4 deaths in the US are due to cancer.
There is still hope!
• In 1999 there were 8.9 million Americans
alive with a previous history of cancer.
• The 5 year survival rate for all cancers
combined is 62%.
• I’m still here, they must be doing something
right!
Where does Cancer come from?
• External Sources:
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Tobacco
Radiation
Chemicals
Infectious Organisms
Where does Cancer come from?
• Internal Factors:
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Inherited Mutations
Hormones
Immune Conditions
Mutations from Metabolism
Cancer is not contagious
• No type of cancer is contagious!
• Cancer can not be spread to others.
• There is no need to fear being around
cancer patients. You will not catch cancer
from them!!!!!
• Cancer is not contagious!
My Story
(How this subject became near and dear to me!)
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Summer 2001, I notice a lump.
September 7, 2001 I visit the urologist.
September 11, 2001, surgical intervention.
September 14, 2001. Cancer diagnosis made.
October 2001, CT Scan shows spread of Cancer.
November/December 2001 - Chemotherapy.
May 2002, Tumor doubles in size.
July/August 2002. In patient Chemotherapy.
September 2002, PET Scan shows no cancer.
How is Cancer Treated?
Surgery
Radiotherapy
Chemotherapy
Surgical Treatment of Cancer
Surgery has been used to cut out tumors for probably over
two thousand years.
Surgery still offers the best chance of cure when the cancer
can be totally contained in the area that is removed.
Surgical removal of cancer may be followed by additional
treatments such as chemotherapy or radiation.
Surgery can be preventative, Diagnostic, or Curative in
nature.
Radiotherapy
Radiation is created by machines, or given off by substances
such as cobalt.
Radiation is applied to the cancer and kills the cancer cells.
The dose needs to be high enough to kill the cancer, but not the
tissue surrounding it.
The skill of the radiation oncologist and the radiotherapy
department can have a significant effect of the success of this
treatment.
Radiation treatment is given in daily fractions lasting a few
minutes each day.
Chemotherapy
• Chemotherapy basically means treating Cancer
with chemicals.
• Often used in conjunction with other treatment
modalities such as surgery.
• Chemotherapy is still rapidly evolving as new
anti-cancer drugs are developed.
• The exact type of cancer and the stage it is in
guides the decision to use chemotherapy.
Origins of Chemotherapy
Chemotherapy was accidentally discovered when a ship carrying
mustard gas exploded during WW-2.
Pathologists were amazed by the damage to lymph systems and
bone marrow of the sailors who died.
Yale University Physicians experimented with nitrogen mustard to
treat cancers of the blood and lymph systems.
This gave birth to what we now know as chemotherapy.
Chemotherapy
• Normally used to treat cancer “systemically”
• These chemicals circulate through the body and
kill cancer cells.
• Seeks out and kills cancer cells not yet even
detected.
• Unfortunately this creates undesirable symptoms
because it kills healthy cells as well.
Chemotherapy
• In simple terms, chemotherapy is a poison.
• The poison must be taken to kill the disease.
• Chemo works most effectively on fast
growing diseases.
• It is less effective on slower diseases such
as prostrate cancer, which is why other
options are used in these cancers.
Chemotherapy
• Can be given as pills, injected into the body,
or applied to skin patches and allowed to
soak into the skin.
• Often the patient has a Port-a-cath or PIC
line to facilitate multiple transfusions.
Other Medications
• Nausea is a significant problem with
chemotherapy and patients receive both I.V.
and P.O. anti-nausea medications.
• Patients also receive steroids and antihistamines to counteract allergic reactions.
• Patients may take these medications after
chemotherapy for “break through”
symptoms.
Blood Components
• Plasma
• Red Blood Cells
• White Blood Cells
• Platelets
• Average adult has about 5 liters of
blood
Plasma
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Plasma is the liquid portion of blood
Clear, straw colored liquid
92% Water, 8% proteins etc.
Cells and Platelets suspended in the plasma
Plasma shifts in and out of circulatory system
as needed
Platelets (Thrombocytes)
• Platelets are not complete cells
• In circulation the fragments break down into
smaller fragments
• Platelets cause the blood to clot
• The lack of platelets will result in bleeding
• Normal platelet count is 130-360K/cubic mm
Red Blood Cells
(Erythrocytes)
• Tiny biconcave disk shaped cells related to
cells function
• Main function is to transport gasses
• What gasses?
• Oxygen and Carbon Dioxide.
• Normal RBC count 4,600,000-6,200,000
per cubic mm
White Blood Cells
(Leukocytes)
• There are several types of WBC’s
• Their primary function is to fight infection
and disease
• Normal WBC count is 5-10K per cubic mm
• High WBC indicates possible infection
• Low WBC means patient is vulnerable to
infection
Normal Lab Values
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WBC
5.0 - 10.0
RBC
4.5 - 5.9
Platelets 150. - 350.
HCT
41.0 - 53.0
Hematocrit (HCT) is the percentage of red
cells to plasma. Normally around 45%.
Typical Chemotherapy Cycle
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Patient has chemo in week one.
In week two, cell counts drop off.
In week three patient recovers somewhat.
Patient starts cycle again by receiving
chemo.
• Cycles run one week on, two weeks off or
variations of that.
Common Chemotherapy Drugs
Taxol
Ifosamide
Platinum
Altretamine
Aminoglutethimide
Bleomycin
Carboplatin
Cytarabine
Docetaxel
Doxorubicin
Etoposide
Floxuridine
Fluorouracil
Gemcitabine
Interferons
Levamisole
Lomustine
Methotraxate
Mitomycin
Procarbazine
Rituximab
Streptozocin
Tamoxifen
Vincristine
Most common side effects
Nausea
Hair Loss
Loss of appetite
Fatigue
Anemia
Infection
Clotting Problems
Diarrhea
Constipation
Nerve/Muscle problems
Mouth/Gum/Throat problems
Skin/Nail effects
Kidney/Bladder problems
Fluid Retention
Tooth decay
Sexual/Reproductive changes
When patients are advised to call
their physician.
Fever higher than 100.5 F
Shaking or Chills
Unusual bleeding or bruising
Shortness of breath
Severe constipation or diarrhea
Vomiting that continues 72 hours after treatment
Painful or burning urination
Blood in urine or stool
Soreness of the intravenous site
When does EMS get called for
Chemotherapy patients?
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Allergic Reaction
Weakness/Dizziness
Shortness of breath
Infection or Fever
Medical/Trauma problem where
chemotherapy is secondary to the reason for
the call.
Weakness/Dizziness
• Red Blood Cell counts get low.
• Patient becomes anemic.
• Pt. may become hypovolemic due to
reduced oral intake.
• Vomiting and Diarrhea may also reduce
patients overall volume.
• Internal bleeding from loss of platelets may
also be a factor.
Shortness of Breath
• Loss of RBC,s results in loss of oxygen
transportation capabilities.
• Patients are easily exhausted and often have
marked dyspnea on exertion as demand
exceeds available supply.
• Other medical conditions such as COPD
may be exacerbated by this situation.
Fever/Infection
• White Blood Cells combat infection, but are
also attacked by chemotherapy causing an
overall reduction of WBC’s.
• The body becomes susceptible to outside
pathogens.
• Chemotherapy Patients must wash hands
regularly, avoid fresh fruits, salad bars etc.
or they risk developing a systemic infection.
What to ask when getting history
(Specific to the chemotherapy patient)
• Type of cancer, and type of treatment
patient is undergoing.
• Where in the cycle is the patient.
• How have the side effects been. What are
the counts like.
• What caused the patient to call EMS now.
Assessment of the Chemotherapy Patient
• Assess like all other patients. Start with the ABC’s
• Initial Assessment, Physical Exam, and History
– Type of Cancer?
– Where in the cycle is the patient?
– How have their blood counts been?
• Pulse Oxymetry can be very helpful for both
respiratory and circulatory status
Providing care to Chemotherapy Patients
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Treatment is based on symptoms present
Start with ABC’s
Oxygen may be helpful
Fluids may help dehydration but avoid overload
Handle gently and avoid over exerting the patient
Remember the patient is the decision maker
Follow local protocols
Emotional Aspects of Care
• Cancer patients may be reluctant to go to
the hospital fearing a loss of control
• Like all patients, they need to be in control
of their destiny
• Remember the patient may live with the
threat of death hanging over them.
• They may not respond to normal arguments
as to why they should be transported.
Fluid/Medication Administration
• Is IV access absolutely necessary?
• When the patient says they have bad veins,
believe them!
• Use pre-existing access whenever possible.
(Portacath, PIC Line, etc.) if allowed by
Medical Control.
A Word on Portacath Access
PICC Lines
Peripherally Inserted Central Catheter
Infection Control
• Chemotherapy patients need to be protected
from infection.
• Wash your hands, use gloves.
• Use a mask if you have any cold symptoms.
• Use aseptic technique when performing
procedures such as IV’s.
Thank You for your Kind Attention
Questions?
Jerry Myers
[email protected]