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{{Family tree/start}}
===Symptoms Related to Tumor Growth in the Thorax===
{{familytree | | | | | | | | | | | | | | | | | | | A01 | | |A01=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''Identify cardinal findings that increase the pretest probability of wide complex tachycardia''' <br>❑ [[Palpitations]] <br> ❑ [[QRS complex]] > 120 ms <br>❑ [[Heart rate]] > 150 beats/min </div> <br> }}
* [[Cough]] (most common symptom)<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref><ref name="pmid12527569">{{cite journal| author=Beckles MA, Spiro SG, Colice GL, Rudd RM| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes. | journal=Chest | year= 2003 | volume= 123 | issue= 1 Suppl | pages= 97S-104S | pmid=12527569 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12527569  }} </ref>
{{familytree | | | | | | | | | | | | | | | | | | | |!| | | }}
* [[Wheezing]]<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
{{familytree | | | | | | | | | | | | | | | | | | | B01 | | |B01=<div style="float: left; text-align: left; width: 18em; padding:1em;">'''Does the patient have any of the following findings that require urgent cardioversion?''' <br>
* [[Dyspnea]]<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
❑ Hemodynamic instability
* [[Hemoptysis]]<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397  }} </ref>
:❑ [[Hypotension]]
* [[Chest pain]]<ref name="pmid21565397">{{cite journal| author=van Meerbeeck JP, Fennell DA, De Ruysscher DK| title=Small-cell lung cancer. | journal=Lancet | year= 2011 | volume= 378 | issue= 9804 | pages= 1741-55 | pmid=21565397 | doi=10.1016/S0140-6736(11)60165-7 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21565397 }} </ref>
:❑ [[Cold extremities]]
 
:❑ [[Cyanosis|Peripheral cyanosis]]
===Constitutional Symptoms===
:❑ [[Mottling]]
* [[Fatigue]]
:❑ [[Altered mental status]]
* [[Anorexia]]
❑ [[Chest discomfort]] suggestive of [[ischemia]] <br>
* [[Weight loss]]
❑ [[Heart failure|Decompensated heart failure]]</div>}}
 
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===Symptoms Related to Paraneoplastic Syndrome===
{{familytree | | | | | | | | | | | | | | | B01 | | | | | | B02 | | | | | | | | | | |B01=<div style="float: left; text-align: central; background: #FA8072; width: 15em; padding:1em;"> {{fontcolor|#F8F8FF| ❑ '''Yes'''}} </div>|B02=❑ '''No'''}}
 
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===Symptoms Related to the Distant Spread of the Tumor===
{{familytree | | | | | | | | | | | | | | | |!| | | | | | | C02 | | | | |C02=<div style="float: left; text-align: left; width: 15em; padding:1em;"> ❑ '''[[Wide complex tachycardia resident survival guide#Complete Diagnostic Approach|Continue with the complete diagnostic approach below]]''' </div>}}
* [[Hoarseness]] (involvement of the [[recurrent laryngeal nerve]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
{{familytree | | | | | | | | | | | | | | | C03 | | | | | | | | | | | | | | | |C03=<div style="float: left; text-align: left; background: #FA8072; width: 15em; padding:1em;"> {{fontcolor|#F8F8FF| '''Prepare the patient for immediate cardioversion and simultaneously do the following:'''<br>  ❑ Maintain patent airway; assist breathing as necessary<br> ❑ Adminster [[oxygen]] (if the patient is hypoxemic)<br> ❑ Cardiac monitor to identify rhythm; monitor [[blood pressure]] and oximetry <br> ❑ Give IV sedation if the patient is conscious (don't delay cardioversion to sedate the patient) <br> ❑ Consider expert consultation }} </div>}}
* [[Dyspnea]] (one of the causes is the involvement of the [[phrenic nerve]] and subsequent elevation of the hemi-[[diaphragm]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
{{familytree | | | | | | | | | | |,|-|-|-|-|+|-|-|-|-|.| | | | | | | | | | | |}}
* [[Pain]], [[muscle wasting]], or change in the skin temperature in areas corresponding to C8, T2 to T4 (involvement of the [[brachial plexus]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
{{familytree | | | | | | | | | | A01 | | | A02 | | | A03 | | | | | | | | | | |A01=<div style=" width: 15em; padding:1em;"> <div style="background: #FA8072"> {{fontcolor|#F8F8FF| '''[[VT]]/[[VF]] in the form of [[cardiac arrest]]'''<br> '''[[Cardiac arrest resident survival guide|<span style="color:white;">Click here for Cardiac arrest resident survival guide</span>]]''' }} </div> </div> |A02=<div style=" width: 15em; padding:1em;"> <div style="background: #FA8072"> {{fontcolor|#F8F8FF| '''Unsynchronized cardioversion'''<br> ❑ If a patient has polymorphic VT and is unstable, treat the rhythm as VF and deliver high-energy unsynchronized shocks <br>
* [[Chest pain]] (one of the causes is the involvement of the chest wall)<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
:❑ Provide an initial shock of 200 Joules<br>
* [[Pleuritic chest pain]]<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
:❑ Increase the dose if no response to the first shock (eg, 300 J, 360 J, 360 J) }} </div> </div>|A03=<div style=" width: 15em; padding:1em;"> <div style="background: #FA8072"> {{fontcolor|#F8F8FF| '''Synchronized cardioversion''' }} </div> </div>}}
* [[Horner syndrome]] manifested by unilateral [[miosis]], [[ptosis]] and anhydrosis (involvement of the sympathetic trunk)<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
{{familytree | | | | | | | | | | | | | | | | | |,|-|-|+|-|-|.| | | | | | | | }}
* [[Arrhythmia]] (involvement of the [[pericardium]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
{{familytree | | | | | | | | | | | | | | | | D01 | | D02 | | D03 | | | | | | |D01=<div style="float: left; text-align: left; background: #FA8072; width: 15em; padding:1em;"> {{fontcolor|#F8F8FF| '''Atrial fibrillation with aberrancy'''
* [[Cardiac tamponade]] manifested by chest pain, [[altered mental status]], [[cold extremities]], peripheral [[cyanosis]] (involvement of the [[pericardium]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
:❑ Provide an initial dose of biphasic cardioversion of 120-200 Joules ([[ACC AHA guidelines classification scheme|Class IIa, level of evidence A]])
* [[Dysphagia]] (compression of the [[esophagus]])<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166  }} </ref>
:❑ If the initial shock fails, increase the dose in a stepwise fashion }} </div>|D02=<div style="float: left; text-align: left; background: #FA8072; width: 15em; padding:1em;"> {{fontcolor|#F8F8FF| '''Arial flutter and other SVTs with aberrancy'''
* [[Superior vena cava syndrome]] manifested by [[dyspnea]], [[headache]], and [[swelling]] of the face, neck, trunk, and arms<ref name="pmid17873166">{{cite journal| author=Spiro SG, Gould MK, Colice GL, American College of Chest Physicians| title=Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition). | journal=Chest | year= 2007 | volume= 132 | issue= 3 Suppl | pages= 149S-160S | pmid=17873166 | doi=10.1378/chest.07-1358 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17873166 }} </ref>
:❑ Provide an initial dose of biphasic cardioversion of 50-100 Joules ([[ACC AHA guidelines classification scheme|Class IIa, level of evidence B]])
 
:❑ If the initial shock fails, increase the dose in a stepwise fashion
===Uncommon Symptoms===
:❑ If monophasic wave form is used, begin at 200 Joules and increase in stepwise fashion if not successful }} </div>|D03=<div style="float: left; text-align: left; background: #FA8072; width: 15em; padding:1em;"> {{fontcolor|#F8F8FF| '''Monomorphic VT (regular form and rate)'''
* [[Abdominal discomfort]] due to bilateral adrenal mass<ref name="pmid23825789">{{cite journal| author=Singh N, Madan K, Aggarwal AN, Das A| title=Symptomatic large bilateral adrenal metastases at presentation in small-cell lung cancer: a case report and review of the literature. | journal=J Thorac Dis | year= 2013 | volume= 5 | issue= 3 | pages= E83-6 | pmid=23825789 | doi=10.3978/j.issn.2072-1439.2011.09.05 | pmc=PMC3698258 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23825789 }} </ref>
:❑ Provide an initial dose of biphasic cardioversion of 100 Joules ([[ACC AHA guidelines classification scheme|Class IIb, level of evidence C]])
* [[Facial nerve palsy]] due to [[metastasis]] to the [[facial nerve]]<ref name="pmid21526004">{{cite journal| author=Yildiz O, Buyuktas D, Ekiz E, Selcukbiricik F, Papila I, Papila C| title=Facial nerve palsy: an unusual presenting feature of small cell lung cancer. | journal=Case Rep Oncol | year= 2011 | volume= 4 | issue= 1 | pages= 35-8 | pmid=21526004 | doi=10.1159/000324182 | pmc=PMC3082487 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21526004 }} </ref>
:❑ If the initial shock fails, increase the dose in a stepwise fashion }} </div> }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | }}
{{familytree | | | | | | | | | | | | | | | C01 | | | | | | | | | | | | | | | |C01=<div style="float: left; text-align: left; background: #FA8072; width: 15em; padding:1em;"> {{fontcolor|#F8F8FF| ❑ Urgent [[synchronized cardioversion|<span style="color:white;">synchronized cardioversion</span>]]<br>
:❑ Provide an initial shock of 100 Joules
:❑ If there is no response to the first shock, increase the dose in a stepwise fashion (eg, 100 J, 200 J, 300 J, 360 J)<ref name="ACLS">{{Cite web  | last = | first = | title = Part 8: Adult Advanced Cardiovascular Life Support | url = http://circ.ahajournals.org/content/122/18_suppl_3/S729.full | publisher = | date = | accessdate = 3 April 2014 }}</ref><ref name="circ.ahajournals.org">{{Cite web  | last = | first =  | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref>
❑ If the patient has polymorphic VT and is unstable, treat the rhythm as VF and deliver high-energy unsynchronized shocks
:❑ Provide an initial shock of 200 Joules
:❑ Increase the dose if no response to the first shock (eg, 300 J, 360 J, 360 J)<ref name="ACLS">{{Cite web  | last =  | first = | title = Part 8: Adult Advanced Cardiovascular Life Support | url = http://circ.ahajournals.org/content/122/18_suppl_3/S729.full | publisher = | date = | accessdate = 3 April 2014 }}</ref><ref name="circ.ahajournals.org">{{Cite web  | last = | first =  | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date = | accessdate = 15 August 2013 }}</ref> }}<ref name="ACLS">{{Cite web  | last = | first = | title = Part 8: Adult Advanced Cardiovascular Life Support | url = http://circ.ahajournals.org/content/122/18_suppl_3/S729.full | publisher = | date =  | accessdate = 3 April 2014 }}</ref><ref name="circ.ahajournals.org">{{Cite web  | last = | first = | title = ACC/AHA/ESC Guidelines for the Management of Patients With Supraventricular Arrhythmias—Executive Summary | url = http://circ.ahajournals.org/content/108/15/1871 | publisher = | date =  | accessdate = 15 August 2013 }}</ref> </div>  }}
{{familytree | | | | | | | | | | | | | | | |!| | | | | }}
{{familytree | | | | | | | | | | | | | | | D01 | | | | D01= <div style="float: left; text-align: left; width: 15em; padding:1em;">❑ '''[[Wide complex tachycardia resident survival guide#Complete Diagnostic Approach|After the stabilization of the patient, continue with the complete diagnostic approach below]]''' </div>}}
{{Family tree/end}}

Latest revision as of 13:48, 19 June 2014

Symptoms Related to Tumor Growth in the Thorax

Constitutional Symptoms

Symptoms Related to Paraneoplastic Syndrome

Symptoms Related to the Distant Spread of the Tumor

Uncommon Symptoms

  1. ↑ 1.0 1.1 1.2 1.3 1.4 van Meerbeeck JP, Fennell DA, De Ruysscher DK (2011). "Small-cell lung cancer". Lancet. 378 (9804): 1741–55. doi:10.1016/S0140-6736(11)60165-7. PMID 21565397.
  2. ↑ Beckles MA, Spiro SG, Colice GL, Rudd RM (2003). "Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes". Chest. 123 (1 Suppl): 97S–104S. PMID 12527569.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 3.9 Spiro SG, Gould MK, Colice GL, American College of Chest Physicians (2007). "Initial evaluation of the patient with lung cancer: symptoms, signs, laboratory tests, and paraneoplastic syndromes: ACCP evidenced-based clinical practice guidelines (2nd edition)". Chest. 132 (3 Suppl): 149S–160S. doi:10.1378/chest.07-1358. PMID 17873166.
  4. ↑ Singh N, Madan K, Aggarwal AN, Das A (2013). "Symptomatic large bilateral adrenal metastases at presentation in small-cell lung cancer: a case report and review of the literature". J Thorac Dis. 5 (3): E83–6. doi:10.3978/j.issn.2072-1439.2011.09.05. PMC 3698258. PMID 23825789.
  5. ↑ Yildiz O, Buyuktas D, Ekiz E, Selcukbiricik F, Papila I, Papila C (2011). "Facial nerve palsy: an unusual presenting feature of small cell lung cancer". Case Rep Oncol. 4 (1): 35–8. doi:10.1159/000324182. PMC 3082487. PMID 21526004.
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