Palliative medicine: Difference between revisions
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#comfort only | #comfort only | ||
##admit to hospice unit/palliative care service or manage acute sxs in ED then dc with home hospice | ##admit to hospice unit/palliative care service or manage acute sxs in ED then dc with home hospice | ||
==See Also== | |||
*[[Pain control]] | |||
[[Category:Misc/General]] | [[Category:Misc/General]] |
Revision as of 15:01, 10 June 2015
Palliative Care in the ED
- palliative care team involvement early in EOL (end of life)
- can be distressing time for family/providers
Dyspnea
- not a time to reclarify goals of care
- reassurance is key to family
- O2, NIPPV
- bedside Fan
- morphine start "low and go slow", 1-2mg IVP Q10-15min until desired effect
- if opioid tolerant, in addition to standing use - 10% of 24 hour opioid regimen Q10min; or 25% of 4 hour opioid regimen Q10min
Dehydration
- anorexia does not cause distress, no evidence for IVF, TPN
- normal to decrease po intake in last weeks of life
- swabs on mouth/lips to prevent dry lips
- artificial tears for dry eyes
Delirium
- reassurance in normal part of dying process, not "going crazy at the end"
- common to see deceased relatives
- quiet, well lit room, windows preferable, familiar faces present
- Haldol 0.5-1mg IVP show to be useful, Benzo as additional adjunct
Disposition at End of Life
- all life sustaining care desired - self explanatory
- comfort + limited life sustaining interventions
- admit to ward/pcu bed with time limited trial (establish this beforehand) for abx or nippv
- comfort only
- admit to hospice unit/palliative care service or manage acute sxs in ED then dc with home hospice