End of life care - Revision history

ClaireLewis: /* References */

2019-10-07T13:28:23Z

References

← Revisión anterior		Revisión del 13:28 7 oct 2019
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	[[Category:Misc/General]]		[[Category:Misc/General]]
	[[Category:Palliative Medicine]]		[[Category:Palliative Medicine]]
			[[Category:Critical Care]]

ClaireLewis at 01:14, 27 January 2019

2019-01-27T01:14:09Z

← Revisión anterior		Revisión del 01:14 27 ene 2019
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	==Clinical Features==		==Clinical Features==
	*Weakness, fatigue, and functional decline		*[[Weakness]], fatigue, and functional decline
	**Increased risk of pressure ulcers		**Increased risk of pressure ulcers
	*Decreased oral intake		*Decreased oral intake
	*Neurologic changes		*Neurologic changes
	**Decreasing levels of consciousness leading to coma and death		**Decreasing levels of consciousness leading to [[coma]] and death
	**Terminal delirium confusion, restlessness, agitation, day-night reversal		**Terminal [[delirium]] confusion, restlessness, agitation, day-night reversal
	*Accumulation of upper airway secretions		*Accumulation of upper airway secretions
	**Decreased gag reflex and ability to swallow leads to gurgling, or rattling sounds with each breath		**Decreased gag reflex and ability to swallow leads to gurgling, or rattling sounds with each breath
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	==Management==		==Management==
	*Pain and dyspnea		*Pain and dyspnea
	**Opioids are the mainstay of treatment		**[[Opioids]] are the mainstay of treatment
	**Choice of opioid based on provider preference, no trials to support one over another		**Choice of opioid based on provider preference, no trials to support one over another
	**Opioid naïve patients:		**Opioid naïve patients:
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	**Discontinue non-essential IV fluids or enteral feedings		**Discontinue non-essential IV fluids or enteral feedings
	**Position the patient on his or her side		**Position the patient on his or her side
	**Glycopyrrolate (0.2 mg SC q4-6hrs, or 0.2 to 0.4 mg PO q8hrs		**[[Glycopyrrolate]] (0.2 mg SC q4-6hrs, or 0.2 to 0.4 mg PO q8hrs
	***Generally preferred over atropine and scopolamine because of less central effects		***Generally preferred over [[atropine]] and [[scopolamine]] because of less central effects
	*Delirium		*Delirium
	**[[Haloperidol]] 0.5 to 1 mg haloperidol (PO, IV, IM, or SC), repeat dose every 45 to 60 minutes titrated against symptoms		**[[Haloperidol]] 0.5 to 1 mg haloperidol (PO, IV, IM, or SC), repeat dose every 45 to 60 minutes titrated against symptoms
	**For patients with persistent agitated delirium, a single dose of [[lorazepam]] may be beneficial as an adjunct to haloperidol.		**For patients with persistent agitated delirium, a single dose of [[lorazepam]] may be beneficial as an adjunct to haloperidol.

	==Disposition==		==Disposition==

Lisayee25: Created page with "==Background== Despite widespread hospice services, many terminally ill patients visit the ED at the end of life (EOL) Up to one third of cancer patients visit the ED in the..."

2017-07-09T09:23:59Z

Created page with "==Background== *Despite widespread hospice services, many terminally ill patients visit the ED at the end of life (EOL) *Up to one third of cancer patients visit the ED in the..."

Página nueva

==Background==
*Despite widespread hospice services, many terminally ill patients visit the ED at the end of life (EOL)
*Up to one third of cancer patients visit the ED in the last 2 weeks of life <ref>Barbera L. Why do patients with cancer visit the emergency department near the end of life? Can Med Assoc J. 2010;182(6):563-568.</ref>

==Clinical Features==
*Weakness, fatigue, and functional decline
**Increased risk of pressure ulcers
*Decreased oral intake
*Neurologic changes
**Decreasing levels of consciousness leading to coma and death
**Terminal delirium confusion, restlessness, agitation, day-night reversal
*Accumulation of upper airway secretions
**Decreased gag reflex and ability to swallow leads to gurgling, or rattling sounds with each breath
*Incontinence of urine and/or stool
*Inability to close eyes
**Cachexia leads to loss of retro-obital fat pad
**Ophthalmic lubricants for dry eyes

==Differential Diagnosis==

==Evaluation==

==Management==
*Pain and dyspnea
**Opioids are the mainstay of treatment
**Choice of opioid based on provider preference, no trials to support one over another
**Opioid naïve patients:
***Consider starting doses of 1-2mg IV [[morphine]] or 0.2 to 0.4mg IV [[hydromorphone]]
***May safely redose in 10 minutes
**Opioid tolerant patients:
***Consider starting with 10% of total daily opioid dose
*Airway secretions
**The “death rattle” tend to be more distressing to family members than to the patients themselves
**Discontinue non-essential IV fluids or enteral feedings
**Position the patient on his or her side
**Glycopyrrolate (0.2 mg SC q4-6hrs, or 0.2 to 0.4 mg PO q8hrs
***Generally preferred over atropine and scopolamine because of less central effects
*Delirium
**[[Haloperidol]] 0.5 to 1 mg haloperidol (PO, IV, IM, or SC), repeat dose every 45 to 60 minutes titrated against symptoms
**For patients with persistent agitated delirium, a single dose of [[lorazepam]] may be beneficial as an adjunct to haloperidol.
==Disposition==

==See Also==
*[[Goals of care]]
*[[Delivering bad news]]

==External Links==

==References==
<references/>

[[Category:Misc/General]]
[[Category:Palliative Medicine]]

End of life care - Revision history

ClaireLewis: /* References */

ClaireLewis at 01:14, 27 January 2019

Lisayee25: Created page with "==Background== *Despite widespread hospice services, many terminally ill patients visit the ED at the end of life (EOL) *Up to one third of cancer patients visit the ED in the..."

Lisayee25: Created page with "==Background== Despite widespread hospice services, many terminally ill patients visit the ED at the end of life (EOL) Up to one third of cancer patients visit the ED in the..."