Diferencia entre revisiones de «Palliative medicine»

Revisión del 02:10 19 ago 2013

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 EOL

all life sustaining care desired - self explanatory
comfort + limited life sustaining interventions
1. admit to ward/pcu bed with time limited trial (establish this beforehand) for abx or nippv
comfort only
1. admit to hospice unit/palliative care service or manage acute sxs in ED then dc with home hospice

Authors:

@@ Línea 1: / Línea 1: @@
-Palliative Care in the ED
+==Palliative Care in the ED==
+*palliative care team involvement early in EOL (end of life)
+*can be distressing time for family/providers
-- palliative care team involvement early in EOL (end of life)
+==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
-- can be distressing time for family/providers
+==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
-<br>
+==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
-&nbsp;Dyspnea
+==Disposition at EOL==
+#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
-- not a time to reclarify goals of care
+[[Category:Misc/General]]
-- 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
-<br>
-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
-<br>
-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
-<br>
-Disposition at EOL
-. all life sustaining care desired - self explanatory&nbsp;
-. 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&nbsp;