Diferencia entre revisiones de «Palliative medicine»
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==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 | ||
==Dyspnea== | ==Dyspnea== | ||
* | *Not a time to reclarify goals of care | ||
* | *Reassurance is key to family | ||
*O2, NIPPV | *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== | ==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== | ==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 | *Haldol 0.5-1mg IVP show to be useful, Benzo as additional adjunct | ||
==Disposition at End of Life== | ==Disposition at End of Life== | ||
# | #All life sustaining care desired | ||
# | #*Self explanatory | ||
# | #Comfort + limited life sustaining interventions | ||
# | #*Admit with time limited trial (establish this beforehand) for abx or nippv | ||
# | #Comfort measures only | ||
#*Admit to hospice unit/palliative care service or manage acute sxs in ED then dc with home hospice | |||
==See Also== | ==See Also== | ||
Revisión del 03:13 1 sep 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 with time limited trial (establish this beforehand) for abx or nippv
- Comfort measures only
- Admit to hospice unit/palliative care service or manage acute sxs in ED then dc with home hospice