Diferencia entre revisiones de «Palliative medicine»
(Text replacement - "sxs " to "symptoms ") |
(Text replacement - "abx" to "antibiotic") |
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| Línea 27: | Línea 27: | ||
#*Self explanatory | #*Self explanatory | ||
#Comfort + limited life sustaining interventions | #Comfort + limited life sustaining interventions | ||
#*Admit with time limited trial (establish this beforehand) for | #*Admit with time limited trial (establish this beforehand) for antibiotic or nippv | ||
#Comfort measures only | #Comfort measures only | ||
#*Admit to hospice unit/palliative care service or manage acute symptoms in ED then dc with home hospice | #*Admit to hospice unit/palliative care service or manage acute symptoms in ED then dc with home hospice | ||
Revisión del 03:37 14 jul 2016
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 antibiotic or nippv
- Comfort measures only
- Admit to hospice unit/palliative care service or manage acute symptoms in ED then dc with home hospice