Palliative medicine
Revision as of 19:18, 5 September 2016 by ClaireLewis (talk | contribs)
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 antibiotics or NIPPV
- Comfort measures only
- Admit to hospice unit/palliative care service or manage acute symptoms in ED then dc with home hospice
External Resources
- Fast Facts : great quick-reference resource for practical/specific info on myriad palliative care topics