Palliative Care

Version 1: 19-03-2020

Symptom Management for Patients at End of Life (Prognosis hours to days)
 


Pain or Dyspnea

  • Hydromorphone 0.5- 1 mg sc q1h prn pain or dyspnea.

  • If persistent pain or dyspnea, schedule hydromorphone 0.5- 1mg sc q4h strict.

  • Reassess and titrate scheduled dose based on number of prns used in 24 hr period.


​OR
 

  • Morphine 1.25- 2.5 mg sc q1h prn for pain or dyspnea

  • If Persistent pain or dyspnea, schedule morphine 1.25-2.5 mg sc q4h scheduled

  • Reassess and titrate scheduled dose based on number of prns used in 24 hr period.

 
Nausea

  • Haldol 0.5-1 mg sc q2h prn. Max 6mg/24 hour period.

  • May schedule Haldol 1mg sc bid if persistent nausea/vomiting.

 
 
Agitation/Restlessness
 

  • Include non pharmacological measures to address

  • Haldol 0.5-1 mg sc q2h prn. Max 6mg/24 hour period.

  • May schedule Haldol 1mg sc bid if persistent restlessness

  • If refractory after multiple doses, stop Haldol and institute nozinan 6.25-12.5mg sc q4h prn severe restlessness/agitation

  • Avoid benzos unless necessary- worsen delirium

 
Secretions
 

  • Repositioning the patient

  • Educate family re: secretions as a common symptom of EOL

  • If distressing to patient, try scopolamine 0.4mg sc q4h prn

 
Fever

  • Acetaminophen 650mg po/pr q4h prn

 
One-Way Extubation
 

  • For patients being extubated with a prognosis of hours, follow your ICU’s protocol 

 
Consult Palliative Care for:
 

  • Patients whose symptoms have not been adequately controlled with the above measures

  • Patients with complex symptom control needs

  • Patients already followed by a palliative care specialist

  • Consideration of Palliative Sedation for patients outside of the ICU

 
Resources
Palliating a pandemic:“all patients must be cared for”

 

https://oxfordmedicine.com/view/10.1093/med/9780190066529.001.0001/med-9780190066529-chapter-9#med-9780190066529-chapter-9-boxedMatter-7

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