Palliative Care
Version 1: 19-03-2020
Symptom Management for Patients at End of Life (Prognosis hours to days)
Pain or Dyspnea
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Hydromorphone 0.5- 1 mg sc q1h prn pain or dyspnea.
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If persistent pain or dyspnea, schedule hydromorphone 0.5- 1mg sc q4h strict.
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Reassess and titrate scheduled dose based on number of prns used in 24 hr period.
OR
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Morphine 1.25- 2.5 mg sc q1h prn for pain or dyspnea
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If Persistent pain or dyspnea, schedule morphine 1.25-2.5 mg sc q4h scheduled
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Reassess and titrate scheduled dose based on number of prns used in 24 hr period.
Nausea
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Haldol 0.5-1 mg sc q2h prn. Max 6mg/24 hour period.
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May schedule Haldol 1mg sc bid if persistent nausea/vomiting.
Agitation/Restlessness
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Include non pharmacological measures to address
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Haldol 0.5-1 mg sc q2h prn. Max 6mg/24 hour period.
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May schedule Haldol 1mg sc bid if persistent restlessness
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If refractory after multiple doses, stop Haldol and institute nozinan 6.25-12.5mg sc q4h prn severe restlessness/agitation
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Avoid benzos unless necessary- worsen delirium
Secretions
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Repositioning the patient
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Educate family re: secretions as a common symptom of EOL
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If distressing to patient, try scopolamine 0.4mg sc q4h prn
Fever
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Acetaminophen 650mg po/pr q4h prn
One-Way Extubation
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For patients being extubated with a prognosis of hours, follow your ICU’s protocol
Consult Palliative Care for:
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Patients whose symptoms have not been adequately controlled with the above measures
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Patients with complex symptom control needs
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Patients already followed by a palliative care specialist
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Consideration of Palliative Sedation for patients outside of the ICU
Resources
Palliating a pandemic:“all patients must be cared for”