GERIATRICS
PALIATIVE CARE
PromptDefine Paliaitive care
ResponseLife limiting illness includes cancer and chronic disease
Focus on quality of life, treatment not aimed at cure
Prevent and treat suffering
Holistic approach addressing physical, emotional, mental, social and spiritual needs
Focus on quality of life, treatment not aimed at cure
Prevent and treat suffering
Holistic approach addressing physical, emotional, mental, social and spiritual needs
PromptConsiderations when determining ceiling of care
ResponsePatient wishes (Family to guide if pt not competent)
Advanced health directive
Substitute decision maker if patient incompetent
Patients quality of life/baseline level of function
Potential reversibility of question
Nature of intervention required
Co-morbididties
Details of malignancy (or disease) - known/unknown, prognosis, treatability
Advanced health directive
Substitute decision maker if patient incompetent
Patients quality of life/baseline level of function
Potential reversibility of question
Nature of intervention required
Co-morbididties
Details of malignancy (or disease) - known/unknown, prognosis, treatability
PromptList and chart palliative care medications
ResponseMorphine 2.505mg s/c Q30min - Pain/dyspnoea
Midazolam 2.5-5mg s/c Q1h - Anxiety/adgitation
Haloperidol 0.5-1mg s/c Q3h - Nausea/vomiting
Hyoscene butylbromide - 200-400 mics s/c Q2h - respiratory secretions
Midazolam 2.5-5mg s/c Q1h - Anxiety/adgitation
Haloperidol 0.5-1mg s/c Q3h - Nausea/vomiting
Hyoscene butylbromide - 200-400 mics s/c Q2h - respiratory secretions
PromptPreparation for palliative extubation in ED
ResponseFamily discussion – withdrawing lifesaving support (in ED)
Explain likely outcome + estimated time of death
Discontinue unnecessary meds
Continue palliative meds
Private room
Social work
Chaplain/religious input
Reduce FiO2 and PEEP, ensure paralysis has worn off prior to extubation
Explain likely outcome + estimated time of death
Discontinue unnecessary meds
Continue palliative meds
Private room
Social work
Chaplain/religious input
Reduce FiO2 and PEEP, ensure paralysis has worn off prior to extubation
PromptImportant points in family discussion regarding escalating care
ResponseDiagnosis
Prognosis, reversible factors, expected recovery
Current quality of life
Treatment options including ward care
Explanation of ICU care, interventions, and ICU admission not guaranteed
Futile treatment concepts
Patients wishes, patients dignity
Setting treatment limitations
Complications of prolonged ventilation, trachy, compliations, etc.
Document discussion
Don’t say things like “organ donation” when you’re actively treating a patient, or ICU is full. You sound like a doofus
Prognosis, reversible factors, expected recovery
Current quality of life
Treatment options including ward care
Explanation of ICU care, interventions, and ICU admission not guaranteed
Futile treatment concepts
Patients wishes, patients dignity
Setting treatment limitations
Complications of prolonged ventilation, trachy, compliations, etc.
Document discussion
Don’t say things like “organ donation” when you’re actively treating a patient, or ICU is full. You sound like a doofus