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Next step when managing suspected spinal cord compression secondary to mets
IV dexamethasone (usually 16mg) to reduce cord edema and prevent further neurological deterioration while arranging an urgent MRI. Then urgent neurosurgical referral
Clin F of cauda equina syndrome
Progressive neurological dysfunction, bladder dysfunction (incontinence and retention), and saddle anesthesia
What is tamoxifen used to treat
It is a SERM (selective estrogen receptor modular) used to treat estrogen positive breast ca
What is letrozole used to treat
It is an aromatase inhibitos used for breast ca treatment in post menopausal women.
What is passive voluntary euthenasia
Withdrawing/ witholding life sustaining treatments while providing comfort care which allows for natural death to occur.
Active voluntary euthanasia
nvolves deliberately administering substances to end life, which is illegal in most jurisdictions
Assisted suicide
refers to providing means for a patient to end their own life, which is distinct from withdrawing treatment
Medical homicide
implies wrongful killing, which does not apply to appropriate end-of-life care decisions
Therapeutic nihilism
refers to the belief that medical interventions are pointless, rather than making considered decisions about treatment withdrawal
Antidepressant discontinuation syndrome
Following abrupt cessation of SSRI
Occurs 2-4 days after
SX: dizzy, nausea, anxiety, sensory disturbances- ‘electric shock’ sensations
Management of antidepressant discontinuation syndrome
Restarting antidepressant at previous dose- ususally resolves symptoms within 24-48 hours
Management of acute dystonia due to missed doses of levodopa- carbidopa in the context of end stage Parkinson’s disease
SC midazolam
Transdermal rotigotine patch considered as longer term mng to replace PO levodopa but doesn’t provide immediate relief for acute dystonia as its onset is 24-48 hours
Effective alternative pain management in patients unable to tolerate PO opiods due to N/V
Transdermal buprenorphine - continuous, useful in renal impairment
SC morhpine is possible but requires more frequent monitoring and adjustement. May also not be practical if community setting
First line treatment for symptomatic SIADH in ca patients
Fluid restriction to 800-1000ml/ day –> promotes gradual increase in serum sodium concentration by limiting free water intake
–> gradual correction and reduces the risk of central pontine myelinosis
Clin F of severe SIADH
= clin f of severe hyponatremia- seizures, severe confusion, vomiting, cardiorespiratory distress
Mng of severe SIADH
= mng of severe hyponatremia - 3% hypertonic saline
Definitive treatment for malignant spinal cord compression
radiotherapy within 24hours of corticosteroid initiation
Most suitable method for providing consistent symptom control in EOLC especially when frequent breakthrough doses are required
Continuous SC infusion pump, syringe driver
First line treatment of death rattle
- Anticholinergics - glycopyrronium
Position patient upright may provide some temporary relief but would not address the underlying problem of excessive secretion production. Additionally, repositioning may cause further distress to an already agitated patient.
Commence nebulised saline would be counterproductive as it would increase airway secretions and potentially worsen the situation. Nebulised saline is sometimes used to help mobilise thick secretions in patients who can effectively cough and clear their airways, which is not the case here.
Regular oral care and suctioning may be traumatic and distressing for the patient at this stage. Suctioning can stimulate more secretion production and cause additional discomfort without providing lasting benefit.
Management of terminal delirium
1- haloperidol
2- midazolam
