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management option for poorly controlled pancreatic ca with pain despite escalating opiod doses
Celiac plexus block
Management of refractory ascites in the context of end stage liver disease
Repeated large volume paracentesis
plus definitive management with a indwelling peritoneal catheter
When to use supplemental oxygen therapy in palliative patients
Can be used in conjunction with other treatments
Benefit is in patients with sats below 88% on RA with a Pao2 of <55
First line management of dyspnea in palliative patients with acute pulmonary edema
Morphine 2.5-5mg IV
First line treatment for symptomatic brain mets
IV dexamethasone
Which patients should require careful monitoring/ dose adjustment of opioids?
Those with end stage renal disease
Features of opioid withdrawl
Agitation
Tachycardia
HTN
Diaphoresis
Dilated pupils
Piloerection
Management of terminal hemorrhage in advanced ca patients
SC midazolam - provides rapid sedation and comfort. If prolonged, evidence of pain/ distress then add a strong opiod like SC morphine
When is blood transfusion use for management of iron deficiency ?
acute symptomatic anemia or CV compromise
Management of hypercalcemia of malignancy
Initial - volume expansion with IVF
1. Bisphosphonates to inhbit osteoclast mediated bone resorption - typically lowers calcium levels within 48-72 hours =. Give in renal imparment with adjusted doses
2. Denosumab - for bisphosphonate resistant malignancy hypercalcemia
Management of restless leg syndrome in patients with ESRF
Non pharm - massage, exercise, good sleep hygiene, avoid caffeine
Pharm- gabapentin
absolute contraindications to organ 1donation
CJD
active HIV
uncontrolled infection (donor sepsis)
metastatic or non-curable malignant disease
Past history of malignancy that poses risk for transmission no matter how long the apparent disease-free period (e.g. melanoma, choriocarcinoma)
How to calculate a typical breakthrough dose?
1/6th to 1/10th of the total daily background opiod dose
First line treatment for breakthrough seizures in palliative care settings
Benzodiazepines
Features of cannabis withdrawl syndrome
Anxiety, irritability, sleep disturbance, autonomic symptoms occuring within 24-48 hours of cessation
Management of subsegmental pulmonary emboli in patients with active ca
Therapeutic anticoags despite bleeding risk - prefer LMWH over DOACS for ca related thrombosis
Management of fatigue in palliative setting
- Supportive - edu, exercise, dietary advice, psychosocial support, involvement of allied health
