4th April [26th-2nd] Flashcards
What does the ADRT contain?
- Personal details
- Who you’ve discussed Advanced Decision with
- Refusals of Tx
- To avoid doubt
- Advance statement
- People involved in the are
- Lasting Power of Attorney
- Signature
- Witness signature
What is the ‘to avoid doubt’ section in the ADRT?
- Yes/no to all pain relief
- pregnancy and having the baby when palliative
- organ donation
Baile’s model for breaking bad news
S - setting P - perception I - invitation K - knowledge [check/chunk] E - empathic S - summary/strategy
Success rates on general population in hospital CRP?
Around 18% recover sufficiently in hospital
- though number very variable based on health of person
What could be given for an end of life patient with heat failure to help with his breathing?
Opiates
- via syringe drivers [titrating up]
- via buprenorphine patches
Benzos
- in small doses for acute episodes would help [Mirdazalam/Lorazepam]
Advantages/disadvantages of different types of opiates administration
Syringe drivers
- quick action
- can titrate up easily
- easier to OD with
- need to be attached to a machine
Patches [buprenorphine]
- can cause sore skin area
- take longer to work
- not as easy to titrate up
Chance of people with advanced metastatic disease [particularly the upper thorax] recovering from CPR
Rare -> around 2% chance, with near 0% chance fully recover and get discharged.
Patient factors hyper/hypovolaemia and hydration
Trauma, febrile illness/sepsis, age, burns. polyuria etc.
Sx of dehydration
Cyanososi, SOB, pallor, malar flush, oedema, leukonychia [end-stage liver disease, protein-losing enteropathy], colour hands, temperature, CRT, skin turgor, radial pulse, brachial pulse, BP, JVP, eyes [sunken/pallor], mucous membranes mouth, chest for heart/lungs sounds, abdomen for shifting dullness/distnesion, sacral oedema/pitting pedal oedema
Red flags bowel Ca
- persistent change bowel habits [pooing more often, looser stools, tummy pain]
- blood in the poo w/o Sx of piles
- abdominal pain or discomfort or bloating always brought on by eating
Common Ca to spread to bone
Prostate, breast, lung, kidney, thyroid, myeloma
Sx of secondary bone Ca
Pain - continuous, gnawing often described
Backache - gets worse despite resting
Breaks - bone getting weaker
Hypercalcaemia - dehydration, confusion, being sick, tummy pain, constipation
increased risk infection, SOB, looking pale, bruising and bleeding due to low level blood cells.
Pain/weakness/numbness in the legs/blowel/bladder control due to spinal cord compression
What can CPR involve?
- chest compression
- defibrillator
- artificial ventilation
- giving medicine by injection
Success CPR factors
- Lungs/heart/other organs working before heart/breathing stops
- Near person trained in CPR
- Any equipment needs like defibrillates is ready
Where does pain begin?
Nociceptors [branching ends of peripheral nuerones] -> primary afferent neurones -> spinal thalamic tract -> thalamus -> somatosensory cortex
NT released in pre-synpatic neurones
- GLUTAMATE [-> NMDA, AMPA]
- Substance P [NK-1]
- CGRP [CGRP-R]
Main types of opioid receptors?
M, delta and K
