End of Life Care Flashcards
What is step 1 of the pain ladder?
Paracetamol 1g 4x daily
OR
NSAID 500mg 2x daily
What is step 2 of the pain ladder?
Codeine 30-60mg 4x daily
OR
Co-codamol 30/500 2 tabs 4x daily
What is step 3 of the pain ladder?
Stop codeine and switch to opioid
How is opioid toxicity reversed?
Naloxone
How does opioid toxicity present?
Hallucinations, myoclonus, drowsiness, resp depression
What opioid pain killers are given for severe background pain?
Morphine sulphate 10-15mg 2x daily
What opioids are given for breakthrough pain?
Severdol
Oromorph
What is a key info summary?
Used to plan ahead to avoid panicked decisions at end of life care
What information does the key info summary contain?
Resus wishes
Preferred place of death
“Just in case” medication
Power of attorney
Who is primarily responsible for updating a patient’s KIS?
GP
What are signs that a patient is dying?
Weakness Worsening status Psychological distress No interest in food Sleeping more
What conditions may mimic a patient dying?
Hypoglycaemia Delirium Sepsis AKI Drug toxicity
What steps should be taken once established a patient is dying?
Stop oral meds, routine obs and remove cannula
Give anticipatory medications through a syringe driver
What “anticipatory medications” are given when a patient is dying?
Morphine 2mg SC hourly
Midazolam 2mg SC hourly
Levomepromazine 2.5mg 8 hourly
Buscopan 20mg hourly
What is given for dyspnoea at end of life?
Morphine
What is given for distress at end of life?
Midazolam
What is given for nausea at end of life?
Levomepromazine
What is given for respiratory secretions at end of life?
Buscopan
What steps are involved at verifying death?
Check for spontaneous movement (incl resp effort)
Reaction to voice and pain
Palpate two major muscles for one minute
Inspect eyes for dryness, fixed pupils, absence of corneal reflex and clouding
Auscultate lungs and heart
