Palliative Care Flashcards
What is the care objective of the palliative care guideline?
To provide guidance to paramedics about managing patients with a palliative care plan, who call an ambulance due to new/escalating symptoms.
What new/escalating symptoms are likely to cause a palliative care patient to call 000?
Nausea/vomiting, pain, agitation/anxiety, dyspnoea.
Who does the Palliative Care CPG apply to?
This CPG only applies to patients with advanced, incurable disease who are no longer receiving active treatment, are currently registered with a community palliative care service and who express a wish to stay home.
List 6 possible causes of agitation in the palliative care pt?
Pain, hypoxia, hypotension, sepsis, urinary retention and electrolyte imbalance.
What should be the intent of treatment in the Palliative Care guideline?
To provide relief from distressing symptoms, rather than treat the underlying disease process.
What is the mainstay of treatment in the Palliative Care guideline?
Morphine, administered subcutaneously, in a dose that is likely to keep the patient comfortable until the community palliative care service can attend.
Can Midazolam be administered to Palliative patients? What is the consideration?
Midazolam can be administered where agitation is not associated with pain, however Morphine and Midazolam are not to be administered to the same patient unless under direction of CPCS due to risk of resp. dep.
If CPCS is unable to advise an appropriate dose of subcutaneous morphine, how is it calculated?
Using the AV app, to convert each of the pts opioid analgesics into a single dose equivalent - this does not include PRN medications.
If a subcut. morphine calculated dose exceeds _____, the Clinician must be contacted.
What is the maximum total dosage of subcut. morphine?
> 10mg.
20mg.
If unable to administer Morphine, can Fentanyl be administered instead?
Yes, follow standard conversion rates eg. 10mg Morphine = 100mcg Fentanyl.
When can paramedics administer the pts own medications?
Where there is a clear management plan for that symptom and the paramedic is trained and experienced in the technique of administration.
Can paramedics use insitu subcutaneous devices?
No, unless there is a trained person/family member able to guide. Paediatric palliative care will provide instructions on these over the phone.
What is the process is a paediatric palliative care patient is attended?
Consult the VPPCP via the RCH regarding treatment and transport decisions. Even where a care plan exists, consultation must still occur prior to enacting it.
How should AV medications administered be documented?
Record on the AV Health Information Sheet which should be left with the patient/carers to pass on to the palliative care team.
What are the 2 STATUS points that indicate a need for AV treatment under the Palliative Care guideline?
Pt in the care of a CPCS + the pt has followed their management plan without resolution of symptoms
