palliative emergencies Flashcards
What is an acute pain crisis?
Severe and uncontrolled, causing immense distress to patient and loved ones.
May be acute in onset or worsening gradually to an intolerable level which requires immediate intervention.
7 or more in pain scale.
What are the important aspects of the pain assessment?
Intensity
Nature
Cause
Elicit if this is a new pain or an exacerbation of an existing pain
Exclude reversible factors (eg. acute retention of urine)
What are the principles of management for acute pain crises?
Keep calm and be reassuring.
Seek help from senior members of the team.
Use strong opioids for rapid transition (use IV/SC for rapid onset of analgesia, usually morphine, fentanyl or oxynorm)
MONITOR FOR SIGNS OF TOXICITY^
After pain is controlled -> continuous infusion of opioid.
Start pain chart.
What is stridor?
Abnormal, high-pitched breath sound that is produced by turbulent airflow through a narrowed airway.
Airway passage is often <5mm.
May be gradual or sudden, can be very distressing
What are the causes of stridor?
Tumour of the upper airway
Intraluminal obstruction of the trachea due to lung or esophageal cancers
External compression by tumour, metastasis or mediastinal lymphadenopathy
Recurrent laryngeal nerve palsy (from stroke/metastasis from lung cancer)
What is the non-pharmacological management of stridor?
IMPT TO RECOGNISE & MANAGE EARLY
airway may be secured via tracheostomy or bronchoscopic interventions
Chemo or radiotherpy if the cause is a tumour that is responsive
Good communication and education of patients and family members about what to expect and treatment plans is essential
What are the pharmacological interventions for stridor?
PO/IV/SC dexamethasone 16-24mg/day to decrease peritumour oedema
PO/IV/SC opioids for breathlessness
if agitated, may need sedation (eg. midazolam)
keep fluids to minimum, airway secretions may compromise an already narrowed airway
