S3_Palliative Emergency

Question 1

Acute Pain

Document PRSO

Answer 1

Please recommend the use of Opioid such as Fentanyl, MorphineorOxynorm

• Pain Score
• Respiratory Rate
• Sedation
• Opioid dose

Question 2

Stridor

1st line and subsequent treatment
Medications (DOBM)

Answer 2

Do recommend the following combinations should the patient presents with the following add-on symptoms

(1) edema —> steroids, dexamethosone to bring down the swelling

(2) breathlessness —> opioids, such as morphine, fentanyl, oxynorm

(3) agitation —-> sedation suchasmidazolam

Dexamethasone
Opioids
Buscopan
Midazolam

Question 3

Patient cancer site is bleeding uncontrollably, please help!

Answer 3

(1) do you have any ward-stock
Apply (500mg x4) tranexamic acid 💊 pill , in 60g paraffin base, apply on site for 10mins

Or 500mg/5ml, 10%, tranexamic acid ampoule

Special precautions
—> hematuria
—-> renal impairment
—-> renal retention
—> thrombocytopenia

(2) grab any adrenaline ampoule you can get, (1:1000),
Apply neat,ongauzepad

Question 4

Seizures, —-> Status Epilepsy

Answer 4

1st line:
- Rectal diazepam

2nd line: if seizures persist
- ⁠Midazolam

To reduce oedema:
- ⁠Dexamethasone

• anti-convulsant drugs
  -long term use might not be necessary for patients with poor prognosis
• Phenytoin
• ⁠Valporate
• ⁠Carbamazepam
• ## ⁠ Levetiracetam(keppra)

Question 5

SVCO

Answer 5

—> Dexamethasone

Order CTthorex

Question 6

Hypercalcemia

Answer 6

How is it represented:
—> ECG (shortened ST segment)

Hypocalcemia
—> ECG (prolonged QT elevation)

Management
- bone meds (denosumab, biphosphonates, calcitonin)
-⁠rehydration

Question 7

What are the drugs to discontinue for patients suffering from a seizure?

Answer 7

**Antibiotics: **
cephalosporin
imipenem

Anti-psychotics
Haloperidol

These are the drugs that can lower the seizure threshold

Question 8

What are the common causes of seizure in palliative setting?

Answer 8

In the palliative care setting, the common causes of seizures include:

Structural brain lesions e.g. primary or secondary brain tumour, acute or chronic strokes, hypoxic ischemic brain injury, traumatic brain injury
Inflammatory brain disorders e.g. meningo-encephalitis, autoimmune encephalitis

Metabolic or electrolyte disturbances e.g. uraemia, hyperammonaemia, acidaemia, severe hyponatraemia

Medications known to lower seizure threshold, or lower the efficacy of antiepileptic drugs(AEDs)

Sub-therapeutic levels of antiepileptic drugs

Question 9

Is Radiotherapy useful for MSCC patients?

Answer 9

It depends.

Radiotherapy is not useful in pain relieve for patients with unstable spine.

may require surgery or spinal analgesia to control such pain.

Question 10

What is the most distinctive and prominent sign of SVCO as compared to left sided heart failure?

Answer 10

Dilated neck veins and collateral veins in arms and chest.