Tag: palliative

Organ donation – GIVE

Thanks to ICU consultant Forbes McGain for his annual presentation on organ donation.

 

Organ and Tissue Donation-ED Reg. Presentation-2015

 

Key points:

  1. remember the trigger – GIVE – GCS <5; Intubated, Ventilated, End of life care
  2. Acute intracerebral catastrophe (eg bleed) is the most likely ED scenario wherein donation may be considered
  3. patient’s wishes regarding donation can be unknown to their family and must be broached sensitively
  4. discussions regarding donation may be appropriately deferred to the ICU team or the on-call Donation co-ordinator (phone number found via ICU or switchboard) to maintain separation between ED care-givers and the Donation team
  5. Brain death testing is usually deferred to ICU
  6. Donation after circulatory death is an extremely unlikely ED outcome
  7. observe the fewer absolute contraindications to donation eg. active malignancy, HIV, age > 80

Wednesday Registrar Training 22.03.2017

PALLIATIVE CARE – DR ADRIAN DABSCHEK

Limited presence at Footscray, but phone consultations available

DEMENTIA

  • admission to Aged Care predicts decline

Difficult Discussions Towards End-of-Life 

  • practice the conversation
  • understand the patient’s and family background..”the patient’s journey”

ANTI-EMETICS IN PALLIATIVE CARE SETTING (beware of side effects f used in normal ED setting)
Cyclizine – incombination with dexamethaosine for raised ICP

Haloperidol – high doses often used, combined anti-psychotic effects, effective in renal failure

Ondansetron – effective in chemotherapy and radiotherapy induced N + V

Olanzepine – chemotherapy induced N + V, also antianxiety, 2.5-5mg nocte

CANCER PAIN

Physiology – inflammation vs neuropathic pain

Long acting opiates – breakthrough doses are 1/6 of long acting dose

Rotate opiods to reduce tolerance: Morphine -> oxycodone -> hydromorphone

Fentanyl patches – good for stable cancer pain, fentanyl syringe driver in renal failure

SMART CLINIC – Footscray weekly, open to non-cancer patients, Sunshine twice weekly (oncology patients)

 

COPD BUNDLE OF CARE – Dr Lexi Gerber

 

LFA-COPD-X-doc_V3.02_0815_WEB

DKA – Dr Tamarind Reynolds

hyperkalaemia

hypothermia

difficult IV access

intubation and ventilation challenges

management of shock

 

 

AMA position statement: Euthanasia

Euthanasia and physician assisted suicide is a recurring topic of public discourse.

The Australian Medical Association (AMA) has released their position statement which highlights:

  1. prioritisation of good quality end of life care
  2. ensuring that co-morbid conditions that may impact on a patient’s desire for euthanasia have been adequately and optimally managed (e.g. mental health conditions, cognitive disorders, chronic disease)

The AMA does not endorse euthanasia but acknowledges that there is a diverse range of opinion both within the medical profession and public and that ongoing conversation about the ethical and legal implications is important.

See the full statement (2016) below:

see also Aged Care Liaison Service – Palliation

 

ama-position-statement-on-euthanasia-and-physician-assisted-suicide-2016

GIVE – Organ donation

Organ-and-Tissue-Donation-E.D.-Reg.-Presentation-2016

 

Key points:

  1. remember the trigger – GIVE – GCS <5; Intubated, Ventilated, End of life care
  2. Acute intracerebral catastrophe (eg bleed) is the most likely ED scenario wherein donation may be considered
  3. patient’s wishes regarding donation can be unknown to their family and must be broached sensitively
  4. discussions regarding donation may be appropriately deferred to the ICU team or the on-call Donation co-ordinator (phone number found via ICU) to maintain separation between ED care-givers and the Donation team
  5. Brain death testing is usually deferred to ICU
  6. Donation after circulatory death is an extremely unlikely ED outcome
  7. observe the fewer absolute contraindications to donation eg. active malignancy, HIV, age > 80