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

DKA – Dr Tamarind Reynolds

hyperkalaemia

hypothermia

difficult IV access

intubation and ventilation challenges

management of shock