End-of-life symptoms

November 23, 2014

PANDA

  • Pain – consider diamorphine 2.5 mg SC hourly PRN, adjust as required
  • Agitation – consider midazolam 2.5 mg SC hourly PRN, adjust as required
  • Nausea and vomiting – consider haloperidol 0.5-2 mg QDS PRN, cyclizine, levomepromazine 3.125-6.25 mg SC
  • Dyspnoea – consider regular morphine, steroids, diazepam
  • Airway secretions – consider hyoscine butylbromide 20 mg SC TDS PRN

Consider palliative care team review and syringe driver

Source here

Recognising end-of-life

November 22, 2014

Inert People Breath Slowly (to be used in the clinical context)

  • Infections / ulcers that are recurrent or persistent
  • Progressive weight loss (>10% over last six months)
  • Breathlessness at rest or minimal exertion (MRC scale 4/5)
  • Self-care reduced or lack of interest (in a chair >50% of the time)

More information here

Sepsis 6

November 17, 2013

O2 FLUID

  • Oxygen
  • Fluids IV
  • Lactate measurement
  • Urine output measurement (catheterisation)
  • Infection screen inc. blood cultures, FBC, CRP +/- urine dip/culture, swabs
  • Drugs – antibiotics as appropriate

ACE inhibitor contraindications

October 20, 2013

PARK

  • Pregnancy – teratogenic
  • Allergy
  • Renal artery stenosis (caution in renal failure especially if creatinine >200umol/L)
  • Kalaemia – hyperkalaemia, also hyponatraemia or hypotension/hypovolaemia

Female sterilisation counselling

October 6, 2013

FILM V

  • Failure rate – results not guaranteed
  • Irriversible – important esp. if <30yo as may want family in future
  • Laparoscopic/laparotomy – common surgical methods
  • Menstruation – periods may initially be heavier following lap sterilisation
  • Vasectomy – more desirable, simpler procedure with fewer complications

Source: www.gpnotebook.co.uk

Contraindications to warfarin with AF

April 14, 2013

AF Bleeds Horrendously

  • Adherence poor
  • Falls history/risk
  • Bleeding/coagulation disorders
  • Hypertension (+ warfarin = brain haemorrhage)

Contraindications to NSAIDS

October 23, 2012

BARS

  • Bleeding (peri-op, coagulopathy)
  • Asthma (10% of asthmatics are sensitive to non-steroidals)
  • Renal disease (hypovolaemia)
  • Stomach (peptic ulcer or gastritis).  Can prescribe PPI for gastro-protection

Causes of unintentional weight loss in elderly patients

September 13, 2012

MEALS ON WHEALS

  • Medication effects
  • Emotional problems (especially depression)
  • Anorexia nervosa, alcoholism
  • Late life paranoia
  • Swallowing disorders
  • Oral factors (such as poorly fitting dentures, caries)
  • No money
  • Wandering and other dementia related behaviours
  • Hyperthyroidism, hypothyroidism, hyperparathyroidism, hypoadrenalism
  • Enteric problems
  • Eating problems (such as an inability to feed oneself)
  • Low salt, low cholesterol diet
  • Stones, social problems (such as isolation, an inability to obtain preferred foods)

Respiratory history

July 17, 2012

CAPTION

  • Cough +/- sputum, purulent, blood
  • Atopy or allergy
  • Pain –site and if pleuritic
  • Timing of breathlessness e.g. nocturnal / acute
  • Infective prodrome or not including gastrointestinal symptoms
  • Other similar episodes
  • Normal state and treatment –usual morbidity / co-morbidity

Contributing factors to disease:

STOP

  • Social –smoking, drugs, alcohol
  • Travel
  • Occupation
  • Pets

Hyperkalaemia causes

July 12, 2012

7 A‘s

  • Artifact
  • Aldosterone antagonist
  • Addison’s disease
  • Acidosis
  • ACE inhibitors
  • Angiotensin receptor blocker
  • Anti-inflammatory

Treatment (if >7mmol/L) is 10mL of 10% calcium gluconate IV over 1 minute; to stabilise the action potential of the cell membrane.