Overview of Palliative Care

• Palliative Care:  Cure is not possible, treat to prolong meaningful life.
• Terminal Care:  Treat for comfort without goal of prolonging life.

Goals:  Comfort for things we can't fix, anticipate bad things, reassess frequently, work within the framework of family.

Location:  Home versus Hospital.

Primary Disease Control:  Chemotherapy, Radiation, Surgery, Alternative Treatments.

Symptom Management

• Pain
• WHO ladder

Mild	Moderate	Severe
		Morphine Methadone ...
	Mild Opiod: Codeine Oxycodone Ultram Tranadol
NSAID tylenol

• Oral route is preferred
• Adjunct therapy includes steroids, anticonvulsants, antidepressants, phenothiazines, anxiolytics, local/regional/general anesthesia, alternative treatments.  Don't forget about primary tumor treatment if possible.
• Hypoxia
• Oxygen, CPAP, benzodiazepines, barbiturates, nebulized morphine
• Organ dysfunction and compression
• Sublingual atropine, glycopyrrolate, B&Os, mechanical decompression
• Anxiety, Depression, and Sleep disturbances
• Antidepressants, benzodiazepines, antihistamines, counseling, others
• Infection
• Antibiotics, antifungals, local measures; may not be appropriate in end-stage patient
• Seizures
• Treat when they occur, prophylaxis in risk situations, rectal valium is always available
• Malnutrition
• Anorexia/cachexia is part of dying; decisions to support are individualized
• Bleeding/Anemia
• Important decisions regarding use of blood product support.
• DNR
• Ask early, ask often
• Postmortem examination
• Provides information and closure