see also: [[Advanced Care Directive]], [[Coroner cases]] see: [TNH Care of elderly end of life patient in ED](x-devonthink-item://8FF0D3BB-C7A9-43A7-ACD6-F17C4562FFB1), [Cameron - Death and dying](x-devonthink-item://834512A2-5BD1-42BF-9D04-27DFC4BCCBFC?page=0) and [Palliative care](x-devonthink-item://834512A2-5BD1-42BF-9D04-27DFC4BCCBFC?page=28) [ACEM policy on End of Life and Palliative care in the ED](x-devonthink-item://BC6A9512-B7E7-4659-ACDC-94ED842227E9) **Non-pharmacological supportive measures** - Environment factors - - single room, music and food preferences - patient factors - - remove monitoring - toileting care and skin / pressure cares - avoid procedures - cultural and psychosocial factors - - offer appropriate cultural and religious care and support - care and communication factors - - multi-disciplinary input and approach - timely and sensitive end-of-life discussions with family - ensure has reviews every 4 hours - access for family and updating from clinicians # EOLC medications ## General - pain - morphine 2.5-5mg s/c Q1H PRN - (fent 25-50 s/c Q30 min PRN if renal impairment) - nausea - metoclopramide 10mg s/c Q6H (avoid in bowel obstruction) - haloperidol 0.5-1mg Q4H PRN (avoid in PKD) - ondansetron 4-8mg TDS PRN - cyclizine 25-50mg TDS PRN - agitation - midaz 2.5-5mg s/c Q1H - haloperidol 0.5-1mg Q2H - dysponea - morphine 2.5 s/c s/c Q1H PRN - fan blowing air and sit upright - secretions - glycopyrloate 200-400mcg s/c Q6H - or hyoscine 400 mcg s/c Q4H ## for nursing home | medication | dosing | available quantities | | ---------------------------------------------------------------------------- | --------------------- | ----------------------------- | | *pain, dysponea* | | | | hydromorphone | 0.5-1mg s/c Q1H PRN | 2mg/mL 5x1mL ampoules | | morphine<br>(if eGFR >30) | 1.5-5 mg s/c Q1H PRN | 10mg/mL inj 5 x 1mL ampoules | | ordine liquid | 0.5-1ml po Q2H PRN | 2mg/mL 200mL x1 | | *agitation, dysponea* | | | | clonazepam po | 4 drops po Q1h PRN | 2.5mg/mL (0.1mg/drop) 10mL | | clonazepam s/c | 0.5-1mg s/c Q1H PRN | 1ml/mL inj 5x 1mL ampoules | | midazolam s/c<br>(non-PBS) | 2.5-5mg s/c q1h PRN | 5mg/mL 10x 1mL ampoules | | *nausea / vomiting* | | | | metoclopramide<br>(if pt has bowel obstruction or PKD, use zofran or haldol) | 10mg s/c Q6H PRN | 10mg/2mL 10 x 2mL ampoules | | haloperidol | 0.5-1mg s/c Q8H PRN | 5mg/mL inj 10x 1mL amoules | | ondansetron<br>(non-PBS) | 4-8mg s/c Q8H PRN | 2mg/mL 10x2mL | | *secretions* | | | | atropine eye drops (PO dose!)<br>(non-pbs) | 1-2 drops po Q4H PRN | atropine 1% eye drops 15mL x1 | | hyoscine butylbromide | 20mg s/c Q6H PRN | 20mg/mL 5x 1mL ampoule | | biotene gel<br>for dry mouth; OTC medication | QID regular + PRN Q1H | biotene gel 42 g |