Palliative-Care血液疾病诊断治疗研究方案教学PPT课件.ppt

Drug Class Dosing Indications SE/Comments 5-HT3 Antagonists: Ondansetron Granisetron IV=po, daily dosing, dose depends on prevention or Tx chemo Few- HA, constipation No data for non-chemo N/V $20-100/day Benzodiazepines: Lorazepam 0.5-2mg po/sl/iv q6hr anticipatory sedation poor single agent Corticosteroids: Dexamethasone 6-10 mg load then 2-4mg qid, po=iv central, refractory, some chemo Mood, glucose Antiemetics Case #3: Mr. D Mr. D is a 75 y/o man with end stage COPD who is admitted to the hospital with a COPD exacerbation likely secondary to an aspiration pneumonia. He is managed aggressively for the first 3 days of his hospital stay but remains SOB, hypoxic and quite restless. He clearly stated on admission that he did not wish to be intubated but is now frightened that he will die “struggling for air.” Dyspnea Subjective sensation of difficulty breathing Imbalance between perceived need and perceived ability to breath Present in 70% of dying patients in last 6 weeks of life Most patients with dyspnea not hypoxic Degree of hypoxia may not correlate with severity of dyspnea Frequently associated with anxiety What is Palliative Care? …comprehensive, interdisciplinary care, focusing primarily on promoting quality of life for patients living with a terminal [or serious, chronic] illness and for their families… assuring physical comfort [and] psychosocial support. [It is offered simultaneously with all other appropriate medical treatments.] Billings. J Pall Med 1999;1:73-81 Palliative Medicine “The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families.” World Health Organization In other words… Relieving pain in dying patients (or patients with severe, chronic illness) Relieving other bothersome symptoms in dying patients