Prognosis- Double removal
- Reality: 25 days
- Optimistic doctor thinks 75 days
- Doctor tells patient 90 days
Three cardinal clinical skills - Diagnostics
- Therapeutics
- Prognostication
Pain types
- Nociceptive
- Neuropathic
- (Opioids) but not really
- Amitriptyline (1st line)
- Gabapentin
- Clonazepam
Gold Standards Framework
Notes
- Midazolam is 1st line for terminal agitation
- Haloperidol has double effect
- "Ceiling of care"
- Need to know the prognosis, so you know how much intervention is appropriate
- e.g. Treat neutropaenic sepsis, but not necessarily chest infection in terminal AIDS
- Total pain
- Physical, but also psychological, social, spiritual
- Tapentadol
- Centrally acting analgesi with opioid and non-opioid activity
- Dual mode of action
- Agonist of the μ-opioid receptor
- Norepinephrine reuptake inhibitor
- Potency between tramadol and morphine
- Steroids can => Proximal myopathy
- Referred pain to the back from upper GI disturbance is via the COELIAC PLEXUS
- Pinpoint pupils are common when pain is managed with opioids
- DON'T give naloxone unless RR < 8
- Oral oxycodone is twice as strong as oral morphine
- Domperidone doesn't cross BBB => Good antiemetic choice in Parkinson's
- Ondansetron => Constipation
- Need to contact coroner to certify death if you haven't seen the patient in >1 week
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