Palliative Care (PC) Emergencies
Palliative Care (PC) Emergencies
Palliative Care (PC) Emergencies
C. Woelk MD
Major emergencies in palliative care
• Hypercalcaemia
• Hemorrhage
Hypercalcemia
• Commonest PC emergency
• Diagnosis
• Check renal function and corrected
calcium( need to know albumin
concentration)
• Prognosis
– Hypercalcaemia is a sign of tumour
progression
– Survival is less than 3 months with treatment
– Calcium level >4 leads to renal failure, cardiac
arrhythmias and fits
Prevention of Recurrence
• Compression of
Vasculature
• Direct
Compression
– Vertebral Mets
– Paraspinal
mass
Spinal Cord Compression
• Paresthesias (50%)
• Urinary retention/ incontinence
• Loss of bowel function
• Weakness (75%)
• Stiffness, numbness– distal- proximal
• Peri-anal numbness
Assessment of Spinal Cord
Compression
• Tender spine
• Sensory level
• Weakness of extremities
• Hyperreflexia
• Decreased sphincter tone on rectal exam
Management of Spinal Cord
Compression
• TIME
– Risk of neurological damage is reduced by fast
diagnosis and management
– Delay reduces mobility – QOL
• 70% have substantial weakness by the time of
scanning
• 70% maintain mobility after treatment
• 35% with weakness regain mobility, but only 5%
of complete paraplegics
Goal of Therapy for Spinal Cord
Compression
C. Woelk MD
Superior Venacaval Syndrome
.
Superior Venacaval Syndrome
• Extrinsic tumour or
Node
• Direct Invasion
• Intraluminal
Thrombus
– Complication of
Central Line
Who is at risk
C. Woelk MD
Superior Vena Cava Syndrome
Management
• Does not usually imply immediate threat to
life, except when trachea or pericardium is
compromised
• Important to establish a diagnosis
• Emergency treatment indicated if:
– Compromised airway
– Decreased cardiac output
– Cerebral dysfunction
C. Woelk MD
Management
• Steroids
• Raise the head of the bed
• Diuretics
• Radiotherapy
• Chemotherapy
• Intravascular expandable stents
• Thrombolysis
• Symptomatic treatment of SOB
Take home message
• Emergencies happen, even in dying individuals
C. Woelk MD