Didactics-Evidence Based EOL Care Part 2

Video Transcription

Video Summary

In the video, the speaker discusses evidence-based management of symptoms at the end of life. The first half of the talk is a follow-up to a previous discussion about prognosis. The speaker shares slides with links to helpful resources. In the dying process, there are symptoms that indicate a patient is entering the active phase of dying, which can last from hours to two weeks. Early symptoms include being bed-bound, decreased food and drink intake, and increased sleep. In the middle phase, there is even less time awake, fluctuating vital signs, and an inability to manage secretions. In the late phases, patients are not awake, experience fever, apneas, and modeling of the extremities. Fever at the end of life can have various causes, and management is usually supportive. Agitation is common, and medication reconciliation is important to identify contributing factors. Haloperidol is often used, but benzodiazepines can be added if needed. Secretions are managed through postural drainage and positioning, and medications like hyoscyamine can be used. Dyspnea is addressed by discontinuing IV fluids, using fans or oxygen, and considering low-dose opioids. Pain management at the end of life is driven by prognosis, and a medication review is crucial. Total pain, which includes physical, mental, emotional, spiritual, and existential pain, should be considered. Resources mentioned include the Palliative Performance Scale, Fast Facts, and the Pink Book. The speaker also provides references for further reading.

Asset Subtitle

Lindsey Buckingham
January 2021

Keywords

evidence-based management

symptoms

end of life

prognosis

dying process