Terminal Sedation

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Geri_Gal

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I've read about this technique used for severe symptom management in dying patients, but have never seen it performed...and have never worked at an institution that uses this.

Has anyone used this technique? Seen it done? If so, what was your experience?

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this is a patient with terminal ILD

iv morphine 4mg/iv ativan 2 mg I dont remember the freqency it might have been q30 minutes PRN to keep rr<20, hr<100
 
Hi

Currently a Pall Care fellow in NYC. Have used sedation techniques as mentioned above after removing pts from vents but frequency I use is morphine/and or ativan q2-4 hours around the clock depending on patient's resp status and comfort level. I will use glycopyrrolate or scopolomine to dry up secretions (eliminating that rattling sound). If patient is stable for transfer (after 24 hrs) to an inpatient hospice unit these arrangements are made (with the family's consent).
 
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Currently a PCM fellow as well.
We have used thorazine or valium 5mg IV q5min x3 as a "take down" manuever with massive hemorrhage. Also ketamine.

Experience of it? It had to be done for patient comfort and it was done and it worked. The key is seeing it done by experienced hospice docs. Especially how they handle the social issues with families standing by.
 
Currently a PCM fellow as well.
We have used thorazine or valium 5mg IV q5min x3 as a "take down" manuever with massive hemorrhage. Also ketamine.

Experience of it? It had to be done for patient comfort and it was done and it worked. The key is seeing it done by experienced hospice docs. Especially how they handle the social issues with families standing by.

Please explain the theory behind using ketamine for this type of therapy. I am very intrigued.

HH
 
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