ROP Breaking News: Palliative Care During COVID-19
Vanessa Cardy, MD and Heidi James, MD
- All patients deserve access to good palliative care, regardless of their COVID status and regardless of the pandemic
- COVID+ patients who are newly palliative have some unique features
- Emotional whiplash
- Provide support
- Will need to go through the stages of grieving
- Might need help preparing their affairs
- Isolation
- Figuratively and literally
- Find ways for them to communicate with loved ones
- FaceTime, Skype
- Tablets/cell phones
- Land lines
- Symptoms
- Commonly respiratory but patients can also have multi-organ failure/DIC
- Dyspnea
- Avoid fans in these patients
- Cool face cloths
- Cool water to drink
- Minimize people at bedside (health care workers)
- Guided meditations/Talking with loved ones when dyspneic and anxious
- Opiates/Benzodiazepines/Scopolamine (usual palliative care dyspnea protocol)
- Pain
- Determine source and try to address the cause
- If incident pain only use short acting medications
- Heat and ice
- Try NSAIDs or acetaminophen if no contraindications
- Consider long acting meds if patient not opiate naive
- Consider opiate alternatives (ketamine, TCAs, neuroleptics)
- Guided meditations/Talking with loved ones during pain crisis
- Delirium
- Reorientation cues
- Photographs, clocks, calendars
- Minimize noise, artificial light and overstimulation
- Communication with loved ones
- Medications
- Do not abruptly halt patient’s pre-existing prescriptions without evaluating the risk of withdrawal effects
- Terminal Hemorrhage (secondary to DIC)
- Keep the patient warm
- Dark sheets or towels at bedside
- Sedate so patient not aware of process of terminal hemorrhage
- All other palliative patients also need support and care
- Their care trajectories might be impacted by pandemic
- Might no longer be able to die at home if home care services can not support them
- Caregivers will be limited and will be in PPE once community spread established
- Social distancing protocols means patients will be much more isolated as they approach the end of their life
- Psychosocial and medical support needs to be ongoing
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