A brief guide to emergency drugs in palliative care
Anticipation of problems is an important part of good palliative care. Most emergencies that arise can be dealt with a relatively small core of drugs. Experience dictates that many emergencies arise at night or at weekends when it may be difficult to get hold of medications quickly. It is well worth considering keeping these drugs in readily available places such as the patient's house or the doctor's bag.
|Morphine or Diamorphine injection||Proportional to patient's regular analgesia. A dose for breakthrough pain should be 50-100% of the patient's usual 4-HOURLY morphine or diamorphine dose (for a syringe driver running over 24 hours, divide by 6). To convert from oral morphine (mg) to parenteral morphine divide the 24 hour oral morphine dose in mg by 2, for diamorphine (mg) divide by 3.||Breakthrough pain. Breathlessness.|
|Dexamethasone injection (Decadron shockpack 20mg/5ml)||12-24mg I/V. Get additional advice/help.||Suspected: spinal cord compression (vertebral pain, radicular pain, later sensory changes, motor weakness progressing to sphincter disturbance); laryngeal or tracheal obstruction (stridor); SVC obstruction (oedema, prominent veins, dusky colour to face and arms, headache). All need to be followed by urgent radiotherapy referral.|
|Hyoscine hydrobromide (0.4mg injection)||0.4 mg s/c prn (maximum 2.4 mg/24 hours s/c).||Dries up secretions. Antiemetic. Sedating.|
|Haloperidol 5mg injection||3mg s/c for vomiting. 5mg s/c as an antipsychotic repeated hourly if necessary up to 30mg/24 hours (1.5-3mg in elderly patients).||Antiemetic. Agitation/restlessness (with evidence of hallucinations or paranoia).|
|Midazolam 10mg injection||2.5-5mg s/c stat, 10-30mg s/c over 24 hours (can be titrated up to 40-60mg if necessary).||Overwhelming anxiety. Agitation/restlessness without evidence of hallucinations). Anticonvulsant. Sedation for catastrophic emergency e.g. major haemorrhage (use at least 10mg).|
Diazepam injection (emulsion) 5mg or rectal solution or suppositories
I/V 5-10mg at rate < 5mg/minute.
PR 5-10mg stat. Repeat after 5 minutes if necessary.
Revised 2004 Resource file Palliative care emergency pack 5 Dr Eileen
Updated February 2011