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Published byCornelia French Modified over 9 years ago
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Case Discussions Challenges in End of Life Care 15/11/14 MR D
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MR D 73 year old Man Lung cancer 2 years ago- (treated) 4 mnth ago radiotherapy for humerus mets - Gradual decline over few months. Tired but independent Lives with wife who has MS but is mobile Hates hospital. Preferred Place of care- own Home PMH: MI 6 yrs ago and BPH Meds: Oxycontinin, Oxynorm, Pregabalin Tamsulosin PPI, Aspirin, Statin, ACE
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Phone call Wednesday 2.30pm Vomiting and generalised pains Bowels open 2-3 days ago Has not pu’d since early hours Not well enough to come to surgery
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GP Visit In Bed- Not well Temp 38.2, Pulse 105, Vomiting Abd soft- Some loading of bowel Bladder just palpable - slightly tender Patient and wife distressed
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WHAT ARE YOUR THOUGHTS?
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Discussion Differential Diagnosis Patients doesn’t want to go into hospital What more history and examination?
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What happened next Patient didn’t want to go into hospital DN catheterised patient: some blood ?infection Antiemetics given subcut Patient settled but has some new back pain Examined CNS Decrease power and tone L leg Some sensory impairment Patient then agreed to admission for MRI Steroids started at home
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Metastatic spinal cord Compression Admit to nearest hospital with facility for MRI Inform ambulance: stretcher required. Admit within 1 hr Ensure letter/phone call state possible MSCC If available give 16mg dexamethasone orally
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