Key notes on symptom control issues in Palliative Care



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tarix25.12.2016
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Management


  • In all cases acknowledge and explore the patient’s and family’s ideas and expectations. Deal with fears honestly.

  • Laser treatment is available in a limited number of centres and is highly effective and can be repeated indefinitely.

  • Anti-fibrinolytics such as tranexamic acid 1g tds may help some patients and should be considered when the patient is unfit for other interventions.

  • Oral steroids can help when the haemoptysis is due to tumour progression. Start dexamethasone 8mg as a single morning dose and titrate downwards after one week to the minimum dose that controls symptoms. If no effect after one week stop. Use appropriate GI protection using either a proton pump inhibitor or misoprostol in at risk patients.
Catastrophic haemoptysis

In approximately 1% of all haemoptyses the bleed will be the terminal event. In such cases there has usually been a number of smaller ‘herald’ bleeds.



Managing such cases is difficult and traumatic for all involved. If there is concern about a large haemoptysis, decisions about place of care need to be made with the patient and family. The family need to know what they can do and who to contact.

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