Key notes on symptom control issues in Palliative Care

Agitation associated with visual hallucinations and/or paranoia.

Give a stat dose of haloperidol 5mg subcutaneously. This may have to be combined with midazolam 5mg to get the patient settled initially. A subcutaneous infusion via a syringe driver will need to be set up within the next four hours to ensure control is maintained. Use 10mg of haloperidol over 24hours.

Remember that open and honest communication may help avoid long term complications. Children, parents and grandparents may feel excluded in the last few days of life, and may need to be actively involved by the professionals. Specialist advice might be needed when young children are involved. Look for those members of the family at risk of an abnormal and prolonged grief reaction and organise appropriate support. It may be appropriate for such support to start before the death.