Palliative Care — Last Days Situation (LDS) and Palliative Sedation

Palliative Care · Clinical Specialties

How it begins

Comprehensive clinical, pharmacological, neurophysiological and bioethical approach to the transition to death. Protocols for refractory symptomatic management and sedation adapted to the suffering of the terminally ill patient.

What it covers

1. Last Days and Sedation Situation
2. Pathophysiology of Agony and Transition to Death
3. · The Pathophysiological Cascade of Multiorgan Failure in Agony
4. · Neurochemical Mechanisms of Delirium and Agitation in SUD
5. Clinical Diagnosis of the Situation of the Last Days
6. · SUD Diagnostic Criteria (Menten Criteria)
7. · Signs of Imminent Death (Studies by Hui et al.)
8. Non-Pharmacological Management and Bioethical Framework of SUD
9. · Adequacy of Therapeutic Effort (AET) or Withdrawal of Life Support
10. · Bioethical Framework: Distinction between Limitation of Support, Sedation and Euthanasia
11. · Non-Pharmacological Environmental Comfort Measures
12. Pharmacotherapy of Premortem Rattle
13. · Pathophysiology of Premortem Rattle (Death Rattle)
14. · Classification of Secretions: Type I vs. Type II
15. · Pharmacology of Anticholinergic Agents
16. Control of Dyspnea of Last Days
17. · Pathophysiology of Terminal Dyspnea
18. · Pharmacological Treatment: The Standard Role of Opioids
19. · Dosage and Titration of Morphine Chloride in SUD
20. · Synergistic Anxiolysis with Benzodiazepines
21. Management of Hyperactive Delirium and Agitation in SUD
22. · Etiology of Delirium at the End of Life
23. · Immediate Clinical Differential Diagnosis
24. · Pharmacological Treatment of Terminal Delirium
25. Management of Refractory Pain in SUD
26. · Assessment of Pain in the Non-Communicative Patient
27. · The Subcutaneous Route as a Mandatory Alternative
28. · Pathophysiology of Opioid-Induced Hyperalgesia (OIH)
29. Nausea, Vomiting and Terminal Intestinal Obstruction
30. · Physiological Mechanism of Vomiting in SUD
31. · Antiemetic Pharmacological Strategy
32. · Management of Refractory Malignant Intestinal Obstruction (MBO)
33. Subcutaneous Route and Continuous Infusion Systems
34. · Anatomy and Physiology of Absorption in the Subcutaneous Space
35. · Subcutaneous Catheter Insertion Areas
36. · Hypodermoclysis (Subcutaneous Rehydration)
37. · Elastomeric Infusers: Types and Stability of Palliative Mixtures
38. Palliative Sedation: Fundamentals and Ethical Justification
39. · Classification of Types of Palliative Sedation
40. · The Critical Delimitation: Refractory Symptom vs. Difficult Symptom
41. · Ethical Justification: The Principle of Double Effect
42. Sedation Protocols and Pharmacology of Consciousness
43. · Detailed Pharmacology of the Sedatives of Choice in Palliative Care
44. · Clinical Titration and Escalation Protocol
45. Evaluation, Monitoring and Recording of Sedation
46. · Clinical Monitoring in the Sedated Patient
47. · Ramsay Scale and its Application in Palliative Care
48. · RASS-PAL Scale (Richmond Agitation-Sedation Scale Modified for Palliative Care)
49. Hydration and Nutrition in the Situation of the Last Days
50. · The Metabolic Transition from Nutrition to Fasting in Dying
51. · The Pathophysiology of Dehydration in SUD: The Comfort Paradigm
52. Grief Care, Family Care and Legal Aspects
53. · Attention to the Family in the Transition to Death
54. · Prevention of Pathological Grief
55. · Legal Aspects of SUD and Death Certification