Case Discussions
Challenges in End
of Life Care
15/11/14
MR D
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
Phone call Wednesday
2.30pm
 Vomiting
 Bowels
 Has
 Not
and generalised pains
open 2-3 days ago
not pu’d since early hours
well enough to come to
surgery
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
WHAT ARE
YOUR
THOUGHTS?
Discussion
 Differential
 Patients
Diagnosis
doesn’t want to go into
hospital
 What
more history and
examination?
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
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