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2.4 Planning for emergency care

In palliative care, an emergency is usually a sudden change in circumstances that impacts on quality of life in new ways.
It is important to plan and prepare for emergency care. Having an understanding of possible events and how to respond will build your confidence in case of one of these events. Some events can be expected and planned for, and some even prevented.

Be familiar with any Advance Care Directives to guide your response in case of emergency.
If an ambulance needs to be called, please be mindful of any directives or certificates arranged by the client. Keep the documents on hand to show the ambulance staff on arrival.
Contact the PCSE team if you are unsure of how to proceed.

The following sections describe common palliative emergency scenarios and the steps you can take. The PCSE team will talk to you about these so that you can be prepared.

What to do if the person you are caring for experiences…

 Fall

  • Use pillow and/or blanket to make the person comfortable
  • Do not assist them off the floor
  • CALL 000 if you need urgent assistance or call PCSE for advice/support

A medical review in hospital might be considered.

  • If physical improvements seen, review position of comfort with emergency staff and assist to bed/chair

 High temperature

  • Is the person receiving chemotherapy? When was the last dose of chemotherapy? You may need to contact the hospital where the treatment was given for further advice
  • Has there been any signs of infection e.g. cough, increased need to urinate?
  • CALL PCSE for advice if:
    – temperature is above 38 degrees for 2 hours OR
    – the person has dizziness, sweats, diarrhoea, pain on passing urine, a moist cough, shakes or feels unwell

A nursing visit or medical review in hospital may be required. Do not delay in seeking medical help.

 Nausea and vomiting

  • Give the regular anti-nausea medication early, rather than let the nausea become more severe
  • Keep a record of medication (what/when)
  • Determine if nausea/vomiting is new or existing
  • Give breakthrough medication if available
  • CALL PCSE for advice if not improved or is worse
    A nurse will visit if required and can provide additional medications. The nurse will check for possible causes.

 Restlessness/agitation

  •  Is it new or existing restlessness/agitation?
    – if new, CALL PCSE
    – if existing give breakthrough medication as advised. CALL PCSE for advice if not improved or worse

Nurse visit may be required, nurse may have additional medications

  • You can also try:
    – checking that the person is not too hot
    – checking the bedclothes for any irritation
    – sitting with the person, take their hand & talk to them
    – if it’s night time try a night light, radio or music
    – repositioning for comfort

 Seizures/fitting

  • Make the person safe and position them on their side to keep airway free
  • If the person has a history of seizures they may have medications that you can give, e.g. clonazepam drops under the tongue
  • CALL PCSE for advice and support

A nurse will visit if required; can administer calming medications.

  • CALL 000 if prolonged seizure and not responding to medications

 Severe bleeding

  • If you need help immediately call 000
  • Give breakthrough medication if available
  • Apply positive pressure to an open wound
  • Use dark towels to clean up and cover the area of the bleed
  • CALL PCSE for advice if not improved or worse

There are medications that could be given by the visiting nurse or ambulance officer to sedate and relax in case of a major bleeding event.

 Shortness of breath

  • If shortness of breath is sudden or severe, CALL 000
  • Determine if shortness of breath is new or existing:
    – if new, CALL PCSE
    – if existing, give breakthrough medication if available and repeat in 30 minutes if not improving. CALL PCSE if breathing not improved or worse

A nurse visit or medical review in hospital may be required.

  • You can also try:
    – sitting person upright
    – setting up a fan for gentle air near the face
    – opening a window or door

 Spinal cord compression

  • Is it new back pain or an increase in existing back pain?
  • Is there:
    – pain spreading/radiating down the leg?
    – numbness/pins and needles of the feet and legs?
    – leg weakness?
    – changes in bowel/bladder habits?
    – ‘banding pain’ around body or abdomen?
  • If YES to any of these questions this can be a serious medical emergency, CALL PCSE for advice

A nursing visit or medical review in hospital may be required.

 Sudden change in breathing

  • Change position for comfort; use a fan if it helps
  • Give breakthrough medications
  • Repeat in 30 minutes if not effective
  • CALL PCSE if breathing not improving or getting worse

 Sudden decrease in mobility/movement

  • CALL PCSE for advice

A nurse may visit if required to check for possible causes.

 Sudden unexpected change in consciousness

  • If sudden loss of consciousness, CALL PCSE for advice and support

 Sudden unexpected increase in pain

  • Give breakthrough pain medication if available – give early rather than waiting
  • Keep a record of medication (what/when)
  • Repeat in 30 minutes if not improving
  • CALL PCSE for advice if the pain is not improving or worse

A nurse may visit and administer additional medication.