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

Palliative Care · Clinical Specialties

How it begins

Abordaje clínico, farmacológico, neurofisiológico y bioético integral de la transición a la muerte. Protocolos de manejo sintomático refractario y sedación adaptada al sufrimiento del paciente terminal.

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