Internal Medicine — Palliative Care and Pain Medicine

Internal Medicine · Clinical Specialties

How it begins

Los cuidados paliativos constituyen un enfoque asistencial dirigido a mejorar la calidad de vida de pacientes y familias que afrontan los problemas asociados a una enfermedad potencialmente mortal, mediante la prevención y el alivio del sufrimiento por medio de la identificación precoz, la evaluación rigurosa y el tratamiento del dolor y otros problemas físicos, psicosociales y espirituales. La medicina del dolor,…

What it covers

1. Concepts, Definitions and Delimitation of the Field
2. · The concept of “total pain” (Cicely Saunders)
3. · Fundamental principles of palliative action
4. Care Models, Trajectories and Prognosis
5. · Illness trajectories at the end of life (Lunney)
6. · Tools for identifying palliative needs
7. Multidimensional Assessment of the Palliative Patient
8. · Symptomatic assessment instruments
9. · Advance decision planning (PAD)
10. Neurobiology of Pain and Pathophysiological Classification
11. · The nociceptive pathway: from the periphery to the cortex
12. · Physiopathological classification of pain
13. · Breakthrough pain
14. Clinical Evaluation of Pain
15. · Anamnesis of pain: the acronym ALICIA / OPQRST
16. WHO Analgesic Ladder and Non-Opioid Analgesics
17. · Paracetamol (acetaminophen)
18. · NSAIDs (non-steroidal anti-inflammatory drugs)
19. · Metamizole (dipyrone)
20. Opioids: Pharmacology and Clinical Use
21. · Morphine: the reference opioid
22. · Practical start and indicative doses
23. · Other major opioids
24. · Adverse effects of opioids and their management
25. Opioid Rotation and Equianalgesia Tables
26. · Guidative equianalgesia table
27. Analgesic Adjuvants and Interventional Techniques
28. · Adjuvants for neuropathic pain
29. · Other relevant adjuvants in palliatives
30. · Interventional techniques (the "fourth step")
31. Control of Digestive Symptoms
32. · Nausea and vomiting
33. · Constipation
34. · Malignant intestinal obstruction (MIO)
35. · Anorexia-cachexia and others
36. Control of Respiratory Symptoms
37. · Dyspnea
38. · Cough
39. · Premortem rattles ("death rattles")
40. · massive hemoptysis
41. Neuropsychiatric Symptoms: Delirium, Anxiety and Depression
42. · Delirium
43. · Anxiety and depression
44. · Insomnia and asthenia
45. Other Symptoms: Cutaneous, Genitourinary and Systemic
46. · Itching
47. · Sweating and hot flashes
48. · Pressure ulcers and tumor wounds
49. · Lymphedema
50. · Genitourinary symptoms
51. · Mouth: oral care as a pillar
52. · Anorexia-cachexia syndrome (enlargement)
53. Routes of Administration, Infusers and Compatibilities
54. · Drugs administered subcutaneously
55. The Agony and Care of the Last Days
56. · Principles of management in agony
57. Palliative Sedation
58. · Indications: most frequent refractory symptoms
59. · Drugs
60. Emergencies in Palliative Care
61. · Metastatic spinal cord compression
62. · Superior vena cava syndrome
63. · Malignant hypercalcemia
64. · Convulsive attacks, hemorrhages and others
65. Clinical Communication and Transmission of Bad News
66. · The SPIKES protocol to give bad news
67. · The conspiracy of silence (pact of silence)
68. · Other difficult communication situations
69. Grief and Family Care
70. · Models of the grieving process
71. · Grief accompaniment
72. Ethical Aspects and Legal Framework at the End of Life
73. · Instruments of prospective autonomy
74. · Deliberation methodology
75. Non-Oncological Palliative Care
76. Integrative Synthesis
77. · Ten operating principles for the internist