Transcript Pain Cases
Pain Cases GPVTS Nov 08 Case 1 : Hospice patient • • • • • • RM 67/f 2004: Ovarian cancer oophrectomy +salpingectomy chemotherapy 2008: Pathological fracture to L5 treated with Radiotherapy Case 1 cont. • Admitted to hospice 1 week later for symptom control. • main symptoms: Pain – lower back, dull ache and intermittent sharp pain. Drowsiness – past 24hrs • medications: MST 60mg bd, pregabalin 150mg bd, paracetamol 1g qid Case 1 • O/E T=37.4, pulse= 88, • CVS/RESP/NEURO: NAD • Q1: what are the possible causes of RM’s drowsiness • Q2: what are the possible options to manage pain?. CASE 2: House call • • • • • DM 77/M 2008: Gastric Cancer Not for chemotherapy/Radiotherapy Poor prognosis Case 2: cont • • • • • Main symptoms : pain : Epigastric – severe dull ache Vomiting : increasing over past few days. Dysphagia : new onset Medications: omeprazole 40mg od, MST 120mg bd and PRN oramorph. metoclopramide 10mg tds Case 2 cont • O/E – unwell, grey, restlessness, • abdo: pain on light palpation in epigastrium. • Q1: what analgesics / medications should be started? • Q2:what other considerations are there in managing this patient? Case 3: telephone call: • • • • • • PF 80/f 2007: Rectal Cancer Anterior resection + tumour debulking chemotherapy + radiotherapy. 2008: Referred to palliative care. Case 3 cont • Meds: alfentanil 120mg and 12.5mg levomepromazine by csci • Q1. What prn medication should PF be on and at what dose? Case 4: Busy surgery • TM • 66/f • Long history of osteoarthritis known: previous gastric ulcer and renal impairment • awaiting knee replacement • had previous joint injections for pain Case 4 : cont • main symptom: severe left knee pain. • medications: co-codamol 30/500 qid, tramadol 100mg qid • Q1 what medication could be started? • Q2. what side effects should you warn the patient about?