What else is new (other symptoms) DR ANDREW DAVIES
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1 What else is new (other symptoms) DR ANDREW DAVIES
2 Outline Nausea & vomiting Petroleum jelly (and oxygen)
3 Nausea & vomiting
4 MASCC / ESMO recommendations
5 MASCC / ESMO recommendations General: The anti-emetic drug of choice in advanced cancer is metoclopramide (titrated to effect) MASCC level of consensus high MASCC level of confidence moderate
6 MASCC / ESMO recommendations General: Alternative options include haloperidol, levomepromazine, or olanzapine MASCC level of consensus high MASCC level of confidence low
7 MASCC / ESMO recommendations General: The use of cyclizine or 5-HT3 receptor antagonists is poorly defined to date and may be used where dopamine antagonists are contraindicated or ineffective MASCC level of consensus low MASCC level of confidence low
8 MASCC / ESMO recommendations Bowel obstruction: The drug recommended in a bowel obstruction is octreotide, dosed around the clock, and given alongside an antiemetic (with the committee recommending haloperidol) MASCC level of consensus high MASCC level of confidence high
9 MASCC / ESMO recommendations Bowel obstruction: If octreotide plus antiemetic is ineffective, the use of anticholinergic antisecretory agents (e.g., scopolamine butylbromide, glycopyrronium bromide) and/or corticosteroids is recommended as either adjunct or alternative interventions MASCC level of consensus high (moderate for corticosteroids) MASCC level of confidence moderate (low for corticosteroids)
10 MASCC / ESMO recommendations Bowel obstruction: The use of cyclizine or 5-HT3 receptor antagonists is poorly defined in this setting. Metoclopramide should be used with caution in partial bowel obstruction and should not be used in complete bowel obstruction MASCC level of consensus low MASCC level of confidence low
11 MASCC / ESMO recommendations Opioid-induced: No recommendation can be made for specific antiemetics, although various antiemetics may help. Opioid rotation and route switching ma be effective approaches. There is no data to support prophylactic antiemetics in this situation MASCC level of consensus high MASCC level of confidence low
12 Petroleum jelly (and oxygen)
13 Petroleum jelly
14 Petroleum jelly To prevent cracking of the lips, smear petroleum jelly (for example Vaseline ) on the lips. However, if a person is on oxygen apply a water-soluble lubricant (for example K-Y Jelly ). NICE: CKS Palliative care oral Vaseline or similar for lips (caution is necessary if a person is receiving oxygen, as Vaseline is flammable NEoLCP: End of life care learning resource pack
15 Petroleum jelly No case reports in MEDLINE!
16 Petroleum jelly Ignition temperature minimum temperature at which substance will ignite spontaneously Petroleum jelly: ~ 540 o F / 282 o C (similar to plastics used in oxygen equipment)
17 Petroleum jelly Flash point minimum temperature at which substance will ignite in presence of ignition source Petroleum jelly: ~ 400 o F / 204 o C (similar to plastics used in oxygen equipment)
18 Petroleum jelly Acknowledgments: Dr Matthew Dore Prof Max Watson Dr Clare White
19 Petroleum jelly YouTube clip burning petroleum jelly
20 Petroleum jelly YouTube clip burning oxygen tubing
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