Recommended treatment for patients who have not used opoids (naïve to opoids)
| Oral morphine (or alternative opoids) | 2,5–5 mg every 4 hours |
| Morphin slow release | 10-0-10 mg** (8.00 - 0 - 20.00) |
| Lactulosa (or alternative laxatives) | 10-0-0 ml |
| Antiemetic supplement if necessary: Haloperidol 0.5–1 mg at night for up to 2 hours | |
| Morphine solution | 2.5–5 mg** (= 2–4 drops of Morphine solution 2%) |
| alternatively, morphine i.v. short infusion / s.c. | 1–3 mg** |
Recommended treatment for patients who cannot take oral medications
| Patients who did not use opioids | **1 – 2 mg i.v./s.c. 4 hours or |
| **Morphine 5–10 mg/24 h i.v./s.c. via an infusion pump | |
| Example: 50 mg *Morphine and 50 ml NaCl 0,9%, concentration 1 mg/ml, **Initial dose 0,4 ml/h | |
| Patients who are already taking opoids: | |
| Conversion of previous opioid dose to continuous parenteral administration (i.v. or s.c.) | |
| Example: 60-30-60 mg of Morphine per equivalent aprox. 50 mg i.v./24 h 50 mg *Morphine in 50 ml NaCl 0,9%, concentration 1 mg/ml, **initial dose 2 ml/h | |
Checklist for referral from intensive care unit to palliative care unit
| Indicators | CRITERIA |
|---|---|
| Weak candidate for intensive care |
|
| Continuation of intensive care will not give general benefit |
|
| Weak response to treatment |
|
| The basic condition is irreversible or the desired outcome cannot be achieved |
|
| Extremely bad expected Quality of life |
|
| There is the expected poor Neurological recovery or Long-term dependence on respirators |
|
| Conflicts of decisions / Special considerations |
|