From the Guidelines
Palliative treatment options for a traumatic head injury should prioritize symptom management and comfort care, with a focus on early involvement of palliative care teams and shared decision-making to improve communication, outcomes, and quality of life 1.
Key Considerations
- Pain management is crucial, with acetaminophen (500-1000mg every 6 hours) being a safe first choice, while NSAIDs like ibuprofen (400-600mg every 6 hours) may help with inflammation but should be used cautiously due to bleeding risks.
- For moderate to severe pain, opioids such as morphine (2.5-5mg every 4 hours) or hydrocodone (5-10mg every 4-6 hours) may be necessary.
- Antiemetics like ondansetron (4-8mg every 8 hours) or promethazine (12.5-25mg every 4-6 hours) can address nausea and vomiting.
- Positioning the patient with the head elevated at 30-45 degrees helps reduce intracranial pressure, while maintaining a calm, quiet environment minimizes stimulation.
Decision-Making Process
- The decision to implement palliative care should be made in a multidisciplinary approach, considering the patient’s directives, family feelings, and representatives’ desires 1.
- Defining the end of life in an elderly patient in a trauma setting is a complex process that should consider prognosis, recovery of cognitive ability, and the patient’s advance directives 1.
Importance of Palliative Care
- Palliative care can improve outcomes, reduce in-hospital mortality, length of stay, and improve communication with family members 1.
- Early involvement of palliative care teams can help identify patients who may benefit from palliative care and improve their quality of life 1.
From the Research
Palliative Treatment Options for Traumatic Fall and Head Injury
- The primary goal of palliative treatment is to manage pain and reduce discomfort, and several options are available, including combination analgesics 2, non-opioid analgesics such as acetaminophen and ibuprofen 3, 4, and opioid-based treatments 5, 6.
- Combination analgesics, such as acetaminophen and opioids, can provide additive analgesic effects and reduce adverse effects 2.
- Non-opioid analgesics, including ibuprofen and acetaminophen, can be effective for managing acute pain and may be considered as an alternative to opioids 3, 4, 6.
- Fixed-dose combinations of ibuprofen and acetaminophen may be a viable option for managing acute pain, with potential benefits including reduced need for rescue opioid medication and fewer adverse events 4.
- The use of opioids for acute pain management is being reevaluated due to the risk of overdose and addiction, and non-opioid alternatives are being considered as a first-line treatment option 5, 6.
Non-Opioid Treatment Options
- Acetaminophen and ibuprofen are commonly used non-opioid analgesics that can be effective for managing acute pain 3, 4.
- Combination therapy using a non-opioid pain reliever and a small amount of opioid may be effective and reduce opioid consumption 6.
- Ibuprofen and acetaminophen have different pharmacokinetic parameters, which can affect their suitability for use in everyday practice 3.
Opioid-Based Treatment Options
- Opioids can be effective for managing acute pain, but their use is being reevaluated due to the risk of overdose and addiction 5, 6.
- Combination analgesics, such as oxycodone and acetaminophen, can provide additive analgesic effects and reduce adverse effects, but may be associated with more medication-related adverse events 5.
- The use of opioids for acute pain management should be carefully considered, and non-opioid alternatives should be explored as a first-line treatment option 6.