Until the chemist opens - palliation from the doctor's bag.
BACKGROUND
People with a life limiting illness may have unpredictable exacerbations of their symptoms requiring after hours care by general practitioners using medications that are readily accessible. All doctors are provided with injectable 'doctor's bag' emergency drugs for use in such a crisis.


OBJECTIVE
This article aims to: identify which medications from the doctor's bag can be used in the palliative care crises that are most frequently encountered, present the best possible evidence for these indications, and to provide GPs caring for palliative care patients after hours with management strategies so, whenever appropriate, they can continue to be managed at home.


CONCLUSIONS
The clinical context, including disease trajectory and patient and caregivers' wishes, must be assessed in palliative care crises. Having excluded reversible problems, symptoms can be treated using doctor's bag medications. Attention must be given to route of administration, duration of effect, and appropriate doses for effective palliation.
Seidel
Rebecca
R
Southern Adelaide Palliative Services, Repatriation General Hospital, South Australia.
Sanderson
Christine
C
Mitchell
Geoff
G
Currow
David C
DC
D003221:Confusion / Q000175:diagnosis / Q000188:drug therapy; D004358:Drug Therapy / Q000295:instrumentation / Q000379:methods*; D004417:Dyspnea / Q000188:drug therapy; D005194:Family Practice / Q000379:methods*; D006801:Humans; D007415:Intestinal Obstruction / Q000188:drug therapy; D009294:Narcotics / Q000627:therapeutic use; D009325:Nausea / Q000188:drug therapy; D010146:Pain / Q000188:drug therapy; D010166:Palliative Care / Q000379:methods*; D013727:Terminal Care / Q000379:methods*; D014839:Vomiting / Q000188:drug therapy
D009294:Narcotics