Emergencies in Palliative Care are situations where there is a necessity for urgent treatment to avoid a reduced quality of life for the person affected, such as Metastatic Spinal Cord Compression (MSCC), or where the presentation is potentially life threatening. For some patients, this emergency may be occuring on a background of significant deterioration where the prognosis is thought to be poor whatever is done. Careful and speedy consideration has to be made about the appropriateness of giving such treatments – if an anticipatory care plan is in place this should be referred to, and the implications of treating or not treating carefully discussed with the patient or their proxy, in line with the Adults with Incapacity Act.

For people with cancer, close involvement with their site specific CNS is important, and the CNSs can link with the patient’s oncologists. For people with life limiting conditions other than cancer there may also be a CNS or other professional involved who knows the patient well and can guide you as to their wishes and preferences, and previous treatments.

The Specialist Palliative Care Team, including the on-call consultant team overnight, would be happy to assist in the management of patients presenting with the following problems. Early referral for severe distress is recommended.

Click on each link below to take you to the relevant guideline as per the Scottish Palliative Care Guidelines (SPCG). Some of the medications recommended are used off-license or have QT prolonging effects – please see the relevant SPCG for more information.

For the Metastatic Spinal Cord Compression (MSCC) Guideline – NHS D&G is supported by NHS Lothian. The local / regional links from the link below will work if you are on an NHS computer. If not, the Scottish MSCC generic guidelines can be found here. If you need advice from acute oncology (eg) for urgent radiotherapy following MRI confirming MSCC, then contact the WGH oncology team on 0131 537 1000, or for haematology patients contact the Beatson acute oncology team on 0141 301 7000.