Specialist palliative care services (SPCS) have a vital role to play in the global coronavirus disease 2019 pandemic. Core expertise in complex symptom management, decision making in uncertainty, advocacy and education, and ensuring a compassionate response are essential, and SPCS are well positioned to take a proactive approach in crisis management planning. SPCS resource capacity is likely to be overwhelmed, and consideration needs to be given to empowering and supporting high-quality primary palliative care in all care locations. Our local SPCS have developed a Palliative Care Pandemic Pack to disseminate succinct and specific information, guidance, and resources designed to enable the rapid upskilling of nonspecialist clinicians needing to provide palliative care. It may be a useful tool for our SPCS colleagues to adapt as we face this global challenge collaboratively.

Background: This report describes the use of intranasal dexmedetomidine to control incident pain and facilitate daily change of dressing in a patient with cutaneous breast cancer. Case presentation: A 45-year-old woman with extensive thoracic cutaneous metastatic bilateral breast cancer requiring daily 2-hour dressing changes to manage significant exudate. Pain during change of dressing was severe and unresponsive to usual analgesics. Deeper sedation was not an option as the patient was required to change position 1 hour into dressing change. Case management: Intranasal dexmedetomidine was administered 40 minutes prior to dressing change and provided effective rousable sedation and analgesia for the duration of the procedure. Case outcome: Dexmedetomidine provided rousable sedation, allowing the patient to follow commands and mobilise during the procedure. Pain was controlled. No adverse cardiovascular effects were noted with the use of intranasal dexmedetomidine. Conclusion: Intranasal dexmedetomidine is a potentially useful medication for procedural sedation in the management of complex wound dressings. It provides rousable short-term sedation, anxiolysis and analgesia. Further research into the role of intranasal dexmedetomidine to facilitate challenging dressing changes in a community setting is warranted.

This case report describes the use of dexmedetomidine for refractory cancer pain management in a patient with significant pelvic disease due to metastatic urothelial cancer. Specifically, the management of increased opioid sensitivity secondary to dexmedetomidine is discussed. Further, the phenomenon of dexmedetomidine withdrawal syndrome and our management of this is addressed.

AimJunior doctors are frequently required to discuss resuscitation status with patients. They generally lack experience, confidence and skill in having these conversations. However, there is currently no formal postgraduate education requirement to improve or develop in this area. The aim of this educational intervention was to improve junior doctors’ level of confidence and skill in having resuscitation status conversations with patients.MethodAn educational intervention for 27 prevocational postgraduate second and third-year house officers at a tertiary hospital in Hamilton, New Zealand was conducted. A self-administered survey was completed preintervention and postintervention.ResultsFour factors were assessed in the survey (level of confidence having conversations regarding resuscitation status, ability to prognosticate, content of conversations and perceived barriers to having conversations), with a statistically significant difference found with respect to level of confidence having conversations regarding resuscitation status (p=0.001).ConclusionThis study demonstrated that a short education session improves confidence in discussing resuscitation status. It has also identified the need for further postgraduate training in complex communication skills.

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