After last Friday, who'd have thought that Matt would still be with us, perkier and cheekier than ever, singing away to his tunes with Leaky and Jim yesterday.  He's certainly living up to his double hard bastard status.

Melanie, the poor Marie Curie healthcare assistant who's been looking after Matt at night's has had to have the GP out once or twice every night to try and settle Matt.  He still gets really agitated and does his best to get himself out of bed - still remarkably strong for someone who hasn't eaten for a week.

As a result, Karen, the community nurse, revised Matt's meds as he's already on a high dose of Midazolam, the anti seizure sedative.  The Midazolam has been increased over the week but Matt still seems to have periods of agitation.  Last night we had the hospital at home nurses in at 2000 to give Matt an injection of Nozinan.  Thankfully it seemed to work as the GP wasn't called out last night.  Matt was still a little restless but nothing compared to previous nights.
Levomepromazine, or Nozinan, is increasingly being prescribed and valued worldwide in Palliative Care Medicine. In Palliative Care Medicine Levomepromazine is valued for its multimodal action. It is now being used widely in palliative care to treat intractable nausea or vomiting, and for severe delirium/ agitation in the last days of life. Palliative Care Physicians will commonly prescribe it via subcut syringe drivers in combination with more potent opiate analgesics such as Hydromorphone. 


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