4:45 – 5:45 pm Thursday, September 13

Low Dose Ketamine Use in the Non-ICU Setting for Pediatric Hematology and Oncology Pain (209)

1CNE  Managing severe pain in children, adolescents, and young adults with oncologic malignancies and sickle cell disease present a challenge to members of the multidisciplinary team. Traditional pain treatment strategies rely primarily on opioid analgesia (Wang, 2015) in addition to complementary therapies to provide comfort. Despite these interventions, many patients report inadequate pain control and adverse effects. These side effects can range from tolerable (pruritis) and dose-dependent (constipation) to life-threatening (respiratory depression, sedation). Refractory pain is a common reason for hospital readmission in this patient population, specifically in patients with sickle cell disease or patients being treated at the end of life. Ketamine, a dissociative anesthetic used for sedation, has traditionally been administered in the operating room or in an intensive care unit (ICU) setting with stringent monitoring parameters. In patients with persistent pain despite traditional analgesic interventions, adjuvant therapy with low-dose ketamine infusions have proven beneficial (Hagedorn, 2016). Low-dose ketamine infusions are associated with opioid-sparing effects, improved pain management, and improvement in the child's ability to interact with their family (Finkel, 2007).

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4:45 – 5:45 pm Thursday, September 13

DNR, DNET, DNI: The Alphabet Soup of Resuscitation (208)

1CNE  Caring for infants, children, adolescents, and young adults through the end of life is challenging. "Getting the DNR" is terminology that many nurses are used to hearing; they may even be the ones asking for clarification of "code status" as their patients come closer to the end of their lives. This presentation will clarify definitions and abbreviations commonly used including DNR, AND, and DNET, and the meaning these terms have for the hematology/oncology team, patients, and families. How we talk with families will be reviewed, including discussions of data, what we are not going to do, and asking them to make impossible decisions. Finally, suggestions for discussing goals of care and recommendation and the role of hope will be discussed and practiced.

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10:15 – 11:15 am Saturday, September 15

General Session: Communicating with Adolescents at End of Life: Ethical Dilemmas and Practical Solutions (104)

1CNE  Background: Discussing advanced illness and end-of-life with adolescents and young adults (AYAs) is difficult due to complexities of family and medical systems, developmental issues and the challenges of addressing grief of patients, families, and staff. Ethical dilemmas often present as barriers to good palliative communication.

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