Palliative medicine

Palliative Care in the ED

  • Palliative care team involvement early in EOL (end of life)
  • Can be distressing time for family/providers

Dyspnea

  • Not a time to reclarify goals of care
  • Reassurance is key to family
  • O2, NIPPV
  • Bedside Fan
  • Morphine start "low and go slow", 1-2mg IVP Q10-15min until desired effect
    • If opioid tolerant, in addition to standing use - 10% of 24 hour opioid regimen Q10min; or 25% of 4 hour opioid regimen Q10min

Dehydration

  • Anorexia does not cause distress, no evidence for IVF, TPN
  • Normal to decrease po intake in last weeks of life
  • Swabs on mouth/lips to prevent dry lips
  • Artificial tears for dry eyes

Delirium

  • Reassurance in normal part of dying process, not "going crazy at the end"
  • Common to see deceased relatives
  • Quiet, well lit room, windows preferable, familiar faces present
  • Haldol 0.5-1mg IVP show to be useful, Benzo as additional adjunct

Disposition at End of Life

  1. All life sustaining care desired
    • Self explanatory
  2. Comfort + limited life sustaining interventions
    • Admit with time limited trial (establish this beforehand) for antibiotics or NIPPV
  3. Comfort measures only
    • Admit to hospice unit/palliative care service or manage acute symptoms in ED then dc with home hospice

External Resources

  • Fast Facts : great quick-reference resource for practical/specific info on myriad palliative care topics

See Also