Palliative Aspects Of Emergency Care

Item Information
Item#: 9780199895618
Edition 01
Author Desandre & Quest (Eds)
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The process of patients with advanced illnesses entering the emergency department is fraught with uncertainty for both patients and medical providers. Yet, there is a lack of definitive and accessible resources which provide immediate guidance for the care of these patients. Palliative Aspects
of Emergency Care is a practical guide designed to fill this void. From the paramedic struggling with difficult and/or conflicting information in the home through the palliative care specialist trying to interface effectively with the emergency department, this user-friendly handbook offers
practical help from experts in the interdependent fields of Emergency Medicine and Hospice and Palliative Medicine.

This evidenced-based book covers the prognostication and assessment of relevant, advanced-illness clinical problems, the management of symptoms, and the physical and spiritual treatment of palliative patients in the emergency department through their last hours of living. Also included are chapters
focusing on hospice care, communication techniques, and the legal and ethical issues of palliative care in the emergency department. This guide is a must-have resource for clinicians looking for concise, point-of-care information, and for hospital administrators working to address palliative care
needs in emergency departments through best practice recommendations.

Table of Contents
1. Overview
2. Trajectories and Prognostication in Emergency Care
Emergency Department and Functional Trajectories
Prognostication and Prognostic Tools
Cancer
Heart Failure
Chronic Obstructive Pulmonary Disease
Dementia
Communicating the Prognosis
Creating a Plan of Action
3. Rapid Palliative Case Assessment
The Critically Ill or Unstable Patient
The Medically Stable Patient
4. Cancer Emergencies
Spinal Cord Compression
Pathophysiology
Epidemiology
Signs and Symptoms
Diagnosis
Interventions
Corticosteroids
Radiation Therapy
Surgery
Bisphosphonates
Superior Vena Cava Syndrome
Pathophysiology
Etiology
Signs and Symptoms
Diagnosis
Interventions
Radiation Therapy and Chemotherapy
Endovascular Stenting
Prognosis
Hypercalcemia of Malilgnancy
Pathophysiology
Interventions
5. Malignant Pain
The Cancer Pain Emergency
The Emergent Pain Assessment
Pain scales
Classification
Opioid nave and opioid tolerant
Pharmacologic Management
Choosing an Algorithm
Using Equianalgesic dosing tables
Calculating the Initial Dose of an Opioid
Advanced Age, Renal Impairment, and Hepatic Impairment
Routes of Administration and Pharmacokinetics
Pain Reassessment after Treatment
Opioid Side Effects and Toxicities
Sedation and Respiratory Depression
Nausea and Vomiting
Myoclonus
Constipation
Controntation of Barriers
Methadone
Non-Opioid Pharmacologic Management
Neuropathic Pain
Bone Pain
Other Approaches
6. Non-malignant Pain
Pain Pathophysiology
Physiologic and Clinical Differences between Acute and Chronic Pain
Definitions
Tolerance
Physical dependence
Addiction
Pseudoaddiction
General Principles for Managing Chronic Pain
Policies Informing Emergency Department Management of Chronic Pain
An Emergency Department Approach to Managing Chronic Pain
7. Symptom Management
Dyspnea
Pharmacologic approaches
Oxygen
Opioids
Anxiolytics
Complementary and Non-Pharmacologic Approaches
Delirium
Anxiety
Fatigue and Weakness
Insomnia
Fluid Balance and Edema
Nausea and Vomiting
Constipation
Diarrhea
8. Spiritual Suffering and Bereavement
Definitions
Grief: Normal and Complicated
Spiritual Needs in the Emergency Department
Role of the Clinician
Role of the Chaplain
Rapid Spiritual Assessment
Responding to Hoping for a Miracle
9. Communication
Breaking Bad News
Death Disclosure
Special Considerations
Culture
Requests to Withhold Information
Telephone Notification
No Next of Kin Available
Communicating with Children
Death of a Child
Sudden Infant Death Syndrome
Miscarriage or Stillbirth
Self-Care and the Care of Other Emergency Department Staff
10. Resuscitation, Family Presence, and Last Hours of Living
Cardiopulmonary Resuscitation and Prognosis in Advanced Illness
Family Presence During Resuscitation
Witholding or Withdrawing Interventions
CPR
Intubation and Artificial Ventilation
Artificial Nutrition and Hydration
Antibiotics
Care of the Actively Dying Patient
Environment
Symptom Control
Secretions
Dry Mouth
Agitation
Opioid Toxicity
11. Hospice
Understanding Hospice Care
Eligibility
Underutilization
Scope of Services and Reimbursement
Discontinuing Hospice Care
Emergency Department Management of Patients under Hospice Care
Common Presentations
Initiating New Hospice Referrals from the Emergency Department
12. Legal and Ethical Issues of Palliative Care in the Emergency Department
The Interrelation of Law, Ethics, and End-of-Life Care
Informed Consent
Limitation of Treatment
Determination of Decision-Making Capacity
Decision-Making for the Incapacitated
DNR Orders and Physician Orders for Life-Sustaining Treatments
Opioids and End-of-Life Care
Suicide and Physician-Assisted Suicide
Futility