Palliative Aspects of Emergency Care

Palliative Aspects of Emergency Care


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Product Details

ISBN-13: 9780199895618
Publisher: Oxford University Press, USA
Publication date: 05/31/2013
Series: Oxford American Palliative Care Library Series
Pages: 152
Product dimensions: 4.90(w) x 7.90(h) x 0.40(d)

About the Author

Assistant Professor, Department of Emergency Medicine and Center for Palliative Care; Associate Fellowship Director, Hospice and Palliative Medicine, Emory University School of Medicine, Atlanta, Georgia

Table of Contents

Chapter 1: Overview

Chapter 2: Trajectories and Prognostication in Emergency Care
· Emergency Department and Functional Trajectories
· Prognostication and Prognostic Tools o Cancer o Heart Failure o Chronic Obstructive Pulmonary Disease o Dementia
· Communicating the Prognosis
· Creating a Plan of Action

Chapter 3: Rapid Palliative Care Assessment
· The Critically Ill or Unstable Patient
· The Medically Stable Patient

Chapter 4: Cancer Emergencies
· Spinal Cord Compression o Pathophysiology o Epidemiology o Signs and Symptoms o Diagnosis o Interventions
§ Corticosteroids
§ Radiation Therapy
§ Surgery
§ Bisphosphonates
· Superior Vena Cava Syndrome o Pathophysiology o Etiology o Signs and Symptoms o Diagnosis o Interventions
§ Radiation Therapy and Chemotherapy
§ Endovascular Stenting o Prognosis
· Hypercalcemia of Malignancy o Pathophysiology o Interventions

Chapter 5: Malignant Pain
· The Cancer Pain Emergency
· The Emergent Pain Assessment o Pain scales o Classification o Opioid naïve and opioid tolerant
· Pharmacologic Management o Choosing an Algorithm o Using Equianalgesic dosing tables o Calculating the Initial Dose of an Opioid o Advanced Age, Renal Impairment, and Hepatic Impairment o Routes of Administration and Pharmacokinetics o Pain Reassessment after Treatment o Opioid Side Effects and Toxicities
§ Sedation and Respiratory Depression
§ Nausea and Vomiting
§ Myoclonus
§ Constipation
· Confrontation of Barriers
· Methadone
· Non-Opioid Pharmacologic Management o Neuropathic Pain o Bone Pain o Other Approaches

Chapter 6: Non-malignant Pain
· Pain Pathophysiology
· Physiologic and Clinical Differences between Acute and Chronic Pain
· Definitions o Tolerance o Physical dependence o Addiction o Pseudoaddiction
· General Principles for Managing Chronic Pain
· Policies Informing Emergency Department Management of Chronic Pain
· An Emergency Department Approach to Managing Chronic Pain

Chapter 7: Symptom Management
· Dyspnea o Pharmacologic approaches
§ Oxygen
§ Opioids
§ Anxiolytics o Complementary and Non-Pharmacologic Approaches
· Delirium
· Anxiety
· Fatigue and Weakness
· Insomnia
· Fluid Balance and Edema
· Nausea and Vomiting
· Constipation
· Diarrhea

Chapter 8: Spiritual Suffering and Bereavement
· Definitions
· Grief: Normal and Complicated
· Spiritual Needs in the Emergency Department o Role of the Clinician o Role of the Chaplain
· Rapid Spiritual Assessment
· Responding to Hoping for a Miracle.

Chapter 9: Communication
· Breaking Bad News
· Death Disclosure
· Special Considerations o Culture o Requests to Withhold Information o Telephone Notification o No Next of Kin Available o Communicating with Children
· Death of a Child o Sudden Infant Death Syndrome o Miscarriage or Stillbirth
· Self-Care and the Care of Other Emergency Department Staff

Chapter 10: Resuscitation, Family Presence, and Last Hours of Living
· Cardiopulmonary Resuscitation and Prognosis in Advanced Illness
· Family Presence During Resuscitation
· Witholding or Withdrawing Interventions o CPR
o Intubation and Artificial Ventilation o Artificial Nutrition and Hydration o Antibiotics
· Care of the Actively Dying Patient o Environment o Symptom Control o Secretions o Dry Mouth o Agitation o Opioid Toxicity

Chapter 11: Hospice
· Understanding Hospice Care o Eligibility o Underutilization o Scope of Services and Reimbursement o Discontinuing Hospice Care
· Emergency Department Management of Patients under Hospice Care
· Common Presentations
· Initiating New Hospice Referrals from the Emergency Department

Chapter 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

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