Palliative Aspects of Emergency Care

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

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 naive 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