Palliative Emergencies
Emergencies arise in the palliative care settings, as in another other part of medicine. After all, generally speaking, our patients are often the sickest and thus are more prone to events that incite panic, or require rapid response. We cannot address every emergency in detail - and they will be reviewed other months, other years, or in case presentations that anyone can present this month.
The month we review the approach to care when these emergencies arise: how to identify them, how to respond – tending to the needs of patient, family, and staff. As in any other part of palliative care, “it takes a village” of our interdisciplinary team members.
We'll discuss the patients' and their family's experience these emergencies to any number of settings:
If outside of the hospital or emergency room – When would you consider bringing a patient to hospital or inpatient under the “GIP” (general inpatient) level-of-care with the hospice benefit? How would you respond to a family on the phone caring for patient going through this? If you were the clinician in the home, what would you do? If you were on the phone, on call, speaking with the nurse, or social worker, or chaplain, or aide, or family member, how would you guide them?
I’d like to invite to the discussion, concepts of psychosocial and spiritual emergencies in these settings, as well as our usual medically-focused crises. Please feel free to post a case of such an emergency.
The month we review the approach to care when these emergencies arise: how to identify them, how to respond – tending to the needs of patient, family, and staff. As in any other part of palliative care, “it takes a village” of our interdisciplinary team members.
We'll discuss the patients' and their family's experience these emergencies to any number of settings:
- In hospital
- In emergency rooms
- At home
- On the streets when homeless, in refugee camps
If outside of the hospital or emergency room – When would you consider bringing a patient to hospital or inpatient under the “GIP” (general inpatient) level-of-care with the hospice benefit? How would you respond to a family on the phone caring for patient going through this? If you were the clinician in the home, what would you do? If you were on the phone, on call, speaking with the nurse, or social worker, or chaplain, or aide, or family member, how would you guide them?
I’d like to invite to the discussion, concepts of psychosocial and spiritual emergencies in these settings, as well as our usual medically-focused crises. Please feel free to post a case of such an emergency.
Articles
- ABC of Palliative Care: Emergencies. Falk S, Fallon M. BMJ (1996) 315: 1525-1529 - free full text
- A Clinical Guideline Care Management GuidelinesEmergencies in Palliative Care- free full text - Australian/Tasmanian Department of Public Health, 2010
How the Palliative Care approach differs from the typical Oncologic Approach:
- Crises in palliative care--a comprehensive approach. Friedmann Nauck, Bernd Alt-Epping. The lancet oncology (2008) 9: 1086-91
- Emergencies in Palliative Care. Schrijvers D, van Fraeyenhove F. Cancer Journal: September/October 2010 - Volume 16 - Issue 5 - pp 514-520 doi: 10.1097/PPO.0b013e3181f28a8d
- Radiation Oncology Emergencies. Hematology/Oncology Clinics of North America (2006) 20(2): 505-522
On cord compression-
- Spinal Cord Compression in Patients With Advanced Metastatic Cancer: “All I Care About Is Walking and Living My Life” JAMA. (2008) 299(8):937-946
On Bleeding-
- Management of Bleeding in Patients with Advanced Cancer. Jose P, Tien P. The Oncologist (2004) 9:561-570; doi:10.1634/theoncologist.9-5-561 - free full text
- Subcutaneous midazolam for acute hemorrhage in patients with advanced cancer. Oneschuk D. Can Fam Physician. 1998 Jul;44:1461-2. - free full text
On agitation & delirium-
- Agitation and delirium at the end of life: "We couldn't manage him". Breitbart W, Alici Y.JAMA. 2008 Dec 24;300(24):2898-910, E1
On witnessing this suffering-
- Sitting with your Suffering: Lessons about intractable pain at the end of life. Rebecca L. Sudore, Patrice Villars and Elise C. Carey. Journal of Palliative Medicine. June 2010, 13(6): 779-782. doi:10.1089/jpm.2009.0325.