Palliative Aspects of Emergency Care

Paperback | June 12, 2013

EditorPaul L. DeSandre, Tammie E. Quest

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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 Aspectsof 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 offerspractical 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 chaptersfocusing 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 careneeds in emergency departments through best practice recommendations.

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From the Publisher

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 Aspectsof Emergency Care is a practical guide desi...

Paul L. DeSandre is Assistant Professor, Emergency Medicine; Assistant Chief, Section of Palliative Care at the U.S. Department of Veterans Affairs Medical Center, Emory University School of Medicine, Atlanta, Georgia. Tammie E. Quest is Roxann Arnold Professor in Palliative Medicine; Director, Emory Palliative Care Center; Associate P...

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Format:PaperbackDimensions:300 pages, 8 × 5 × 0.68 inPublished:June 12, 2013Publisher:Oxford University PressLanguage:English

The following ISBNs are associated with this title:

ISBN - 10:0199895619

ISBN - 13:9780199895618

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Extra Content

Table of Contents

1. Overview2. Trajectories and Prognostication in Emergency CareEmergency Department and Functional TrajectoriesPrognostication and Prognostic ToolsCancerHeart FailureChronic Obstructive Pulmonary DiseaseDementiaCommunicating the PrognosisCreating a Plan of Action3. Rapid Palliative Case AssessmentThe Critically Ill or Unstable PatientThe Medically Stable Patient4. Cancer EmergenciesSpinal Cord CompressionPathophysiologyEpidemiologySigns and SymptomsDiagnosisInterventionsCorticosteroidsRadiation TherapySurgeryBisphosphonatesSuperior Vena Cava SyndromePathophysiologyEtiologySigns and SymptomsDiagnosisInterventionsRadiation Therapy and ChemotherapyEndovascular StentingPrognosisHypercalcemia of MalilgnancyPathophysiologyInterventions5. Malignant PainThe Cancer Pain EmergencyThe Emergent Pain AssessmentPain scalesClassificationOpioid nave and opioid tolerantPharmacologic ManagementChoosing an AlgorithmUsing Equianalgesic dosing tablesCalculating the Initial Dose of an OpioidAdvanced Age, Renal Impairment, and Hepatic ImpairmentRoutes of Administration and PharmacokineticsPain Reassessment after TreatmentOpioid Side Effects and ToxicitiesSedation and Respiratory DepressionNausea and VomitingMyoclonusConstipationControntation of BarriersMethadoneNon-Opioid Pharmacologic ManagementNeuropathic PainBone PainOther Approaches6. Non-malignant PainPain PathophysiologyPhysiologic and Clinical Differences between Acute and Chronic PainDefinitionsTolerancePhysical dependenceAddictionPseudoaddictionGeneral Principles for Managing Chronic PainPolicies Informing Emergency Department Management of Chronic PainAn Emergency Department Approach to Managing Chronic Pain7. Symptom ManagementDyspneaPharmacologic approachesOxygenOpioidsAnxiolyticsComplementary and Non-Pharmacologic ApproachesDeliriumAnxietyFatigue and WeaknessInsomniaFluid Balance and EdemaNausea and VomitingConstipationDiarrhea8. Spiritual Suffering and BereavementDefinitionsGrief: Normal and ComplicatedSpiritual Needs in the Emergency DepartmentRole of the ClinicianRole of the ChaplainRapid Spiritual AssessmentResponding to Hoping for a Miracle9. CommunicationBreaking Bad NewsDeath DisclosureSpecial ConsiderationsCultureRequests to Withhold InformationTelephone NotificationNo Next of Kin AvailableCommunicating with ChildrenDeath of a ChildSudden Infant Death SyndromeMiscarriage or StillbirthSelf-Care and the Care of Other Emergency Department Staff10. Resuscitation, Family Presence, and Last Hours of LivingCardiopulmonary Resuscitation and Prognosis in Advanced IllnessFamily Presence During ResuscitationWitholding or Withdrawing InterventionsCPRIntubation and Artificial VentilationArtificial Nutrition and HydrationAntibioticsCare of the Actively Dying PatientEnvironmentSymptom ControlSecretionsDry MouthAgitationOpioid Toxicity11. HospiceUnderstanding Hospice CareEligibilityUnderutilizationScope of Services and ReimbursementDiscontinuing Hospice CareEmergency Department Management of Patients under Hospice CareCommon PresentationsInitiating New Hospice Referrals from the Emergency Department12. Legal and Ethical Issues of Palliative Care in the Emergency DepartmentThe Interrelation of Law, Ethics, and End-of-Life CareInformed ConsentLimitation of TreatmentDetermination of Decision-Making CapacityDecision-Making for the IncapacitatedDNR Orders and Physician Orders for Life-Sustaining TreatmentsOpioids and End-of-Life CareSuicide and Physician-Assisted SuicideFutility