The rapid code status conversation guide for seriously ill older adults in acute respiratory failure

rapid code status

You are working a shift in your emergency department (ED) when an 85 year old female presents with a complaint of altered mental status. She comes from an extended care facility, where paramedics are able to tell you “they called us to come get her,”you are handed a stack of paperwork, given some vital signs, and you notice the patient is altered and unable to provide any further history. You dig a little in the paperwork and note a history of dementia as well as a long list of other medical problems, you notice no known advanced directive, and see that her daughter lives out of state but is available via phone. Have you been here? Seen this patient? If you have worked in emergency medicine long enough you certainly have. The tool outlined below is designed to help you know what to do in these difficult situations.

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By |2020-05-31T19:05:01-07:00May 25, 2020|Palliative Care|

Work Grief: A Primer for Emergency Medicine Providers

griefHeartbreaking patient situations are the backbone of Emergency Medicine. Whether it’s a new cancer diagnosis, telling a family member that their loved one has died, or the creeping dread that a mistake that we’ve made will negatively impact one of our patients, we all experience extraordinary stress in our day-to-day clinical practice. Most clinicians are not tasked with routinely sharing news about the violent, unexpected, and horrific life-changing situations that occur in the emergency department, and yet we are given so few tools to help us manage this firehose of grief. This article is intended to share some of the best practices of grief management with clinicians who are immersed in grief, even if unawares.

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By |2020-05-22T12:34:22-07:00May 22, 2020|Palliative Care, Wellness|

What is palliative emergency medicine and why now?

elder hand palliative emergency medicine care

The skilled and rapid resuscitation of critically ill patients is a central premise in the specialty of emergency medicine (EM). A paradox for providers often arises when in the midst of resuscitating a patient with advanced chronic illness, the question of risks versus benefits arises. For this patient, we may successfully stabilize vital signs, but at what cost? Will this patient return to a quality of life they deem acceptable? What are the patient’s goals of treatments given his/her underlying disease? These questions illustrate the need for emergency physicians to be more aware of and comfortable with palliative care practices.

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By |2019-07-23T00:34:41-07:00Jul 31, 2019|Geriatrics, Palliative Care|

Beyond the Abstract: Patient video testimonials improve physician interpretation of advance directives and POLST

advance directives and POLST with videoOver 1,300 physicians across the U.S. were asked to interpret patient preferences for end-of-life care in theoretical cases. Physicians rarely reached consensus about patient preferences when they were given only living wills and POLST documents to interpret. The addition of a patient video testimonial helped physicians make better care decisions that reflected their patients’ wishes. Will video become the new national standard for advance care planning?

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