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| Image Credit: Flickr |
Author: Andrew W Phillips, MD MEd
Clinical Fellow, Division of Critical Care
Stanford University
We’ve all been there too many times: A terminally ill patient is rushed to the emergency department (ED) by ambulance in distress, either missing the Physician Orders for Life Sustaining Treatment (POLST) or the family instructs EMS to “do everything.” The ED staff begins to stabilize the patient: inotropes and pressors, central line, intubation, arterial line, pressure bagging, fluids — and then they are told to stop.
Now what? How do you allow the acutely ill patient to pass comfortably with dignity after you just did so many invasive, painful procedures? If there is no other place for the patient but the ED, here are some recommendations, based on literature and my personal experience, to make the patient’s final moments as comfortable as possible.
Preparation [1]
- Put the patient in a private room. The resuscitation bay is not the place to transition a patient to comfort care.
- Get social work, the chaplain, and/or palliative care involved to help with the “small” things that are meaningful (water, chairs for the family, calling family members, etc.) so you can focus on the patient.
- Determine what the most life-threatening physiology is for that patient – it is usually hypotension versus hypoxemia.
