Wednesday Wrap-up: 4/11/2012

Welcome to this week’s edition of Wednesday Wrap-up!

There was some great lectures this morning making it very tough to pick a topic to focus on but I think the subject that generated the most discussion was palliative care in the ED. Thanks Dr. Tan for a great senior lecture. I think just a few years back this was an unheard of topic in the realms of EM (We don’t do palliative care in the ED!), but is now an absolute must know. Speaking to our patients and their families about end of life issues is something that we all must become both comfortable with and skilled at doing. Ideally these conversations should take place in a not so emergent setting such as a primary care or specialists’ office or the patient’s home; however if it hasn’t, then we as ED docs must know how to discuss these issues.

One tip from Dr. Tan that I may start using in my practice is the use of the word “dead” or “die” when discussing cardiac arrest. As in asking the family or patient if they should “die,” meaning arrest, would they want us to use heroic measures such as putting in a breathing tube or pushing on the chest to circulate blood and medications in hopes of reviving them. I imagine if you use “die” patients and family would be more likely to not want heroic measures, but thats just my opinion. What does everyone think about that?

One question I have is how do you handle the more legal aspects of this? Obviously if the patient can speak for themselves that is the ideal situation; but if not, how do you handle confirming that a patient may already be DNR? Specifically, do you need the actual DNR paperwork in your hands? Is it good enough for EMS or a family member to report the patient is DNR? If the patient crashes and the paperwork has not arrived yet, what do you do? And if a family member tells you they are the healthcare proxy but don’t have the paperwork, do you honor their requests or wait for them to produce the forms?

I have seen these issues dealt with in a variety of ways, so I just wanted to put them out there for discussion and see what your thoughts were. Leave your comments below.

Thanks for reading,