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Emergency Medicine Cases

Episode 70 End of Life Care in Emergency Medicine

Emergency Medicine Cases

Dr. Anton Helman

Education, Health & Fitness, Courses, Medicine, Science

4.7602 Ratings

🗓️ 29 September 2015

⏱️ 68 minutes

🧾️ Download transcript

Summary

Most of us in North America live in cultures that almost never talk about death and dying. And medical progress has led the way to a shift in the culture of dying, in which death has been medicalized. While most people wish to die at home, every decade has seen an increase in the proportion of deaths that occur in hospital. Death is often seen as a failure to keep people alive rather than a natural dignified end to life. This is at odds with what a lot of people actually want at the end of their lives: 70% of hospitalized Canadian elderly say they prefer comfort measures as apposed to life-prolonging treatment, yet as many as ⅔ of these patients are admitted to ICUs. Quality End of Life Care in Emergency Medicine is not widely taught. Most of us are not well prepared for death in our EDs – and we should be. There’s no second chance when it comes to a bad death like there is if you screw up a central line placement, so you need the skills to do it right the first time. To recognize when comfort measures and compassion are what will be best for our patients, is just as important as knowing when to intervene and treat aggressively in a resuscitation. Emergency physicians should be able to recognize not only the symptoms and patterns that are common in the last hours to days of life, but also understand the various trajectories over months or years toward death, if they’re going to provide the high quality end of life care that patients deserve. So, with the help of Dr. Howard Ovens, a veteran emergency physician with over 25 years of experience who speaks at national conferences on End of Life Care in Emergency Medicine, Dr. Paul Miller, an emergency physician who also runs a palliative care unit at McMaster University and Dr. Shona MacLachlan who led the palliative care stream at the CAEP conference in Edmonton this past June, we'll help you learn the skills you need to assess dying patients appropriately, communicate with their families effectively, manage end of life symptoms with confidence and much more...

Transcript

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0:00.0

Welcome to the Emergency Medicine Cases Podcast.

0:05.8

I'm your host, Dr. Anton Hellman, bringing you Canada's brightest minds in emergency medicine

0:10.5

from EMC Studios in Toronto.

0:16.1

There is such a pertinence to having a palliative care skill set for all emergency physicians.

0:23.0

You have to establish rapport, give advice, and not get into a power struggle with people

0:28.9

who are in a crisis.

0:33.3

The real risks to resuscitation in the case that we've talked about here are around incomplete recovery.

0:42.3

It was 1995 and after a 13-hour overnight train ride, I was sitting at a rooftop restaurant in Varanasi, India, enjoying breakfast with my wife.

0:52.7

We were a few hundred meters from the famous and deeply

0:55.4

spiritual Ganges River, whose shores were strewn with burning gats, open fire pits housing

1:02.0

burning bodies. The stench of burning protein mixed with a million smells of the city drifted by

1:08.2

our table, and as I peered out toward the river, I noticed a group of

1:12.5

wheelchair-bound older folks on the neighboring rooftop laughing. I turned to the waiter, and I asked

1:19.2

what was going on there. He told me that those people were happy, because they all knew that no

1:25.2

matter when they die, they'll die on the shores of the Ganges

1:28.5

and enter the afterlife in the best possible way. You see, this was the Western equivalent

1:35.0

of a nursing home. Those people, the waiter, told me, were the luckiest old folks in the world.

1:42.2

Now fast forward to 2015 on a busy overnight shift in the ED where you have no prior

1:48.3

knowledge of a crashing patient. It's a noisy, chaotic environment, your time pressured,

1:53.7

and there's variable access to records, to family, and to advance directives. The patients,

1:59.9

a catechic 90-year-old, sent from the local nursing home.

2:03.6

The EMS told you that she's a full code.

...

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