care of the imminently dying patient
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DESCRIPTIONPresented to HPM Fellowship July 2010. Has handout also uploaded.
- 1. Care of the ImminentlyDying Patient July8 th , 2010 Christian Sinclair, MD Kansas City Hospice & Palliative Care
2. Prognostication of the Terminal Phase 3. Working with Ranges - Minutes 4. Working with Ranges - Hours 5. Working with Ranges - Days 6. Death Trajectories
- Sudden Death
- Death from Acute Illness
- Death from Chronic Illness
- After Withdrawal of Life Support
- Palliative Performance Scale
- Palliative Prognostic Index
- Links available from:
- EPERC Fast Facts
8. The Rally 9. What to Managevs. What to Expect Expect Manage 10. What to Managevs. What to Expect Expect Manage 11. Transforming from Patient-Centered Care to Family-Centered Care 12. Time and logistics Time & Logistics 13. Time and logistics Time & Logistics Physical Tasks 14. Time and logistics Time & Logistics Physical Tasks Financial Costs 15. Time and logistics Time & Logistics Physical Tasks Financial Costs Emotional Burden 16. Time and logistics Time & Logistics Physical Tasks Financial Costs Emotional Burden Physical Risks 17. Systems-Based Decline 18. Examination of the dying patient 19. Constitutional Weakness & Fatigue Fever & Hypothermia 20. Eyes & Oropharyngeal 21. 22. 23. Gastrointestinal
- Anorexia Major family education point here GI shut down industrial analogy
- Cachexia body image issues
- Decreased Fluid Intake another major family education point
- Incontinence - dignity
- Poor cap refill, cyanosis, mottling, edema
- Brady / Tachycardia
- possible sign of distress body adjustment
- Implantable Devices
- think ahead about deactivation
- Dont forget about blood pressure meds
- Major prognostic value in imminent death
- Can be fooled with variation
25. Renal 26. Pulmonary 27. Skin Care 28. Neurological/Psychological 29. Considerations of Location 30. 31. Spiritual/Existential Considerations 32. Medication Management
- Prognosis / Goal Mismatch
- If not aligned then change the medications
- Pill Dysphagia
- - Think ahead for other options
- Alternate Routes
- PR is not the only option
- Topical medications eh.
33. Unexplained Prolongation of the Terminal Phase
- No one has really looked at this population but it bears some examination.
- For a copy of the slides, please email: firstname.lastname@example.org
- Recommended Reading/ Key References:
- Furst CJ, Doyle D. The Terminal Phase, Chapter 18, Oxford Textbook of Palliative Medicine, 3 rdEd.
- EPEC Last Hours of Living, Module 12, 1999.
- Ferris FD, von Gunten CF, Emanuel LL.Competency in End-of-Life Care: Last Hours of Life.J of Pall Med.August 2003: 605-613.
- Plonk WM, Arnold RM. Terminal Care: The Last Weeks of Life.J of Pall Med 8(5): 1042-55