Cite this post as:
Scott Weingart, MD FCCM. EMCrit Podcast 25 – End of Life and Palliative Care in the ED. EMCrit Blog. Published on April 24, 2010. Accessed on May 21st 2022. Available at [https://emcrit.org/emcrit/end-of-life-care/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: April 24, 2010
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Dena writes hi! thanks for the podcast, just a couple questions- if a patient does not have capacity to make decisions or assign a healthcare proxy, and a family member is at the bedside, but the family member is saying that the patient has a healthcare proxy for example, in california, and you cant get in touch with them, can you make the patient DNR>> according to the family member at the bedside? also, just to clarify, a non-health care proxy can ask that their family member be DNR, but not DNI… what if its a friend and not a… Read more »
Dr. Weingart, Please comment about “upstream” problematic issues of palliative and end-of-life care in the nursing home and how it may conflict with ED evaluation and care. If the patient is already DNR and would be an appropriate candidate for aggressive comfort care with any acute deterioration, why transfer the patient to the ED? Why hospitalize? Isn’t it most appropriate to carry out all therapies of comfort care (relief of pain and suffering, IV’s, antibiotics) at the nursing home? What about do not transfer and do not hospitalize orders? Once the patient is in the ED, I get the comfort… Read more »
Kyle,
You are totally correct, in a real health care system these patients would never be transferred and if I had more of a public health bent I would be fighting that fight. Unfortunately, that is not my bag, so I just deal with what comes through the door.
As to testing, I usually will avoid anything I can and then the admitting team takes it as far as they or their attending deems appropriate.
Scott,
How do oral/nasal airways and SGA’s fit into the picture w/respect to DNI?