Table of Contents

Chapter 1: Overview Chapter 2: Trajectories and Prognostication in Emergency Care
· Emergency Department and Functional Trajectories
· Prognostication and Prognostic Tools
o Cancer
o Heart Failure
o Chronic Obstructive Pulmonary Disease
o Dementia
· Communicating the Prognosis
· Creating a Plan of Action Chapter 3: Rapid Palliative Care Assessment
· The Critically Ill or Unstable Patient
· The Medically Stable Patient Chapter 4: Cancer Emergencies
· Spinal Cord Compression
o Pathophysiology
o Epidemiology
o Signs and Symptoms
o Diagnosis
o Interventions
§ Corticosteroids
§ Radiation Therapy
§ Surgery
§ Bisphosphonates
· Superior Vena Cava Syndrome
o Pathophysiology
o Etiology
o Signs and Symptoms
o Diagnosis
o Interventions
§ Radiation Therapy and Chemotherapy
§ Endovascular Stenting
o Prognosis
· Hypercalcemia of Malignancy
o Pathophysiology
o Interventions Chapter 5: Malignant Pain
· The Cancer Pain Emergency
· The Emergent Pain Assessment
o Pain scales
o Classification
o Opioid naïve and opioid tolerant
· Pharmacologic Management
o Choosing an Algorithm
o Using Equianalgesic dosing tables
o Calculating the Initial Dose of an Opioid
o Advanced Age, Renal Impairment, and Hepatic Impairment
o Routes of Administration and Pharmacokinetics
o Pain Reassessment after Treatment
o Opioid Side Effects and Toxicities
§ Sedation and Respiratory Depression
§ Nausea and Vomiting
§ Myoclonus
§ Constipation
· Confrontation of Barriers
· Methadone
· Non-Opioid Pharmacologic Management
o Neuropathic Pain
o Bone Pain
o Other Approaches Chapter 6: Non-malignant Pain
· Pain Pathophysiology
· Physiologic and Clinical Differences between Acute and Chronic Pain
· Definitions
o Tolerance
o Physical dependence
o Addiction
o Pseudoaddiction
· General Principles for Managing Chronic Pain
· Policies Informing Emergency Department Management of Chronic Pain
· An Emergency Department Approach to Managing Chronic Pain Chapter 7: Symptom Management
· Dyspnea
o Pharmacologic approaches
§ Oxygen
§ Opioids
§ Anxiolytics
o Complementary and Non-Pharmacologic Approaches
· Delirium
· Anxiety
· Fatigue and Weakness
· Insomnia
· Fluid Balance and Edema
· Nausea and Vomiting
· Constipation
· Diarrhea Chapter 8: Spiritual Suffering and Bereavement
· Definitions
· Grief: Normal and Complicated
· Spiritual Needs in the Emergency Department
o Role of the Clinician
o Role of the Chaplain
· Rapid Spiritual Assessment
· Responding to Hoping for a Miracle. Chapter 9: Communication
· Breaking Bad News
· Death Disclosure
· Special Considerations
o Culture
o Requests to Withhold Information
o Telephone Notification
o No Next of Kin Available
o Communicating with Children
· Death of a Child
o Sudden Infant Death Syndrome
o Miscarriage or Stillbirth
· Self-Care and the Care of Other Emergency Department Staff Chapter 10: Resuscitation, Family Presence, and Last Hours of Living
· Cardiopulmonary Resuscitation and Prognosis in Advanced Illness
· Family Presence During Resuscitation
· Witholding or Withdrawing Interventions
o CPR
o Intubation and Artificial Ventilation
o Artificial Nutrition and Hydration
o Antibiotics
· Care of the Actively Dying Patient
o Environment
o Symptom Control
o Secretions
o Dry Mouth
o Agitation
o Opioid Toxicity Chapter 11: Hospice
· Understanding Hospice Care
o Eligibility
o Underutilization
o Scope of Services and Reimbursement
o Discontinuing Hospice Care
· Emergency Department Management of Patients under Hospice Care
· Common Presentations
· Initiating New Hospice Referrals from the Emergency Department Chapter 12: Legal and Ethical Issues of Palliative Care in the Emergency Department
· The Interrelation of Law, Ethics, and End-of-Life Care
· Informed Consent
· Limitation of Treatment
· Determination of Decision-Making Capacity
· Decision-Making for the Incapacitated
· DNR Orders and Physician Orders for Life-Sustaining Treatments
· Opioids and End-of-Life Care
· Suicide and Physician-Assisted Suicide
· Futility

About the Author

Assistant Professor, Department of Emergency Medicine and Center for Palliative Care; Associate Fellowship Director, Hospice and Palliative Medicine, Emory University School of Medicine, Atlanta, Georgia

Reviews

"This is the only book of its kind, and fills a critical need. ... Every minute you spend with your team (and yourself) following one of these cases reflecting and honoring the dying is time well spent to heal our souls and build the strength and goodness of our departments and hospitals." --Doody's Health Sciences Book Review