EMCrit Podcast EMCrit Podcast 25 – End of Life and Palliative Care in the ED
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Oct 12, 2010 A deep dive into treating end-of-life patients in the emergency setting. Talks about recognizing comfort-care candidates and using temporizing measures instead of immediate invasive treatments. Covers legal forms, how to frame goals-of-care conversations, offering time-limited trials, and practical comfort measures like analgesia, secretion control, and respectful monitoring.
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Identify Potential Comfort Care Patients Early
- Do identify potential comfort care patients early using nursing home status, advanced age, feeding tubes, dementia, or multiple catheters as red flags.
- Scott Weingart urges early recognition to avoid default invasive therapies like intubation that may contradict the patient's wishes.
Temporize With Noninvasive Measures Before Intubation
- Do temporize instead of rushing to invasive measures: use noninvasive ventilation, peripheral fluids, or phenylephrine to buy time for goals-of-care discussions.
- Scott recommends short noninvasive trials (10–20 minutes) even with altered mental status so you can ask the right questions.
Set Clear Goals Of Care As Cure Or Comfort
- Do establish clear goals of care as either aggressive curative therapies or aggressive comfort care and state the primary aim explicitly.
- Scott emphasizes that both paths require hard work, but the aim (cure versus comfort) guides decisions about escalation.