Palliative care in the ED

Primary purpose: Relieve suffering
-Perform an Assessment: find out what the patient wants 
-Listening is the key communication skill
-Symptom management: will help build trust with patient 
-Prognosis: consider functional status + disease  
-Navigate system for the patient: consults as appropriate 

Treating pain:
-Opioid naive:
     -Morphine 1st line: 2-5 mg IV, Reassess in 15 minutes. If pain unchanged or higher, redone and increase by 50-100%
     -If pain decreased, repeat same dose
Opioid tolerant: Dilaudid first line 1-2 mg IV, reassess in 15 minutes
*With liver failure give 1/2 dose and wait 30 minutes before redosing
*To treat SOB use 1/2 of dose that you would give for pain

General approach:
-Provide undivided attention to THEIR agenda, NOT yours
-Track emotion and allow emotion to happen
-Articulate empathy
-Focus on what we CAN do, not what we can’t do: Big picture goals before interventions

The Conversation:
   -Elicit understanding, information preferences (how much to share? who to discuss with?), fears/worries,  goals if time is short (how do you want to spend that time?), trade-offs (for more time to achieve goals), unacceptable states
   -MAKE RECOMMENDATIONS: Useful phrases: What are you hoping for? If you knew time was short, what is most important to you?
   - Pitfalls (NEVER say): There is nothing more we can do.  Do you want everything done? Everything will be OK