Lamba Sangeeta, Mosenthal Anne C
Department of Emergency Medicine, The University Hospital, University of Medicine and Dentistry of New Jersey, Newark, New Jersey 07103, USA.
J Emerg Med. 2012 Nov;43(5):849-53. doi: 10.1016/j.jemermed.2010.04.010. Epub 2010 May 23.
Emergency Medicine (EM) is a resuscitative discipline where the major focus in teaching and practice is to rapidly diagnose, stabilize, and initiate curative therapy. Thus, it may seem counterintuitive to have Hospice and Palliative Medicine (HPM), a specialty often perceived as a last resort measure "when no more can be done" for the patient, included as the latest subspecialty of EM.
We discuss the scope of practice and the role of HPM in the emergency department (ED) to clarify some commonly held misconceptions.
HPM principles are frequently applied in ED patient care. EM clinicians routinely rely on many of the same skills that are refined and advanced by HPM when treating symptoms, facilitating goals of care discussions, communicating bad news, and integrating the treatment of the physical, psychological, and social suffering in patient care. The HPM approach to care is patient-centered as opposed to disease-centered, with a focus on the relief of distressing symptoms to improve the quality of life. This parallels ED care, where priority is given to alleviate distressing symptoms such as acute pain or vomiting, regardless of the underlying disease process. In fact, EM is one specialty in which we may submit a bill purely based on an International Classification of Diseases-9(th) Revision symptom code.
In this article we explore the background of HPM; outline the principles and core skills of HPM that are applicable to the daily practice of EM; and explore the pathway, now available, towards a subspecialty certification.
急诊医学（EM）是一门复苏学科，其教学和实践的主要重点是快速诊断、稳定病情并启动治疗。因此，将临终关怀与姑息医学（HPM）纳入急诊医学的最新亚专业，这似乎有违直觉，因为该专业常被视为在对患者“无计可施”时的最后手段。
我们讨论临终关怀与姑息医学在急诊科的实践范围和作用，以澄清一些常见的误解。
临终关怀与姑息医学的原则在急诊科患者护理中经常应用。急诊医学临床医生在治疗症状、促进护理目标讨论、传达坏消息以及在患者护理中整合身体、心理和社会痛苦的治疗时，经常依赖许多与临终关怀与姑息医学相同的技能，这些技能在临终关怀与姑息医学中得到完善和提升。临终关怀与姑息医学的护理方法是以患者为中心，而非以疾病为中心，重点是缓解痛苦症状以提高生活质量。这与急诊科的护理类似，在急诊科，无论潜在的疾病过程如何，都优先缓解急性疼痛或呕吐等痛苦症状。事实上，急诊医学是我们可能纯粹根据《国际疾病分类》第九版症状代码提交账单的专业之一。
在本文中，我们探讨临终关怀与姑息医学的背景；概述适用于急诊医学日常实践的临终关怀与姑息医学原则和核心技能；并探讨目前可获得的亚专业认证途径。
