Shreves Ashley, Pour Trevor
Department of Emergency Medicine, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Emerg Med Pract. 2013 May;15(5):1-19; quiz 19-20.
Many terminally ill patients seek care in the emergency department. Understanding how to elicit goals of care from dying patients and initiate basic palliative measures is well within the scope of emergency medicine. While a wide variety of factors drive patients at the end of life into the acute-care setting, dyspnea is one of the most distressing symptoms experienced by dying patients, and it is a common reason for such patients to seek care. Many underlying disease states and acute illnesses account for shortness of breath at the end of life, and management tends to be symptomatic rather than diagnostic, particularly in those for whom comfort is the most important goal. Opioids are the most effective and widely studied agents available for palliation of dyspnea in this population, while adjuvant therapies such as oxygen, noninvasive positive pressure ventilation, and fans may also play a role. Other medications (eg, benzodiazepines and low-dose ketamine) may also be useful in select patients. The early involvement of palliative medicine specialists and/or hospice services for dying patients can facilitate optimal symptom management and transitions of care.
许多晚期患者在急诊科寻求治疗。了解如何从临终患者那里引出护理目标并启动基本的姑息治疗措施，完全属于急诊医学的范畴。虽然有各种各样的因素促使临终患者进入急症护理环境，但呼吸困难是临终患者经历的最痛苦症状之一，也是此类患者寻求治疗的常见原因。许多潜在疾病状态和急性疾病会导致临终时呼吸急促，治疗往往是对症而非诊断性的，尤其是对于那些以舒适为最重要目标的患者。阿片类药物是该人群中用于缓解呼吸困难最有效且研究最广泛的药物，而氧气、无创正压通气和风扇等辅助治疗也可能发挥作用。其他药物（如苯二氮䓬类药物和低剂量氯胺酮）在特定患者中可能也有用。姑息医学专家和/或临终关怀服务对临终患者的早期介入可以促进最佳症状管理和护理过渡。
