Harvard Affiliated Emergency Medicine Residency, Massachusetts General Hospital and Brigham & Women's Hospital, Boston, Massachusetts, USA.
Department of Palliative Medicine, Scripps Health, San Diego, California, USA.
J Palliat Med. 2024 Feb;27(2):275-278. doi: 10.1089/jpm.2023.0262. Epub 2023 Oct 25.
In this segment of the emergency department (ED) palliative care (PC) case series, we present a patient with advanced cancer not yet followed by PC or on hospice, who presents to the ED overnight with worsening nausea, vomiting, and acute on chronic abdominal pain. The ED team works to stabilize and treat the patient, reaches out to his oncologist, and seeks remote support and guidance from the on-call PC clinician. After a rapid "just-in-time" training, the ED clinician is able to have a focused goals-of-care conversation with the patient and his family and make person-centered recommendations. The patient is briefly admitted to the intensive care unit for ongoing medical optimization and symptom management, and then subsequently discharged home on hospice in alignment with his elucidated goals.
在这个急诊科（ED）姑息治疗（PC）病例系列的这一部分中，我们介绍了一位晚期癌症患者，尚未接受 PC 或临终关怀，他在夜间因恶心、呕吐和慢性腹痛急性加重而到 ED 就诊。ED 团队努力稳定和治疗患者，联系他的肿瘤医生，并寻求值班 PC 临床医生的远程支持和指导。在快速进行“及时”培训后，ED 临床医生能够与患者及其家属进行重点关注目标的对话，并提出以人为本的建议。患者因持续的医疗优化和症状管理而短暂入住重症监护病房，然后按照他阐明的目标出院回家接受临终关怀。
