Emergencies in palliative care.

Five groups of events are here considered as emergencies in palliative care: haemorrhage, convulsions, fractures, spinal cord compression and acute confusion. Incidence, causes and management of these form the major part of this article. Emergencies in palliative care also include sudden severe exacerbation of symptoms. Therefore, onset of severe pain, exacerbation of breathlessness, and worsening of other symptoms are also discussed with their appropriate treatment. A small armamentarium of appropriate medications is thus shown to cover treatment of the various emergencies that may arise. As palliative care deals with patients who are suffering from progressive fatal conditions, death is the expected end. Nevertheless, however well the family are prepared, death often appears for them as an emergency. Comment is made regarding this family emergency in the care of terminally ill people. Attention in this article is focussed on medical treatment. In the care of the emergency event, however, and in all palliative care, management includes making the patient comfortable, thinking of the needs of other patients and relatives observing the event, explaining what is happening and is being done, involving other members of the team, and communicating reassurance to the patient and the relatives as well as to other observers.