Jen Hughes

Tuesday, May 29, 2018 • 15:00 - 16:30
Track 2 - PALLIATIVE CARE IN THE ED
Track Chair: Dr. Jen Hughes

Rapid Opioid Management in the Palliative Care Patient - Dr. Christian La Rivière

Description: Opioids have been shown to be effective in treating pain and dyspnea in palliative care patient. Managing these symptoms can be done in a simple and effective way in the emergency department where many palliative care patients present in distress.

Learning Objectives:

  1. Learn the basic pharmacology of important opioids
  2. Learn dose equivalents of different opioids
  3. Learn an approach to a rapid ‘time-limited’ therapeutic trial

Pearls

  1. Use a consistent method in selection, dose, and conversion when administering and converting opioids
  2. Opioids (selected and dosed appropriately) are an effective therapy in the treatment of dyspnea refractory to medical management and can be used safely without inducing respiratory compromise
  3. Opioids (selected, dosed appropriately) are indicated for management of moderate to severe pain, even in patients that are elderly or with renal insufficiency

Biography: Dr. La Rivière is an Assistant Professor at the University of Manitoba. He received his MD from the University of Manitoba and trained through the Royal College streams in both Emergency Medicine and Palliative Medicine. He currently works at the Health Sciences Centre Emergency Department and with the Winnipeg Regional Health Authority’s Palliative Care Program. He is the Program Director for the University of Manitoba’s Palliative Care Residency Program and has a special interest in palliative and end-of-life care in the emergency department and acute settings.

Management of the Imminently Dying Patient in the Emergency Department - Dr. Erin O’Connor

Description: This presentation will focus on the medical management of the actively dying patient in the ED with an emphasis on anticipating symptoms and first, second and third line symptom management interventions.

Learning Objectives:

  1. To anticipate potential symptoms at end of life based on the patient’s presenting diagnosis, past medical history and current medications.
  2. To discuss multiple options for management of common symptoms at end of life.
  3. To discuss signs of imminent death and how to talk to caregivers and families about what to expect in the dying process

Pearls:

  1. Symptom management at end of life is tailored to the patient and is not a standard set of orders.
  2. The nursing staff in the ED are key to management of the imminently dying patient, provide them with the tools they need to do it well.
  3. Families appreciate knowing what to expect when a patient is actively dying, the unknown is frightening.

Biography: Dr. Erin O’Connor completed residency in Emergency Medicine and a fellowship in Palliative Medicine at the University of Ottawa. Currently she practices Emergency Medicine and Palliative Medicine at the University Health Network in Toronto. Her interests include early identification of patients in the Emergency Department who could benefit from a palliative approach to care.

Running a Code on a No-Code Patient - Dr. David Williscroft

Description: An overview of when to consider life-saving or emergency interventions in patients with a palliative diagnosis. Use of real cases and CMPA closed settlements to be included in the discussion.

Learning Objectives:

  1. To be able to distinguish what constitutes a palliative emergency.
  2. To be able to recognize when decisions to not intervene need to be communicated to family/substitute decision makers.
  3. To recognize that by a patient having a DNR status does not necessarily mean that they would not be open to certain interventions.

Pearls:

  1. DNR does not mean DNI (intervene).
  2. Patients with a palliative trajectory may benefit from certain interventions.
  3. You can be found at fault for failing to treat patients with a palliative diagnosis.

Biography: David is a Clinical Associate Professor of Emergency and Palliative Medicine at the University of British Columbia. He completed his training in Emergency Medicine at St. Paul’s Hospital in Vancouver in 2004 and obtained a Fellowship in Hospice and Palliative Care from Stanford University in 2014. He currently divides his time between clinical Emergency Medicine at Lions Gate Hospital in North Vancouver and Palliative Care at St. Paul’s Hospital in Vancouver.