Abstract 1518P
Background
Multiple tools exist for the assessment of Palliative care needs in the emergency setting, however none of them seem to have taken the ground realities of working in acute care into consideration.
Methods
A questionnaire, consisting of clinical vignettes pertaining to management of case scenarios, encountered during a one month long emergency medicine posting, was distributed among the residents, trainees and faculty of Emergency medicine during their academic program.
Results
With regards to the management of a case of terminal haemmorhage, 14/17 agreed that the Emergency provided an ideal setting for provision of end of life care, 14/16 agreed that they would provide an ENT as well as an Interventional radiology liaision to this patient. 8/17 agreed that the Palliative medicine ward would be an ideal place to admit such a patient, while 1/15 agreed that discharge home and provision of a contact for a telephonic liaision to ensure continuity of care constitute a viable option at this time. In a case vignette involving a terminally ill patient with metastatic breast cancer with altered sensorium and noisy breathing at the end of life, whose primary caregiver had consented to foregoing life sustaining treatment (including attempts at resuscitation after a cardiopulmonary arrest), the following observations were made - 9/16 agreed that the cause of noisy breathing was a lower respiratory tract infection which needed to be investigated further, 13/16 were in favour of performing a blood culture to rule out septic encephalopathy, 8/16 suggested that she be intubated, 15/16 agreed that they would start medical decompressive therapy and broad spectrum antibiotics. 4/17 agreed that the use of fentanyl would be ill advised, given the risk of developing a wooden chest syndrome. 6/17 agreed that the use of morphine in this setting could be counterproductive given its tendency to cause respiratory depression.
Conclusions
These responses point towards a lack of willingness to embrace the philosophy of palliation. Training in core principles of Palliation, as suited to the reality of acute care, seems to be the need of the hour.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Rahul D. Arora.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.