Critically ill or dying patient Flashcards
What happens when MERT occurs?
- Pt may remain on ward with change in medical mgmt
- Pt may be transferred to ICU
- Pt may be transferred to surgery
What happens post-MERT? (if still on ward)
- Increase frequency of obs
- Post MERT r/v
- Labelled as “patient of concern” for ward (for 24hrs)
What do we need to know for MERT?
Medical plan - CPR?
ARP?
Acute Resuscitation Plan
Discussion b/w Dr, pt, family
Includes decision regarding level of intervention (e.g. IV AB’s, IV fluids, MERTS, ICU)
CgDp?
Clinical guidance for the dying patient
- Assessed as being in last hours of life
- ARP says not for CPR
- Supports clinical judgement
- Daily review by treating team
What happens when a person dies on the ward?
- Curtains and doors closed
- Butterfly on door and sign asking ppl to see N/S before entering
- Medical team notified
- Death verified
- Family notified
- Paperwork completed and documented in chart
- Cleaning and preparation of body
- Autopsy required?
- Involvement of coroner?
- Organ donation?
- Transfer of body to morgue (discreet)
What tests confirm brain death?
- response to painful stimuli
- pupillary light reflex
- corneal reflex
- caloric reflex
- cough reflex
- ability to breathe when disconnected from ventilator
What confirms circulatory death?
- immobility
- apnoea
- absent skin perfusion
- absent arterial pulse for more than 2mins
When can you donate after circulatory death?
Considered when pt is expected to die within 90mins of withdrawal of ventilation (if still alive - can’t donate)
Physio and organ donation?
- keep chest clear
- minimise amount of oxygen needed to maintain PaO2
- continue physio Rx until donation surgery occurs
- be respectful
What are the 2 pathways when a patient deteriorates?
- Medical emergency
2. Palliative care
Palliative care definition?
Focuses on improving the quality of life and quality of care for people with a life-threatening illness, as well as families
Why is traumatic death confronting?
- grief of family
- confronting nature of patient situation
- confronting nature of patient presentation
- treatment for organ donation preparation
Debriefing?
- discuss with colleagues and team leader
- psychology/counselling through employee assistance program
- morbidity and mortality meetings
- can choose rosters, opt out of certain areas
What’s an Advanced Health Directive?
Doc where ppl can make choices about health care they do/don’t want if they can’t make decisions for themselves (names religious, spiritual or cultural beliefs)
