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)
What does ‘prognosis guarded’ mean?
Not sure if pt is gonna survive
What can physios do at the end of life?
- Improve QOL in last few days
- Assess mobility
- Educate pt and family on mobility decline
- Teach family how to assist with mobility
- Teach family how to use mobility equipment
- Teach positioning
When do we cease physio?
Depends on goals of care, prognosis, family and patient wishes, MDT meetings
Issues specific to oncology?
- Risk of terminal haemorrhage
- Can be large burden of disease
- May have been unwell for long time
