End of Life with Dr. Lauer Flashcards
How often does resuscitation actually work?
only about 10%
True or false: physicians are pretty good at giving a prognosis
False - they overestimate by approximately 200%
family docs are even worse
What’s a better way to give a prognosis instead of giving a number?
says hours to days
days to weeks
weeks to months
months to years etc
Describe the trajectories of dying for the following: sudden death, cancer, organ failure (like CHF), dementia
sudden: the duh one - you’re fine until you suddenly die
cancer: gradual slope downward
organ failure: they dip down and then bounce back, but not back to what they once were, so overall the decline is gradual
dementia: they’ll stay at a baseline until they hit a destabilizing event during which they’ll dip down to a new baseline and they won’t go back up afterwards
What are anorexia and cachexia?
anorexia - loss of appetite
cachexia - weight loss, specifically with muscle wasting
Why do anorexia and cachexia often go together?
the loss of ability to use nutritional substrate is accompanied by a loss of appetite.
the body goes from a anabolic state to a catabolic state
Should you tube feed a patient with cachexia?
you CAN, but that doesn’t mean you should - it’s a natural process
Why shouldn’t you fail to follow hunger and thirst signals? (especially lack thereof)
you get increased symptoms - abdominal pain, N/V, diarrhea from feeding food to a belly that can’t handle it
edema and urinary retention from fluids that the body can’t handle
What do we call the tipping point between living and actively dying? WHen does it USUALLY happen
transitioning
on average happens 1-2 weeks before death
What are some features of transitioning?
change in alterness
picking, removing clothes, other stereotyped movements
EOL visions
other excalating symptoms
When someone is actively dying, what organs are saved at the expense of others by the body?
heart and brain - the others will start to lose circulation
What will lose circulation first during active dying?
lower extemities - color changes, cold, thready or absent pulses
What loses circulation after the lower extremities? symptoms?
GU system - incontinence, urinary retention, decreased urine output and renal failure
What loess circulation after the GU system?
GI tract - lower first with bowel incontinence, constipation, poor appetite (form poor motility) and hiccups
Then upper - poor oral transit, weak swallow and eventually the inability to manage secretions
What loses circulation after the GI tract
upper extremities - often seen at the same time as signs on the face
When do you usually see the loss of circulation in the upper extremities?
usually not seen until within hours of death
Breathing changes during active dying are diven by changes in what?
metabolism
brain function
end lung function
During the early stages of active dying, what happens to breathing?
you get rapid shallow respirations due to weakened diaphragm, using accessory muscles and maybe early acidosis
What other respiratory symptoms often accompny this shallow respiraton?
weak or no cough
hypophonia
What happens after the shallow respiration?
kussmaul breathing - big deep breathes = hyperpnea
What’s the cause of kussmaul breathing?
late metabolic acidosis
What are cheyne-stokes respirations?
they’re a sort of crescendo-decrescendo apnea associated with damage to respiratory centers or metabolic encephalopathies
What characterizes ataxic respirations?
when they’re reathing and then take LONG breaks in between breaths
What’s usually the cause of ataxic respirations?
damage to the medulla
