Comments for expensivecare http://expensivecare.com Searching for the big picture in intensive care Sun, 05 May 2013 12:45:23 +0000 hourly 1 http://wordpress.com/ Comment on What is Palliative Care? by Becky http://expensivecare.com/2013/04/20/what-is-palliative-care/#comment-111 Sun, 05 May 2013 12:45:23 +0000 http://expensivecare.com/?p=244#comment-111 This is the most hope filled and on the mark article I have read in eons. Holistic treatment, quality of life. Thank you.

]]> Comment on It’s ethically, morally and legally OK to not do CPR (sometimes.) by Alun Ellis http://expensivecare.com/2013/04/29/its-ethically-morally-and-legally-ok-to-not-do-cpr-sometimes/#comment-109 Sat, 04 May 2013 13:20:45 +0000 http://expensivecare.com/?p=250#comment-109 Eloquently written, David.
“Our purpose in Intensive Care is not to prolong life, but to restore health” – MO’L

]]> Comment on It’s ethically, morally and legally OK to not do CPR (sometimes.) by expensivecare http://expensivecare.com/2013/04/29/its-ethically-morally-and-legally-ok-to-not-do-cpr-sometimes/#comment-107 Fri, 03 May 2013 22:53:29 +0000 http://expensivecare.com/?p=250#comment-107 Thanks Kath. Please don’t get me wrong. I think phone calls from colleagues are great. Medicine is a team sport and especially in the ethically, legally and emotionally fraught world of end of life decision making, a unified approach is ideal. I used to work in a hospital where it was the norm for ICU and ED (and other specialties) to sit down together with families and give a medical consensus view. Unfortunately medicine is becoming increasingly silo-ised and this doesn’t seem to happen much any more. What isn’t so good is to get phone call from a colleague who has already made their mind up and may or may not have made the right decision.

Shame about your NFR order being revoked. I think it’s important to be aware of the fact, however, that such orders can change and that patients and families are allowed to change their mind (of course the final decision still lies with the medical staff.) I suspect your case highlights the fact that medical and surgical teams often have a long term relationship with a patient and need a bit of time to gain enough evidence for themselves that the patient is not responding to curative measures.

There’s a great paper on this by Hinton et al in this month’s Critical Care which I’ll talk more about soon.

D

]]> Comment on It’s ethically, morally and legally OK to not do CPR (sometimes.) by Kath Woolfield http://expensivecare.com/2013/04/29/its-ethically-morally-and-legally-ok-to-not-do-cpr-sometimes/#comment-106 Fri, 03 May 2013 15:20:22 +0000 http://expensivecare.com/?p=250#comment-106 I like to think I have not made one of those phone calls requesting an admission…

But I don’t think phone calls to ICU are always useless, especially when the question of futility is grey, or when the discussion with families becomes difficult. e.g. If the family has not yet been primed for this discussion as per Bec’s comment above (and how often do we seen this in the patient with advanced malignancy or COPD!). If a family/partner is having a hard time coming to terms with the limitations of modern medicine, it may be helpful to have representatives from other specialties supporting your decision not to offer a particular treatment option.

I have had a NFR/not for cardioversion order I made in ED be revoked by an inpatient team. The patient made it to CCU before then being made palliative. It made me realise that good communication amongst specialties as well as families is also important. I can’t imaging how confusing it must have been for the family.

The relatively new acute resuscitation plan (ARP) forms in Queensland are good in that they prompt discussion with families and documentation of this. However they are confusing if there is no NOK etc.

Great post highlighting also some of the grey areas in Australian law regarding end of life, thanks.

]]> Comment on It’s ethically, morally and legally OK to not do CPR (sometimes.) by expensivecare http://expensivecare.com/2013/04/29/its-ethically-morally-and-legally-ok-to-not-do-cpr-sometimes/#comment-101 Mon, 29 Apr 2013 11:16:34 +0000 http://expensivecare.com/?p=250#comment-101 Couldn’t agree more Bec. Thanks.

]]> Comment on It’s ethically, morally and legally OK to not do CPR (sometimes.) by Bec D http://expensivecare.com/2013/04/29/its-ethically-morally-and-legally-ok-to-not-do-cpr-sometimes/#comment-100 Mon, 29 Apr 2013 10:03:10 +0000 http://expensivecare.com/?p=250#comment-100 Thank you David for a very well articulated commentary.
Broadly I couldn’t agree more and felt my own frustrations mirrored in your words. It is an area I feel could be managed so much better in a large percentage of cases.
I think one of the biggest “communication problems” lies in the lack of discussion about end of life care by primary health carers and their specialist teams prior to the patient reaching a terminal phase of the illness. Even if this is discussed, it is difficult to access this documented information after business hours.
So yes, we emergency Doc’s could certainly approach this situation differently as described above in the emergency situation. However there are certain situations where a decision about whether to offer or not offer CPR (and other invasive therapies) as a “treatment” could be made and communicated well before the time that action is imminently required.
I think as a community there is room to move in many areas about how we manage end of life care and the discussions we have with patients and their families including the time and place those discussions take place.

]]> Comment on Crisis. Check. by Todd Fraser http://expensivecare.com/2013/01/17/crisis-check/#comment-44 Thu, 17 Jan 2013 02:33:22 +0000 http://expensivecare.com/?p=205#comment-44 Couldn’t agree more.

Medical critical care environments are frequently compared with aviation. Many are quick to dismiss the analogy for a multitude of reasons, but examples such as these are patently obvious. What is less clear are the reasons we so stubbornly refuse to acknowledge potentially life saving practices founded in the aviation industry.

Checklists are but one example of this, and as you rightly say, if a pilot can do it while under immediate threat of life, what’s stopping us?

]]> Comment on Nurse! Fetch the Nikethamide and the Lobeline! by expensivecare http://expensivecare.com/2013/01/03/nurse-fetch-the-nikethamide-and-the-lobeline/#comment-36 Wed, 09 Jan 2013 21:10:52 +0000 http://expensivecare.com/?p=200#comment-36 Amazing isn’t it? Shame no-one knows about him. I think it was one of the first ever circle systems. Designed by MacIntosh of course…

]]> Comment on Nurse! Fetch the Nikethamide and the Lobeline! by kangaroobeachKangarooBeacg http://expensivecare.com/2013/01/03/nurse-fetch-the-nikethamide-and-the-lobeline/#comment-35 Wed, 09 Jan 2013 20:46:50 +0000 http://expensivecare.com/?p=200#comment-35 I’ve had that Pask video for a while and it never ceases to amaze – probably the bravest man never to go to war … The video of him in the pool, face down is amazing.

What sort of circuit is that?

]]> Comment on Nurse! Fetch the Nikethamide and the Lobeline! by Vince D http://expensivecare.com/2013/01/03/nurse-fetch-the-nikethamide-and-the-lobeline/#comment-31 Sat, 05 Jan 2013 03:59:25 +0000 http://expensivecare.com/?p=200#comment-31 A couple of years ago I stumbled across an old video where I’m pretty sure they were “muscle relaxing” folks and then seeing what their oxygen saturations did during apnea. I honestly don’t remember much about it, but in hindsight it seems like a fascinating clip and despite a ton of searching I just can’t find it again. It almost seems like a video version of the 1959 “Apneic Oxygenation in Man” study. Ever come across something similar?

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