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Section 12 - End of life

Published online by Cambridge University Press:  05 November 2013

Kaushal Shah
Affiliation:
Department of Emergency Medicine, Mount Sinai School of Medicine, New York
Jarone Lee
Affiliation:
Department of Emergency Medicine, Massachusetts General Hospital, Boston
Kamal Medlej
Affiliation:
American University of Beirut
Scott D. Weingart
Affiliation:
Department of Emergency Medicine, Mount Sinai School of Medicine, New York
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Summary

This chapter discusses the care management of the dying patient. It describes special circumstances with regard to family members such as young children of dying patients, and with regard to organ donation. Dying in the critical care setting most often follows the withholding or withdrawal of life-sustaining treatments and therefore has its own unique trajectory. When critical care is no longer achieving patient-centered goals and/or the patient is dying despite aggressive use of life-sustaining therapy, a meeting should be held to determine the goals of care. Withdrawal of ventilator support or liberation from the ventilator is a common step preceding death in the intensive care unit. If desired, families should be informed regarding the estimated survival time once ventilator support is discontinued, as this allows for adequate preparation and planning. Prognostic estimates should be communicated as time frames: minutes to hours, hours to days, or days to weeks.
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Publisher: Cambridge University Press
Print publication year: 2013

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