ABSTRACT
There is growing interest in, and need for, integrating palliative care (PC) into the care of patients undergoing emergency surgery and those with traumatic injury. Thus, PC consults for these populations will likely grow in the coming years. Understanding the nuances and unique characteristics of these two acutely ill populations will improve the care that PC clinicians can provide. Using a modified Delphi technique, this article offers 10 tips that experts in the field, based on their broad clinical experience, believe PC clinicians should know about the care of trauma and emergency surgery patients.
Subject(s)
Hospice and Palliative Care Nursing , Palliative Care , Humans , Referral and ConsultationABSTRACT
Shared decision making requires the exchange of information from the patient and the surgeon (and ideally involves the expertise of the entire multidisciplinary team) to determine the medical and/or surgical treatment that best aligns with the patient's goals and values. Should the surgical patient wish to transition to end-of-life care, the transition to comfort-focused care is within the scope of practice for surgeons. Incorporating the expertise of other health care professionals is an important consideration for whole-patient care. Integrating primary palliative care into surgical practice can help mitigate unnecessary suffering and allow a smoother transition to comfort-focused care.
Subject(s)
Palliative Care , Terminal Care , Advance Directives , Decision Making , Heart-Assist Devices , Humans , Intestinal Obstruction/therapy , Terminal Care/methodsABSTRACT
The purpose of palliative medicine is to prevent and relieve suffering and to help patients and their families set informed goals of care and treatment. Palliative medicine can be provided along with life-prolonging treatment or as the main focus of treatment. Increasingly, palliative medicine has a role in the surgical intensive care unit (SICU) and trauma. Data show involving palliative medicine in the SICU results in decreased length of stay, improved communication with families and patients, and earlier setting of goals of care, without increasing mortality. The use of triggers for palliative medicine consultation improves patient-centered care in the SICU.
Subject(s)
Critical Care , Palliative Care , Wounds and Injuries/therapy , Delivery of Health Care, Integrated , Humans , Intensive Care Units , Resuscitation Orders , Terminal CareSubject(s)
Colonic Pseudo-Obstruction/diagnosis , Colonoscopy/methods , Constipation/etiology , Terminology as Topic , Colonic Pseudo-Obstruction/complications , Colonic Pseudo-Obstruction/surgery , Constipation/diagnosis , Constipation/surgery , Diagnosis, Differential , Fatal Outcome , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: The evaluation and management of blunt abdominal trauma is primarily nonoperative. Previous attempts to identify parenchymal solid-organ injury with sonography have been unsatisfactory. The use of Perflutren Lipid Microsphere (Definity) contrast-enhanced ultrasound (DUS) may provide an additional modality for evaluation of solid-organ injury with decreased risk of radiation exposure and contrast-related complications. METHODS: Injured patients admitted to a state-designated Level I trauma center (January 2008 to July 2009), who showed evidence of solid-organ injury after blunt abdominal trauma on initial computed tomography (CT) were eligible for entry into the study. Patients underwent DUS examinations within 12 hours of initial CT. Ultrasound images were then compared with findings of CT for organ location, size, and grade of injury. RESULTS: Twenty patients with evidence of solid-organ injury on CT were evaluated with DUS. DUS correctly identified five of eight liver lesions, with a sensitivity of 62.5%. DUS correctly identified all nine splenic lesions demonstrating a sensitivity of 100%. DUS correctly identified one of two kidney injuries, demonstrating a sensitivity of 50%. Overall, the positive predictive value for all solid-organ injuries was 100%, with negative predictive value of 20%. The overall sensitivity for DUS was 79% (15 of 19 patients), and specificity was 100% (15 of 15 patients). CONCLUSION: Contrast-enhanced sonography is a potential new modality for the evaluation of solid-organ injury for patients with blunt abdominal trauma. With further research, DUS may provide a safe and accurate alternative to CT. LEVEL OF EVIDENCE: Diagnostic study, level IV.
Subject(s)
Abdominal Injuries/diagnostic imaging , Contrast Media , Fluorocarbons , Trauma Centers , Wounds, Nonpenetrating/diagnostic imaging , Adult , Aged , Female , Humans , Male , Middle Aged , Patient Acceptance of Health Care , Pilot Projects , Predictive Value of Tests , Prospective Studies , Time Factors , Ultrasonography , Young AdultABSTRACT
The purpose of palliative medicine is to prevent and relieve suffering and to help patients and their families set informed goals of care and treatment. Palliative medicine can be provided along with life-prolonging treatment or as the main focus of treatment. Increasingly, palliative medicine has a role in the surgical intensive care unit (SICU) and trauma. Data show involving palliative medicine in the SICU results in decreased length of stay, improved communication with families and patients, and earlier setting of goals of care, without increasing mortality. The use of triggers for palliative medicine consultation improves patient-centered care in the SICU.
Subject(s)
Palliative Care , Family , Humans , Intensive Care Units , Renal Dialysis , Resuscitation OrdersABSTRACT
As the American population grows larger in terms of weight and body mass index each year, a greater percentage of patients admitted to the trauma service are overweight or obese. Obese patients do not have the same injury patterns or outcomes of normal-weight patients. This article reviews some of the latest data regarding the injury patterns, outcomes, and areas of further studies in the obese trauma population.