EM Special 3: Death Notification and Advance Directives

Question 1

most suitable location if you want to touch the grieving individual

Answer 1

shoulder

Question 2

GRIEV_ING method for delivery of death notification

Answer 2

Gather the family
Resources (chaplain, ministers)
Identify (yourself, the deceased, the family, their knolwedge)
Educate (begin at the conclusion of the family’s knowledge of events)
Verify (death)

__ (space; stop talking)
Inquire (if they have questions)
Nuts and bolts
Give (your contact info and condolences)

Question 3

Nuts and bolts during a patient’s death

Answer 3

1) documents
2) autopsy
3) chance to see the body
- remove blood and secretions, close the eyes, and cover the body except of the hands and face
- *it is fine to remove tubes and catheters as long as it is not a medical examiner’s case

*in most situations, it is best to have the family members seated to avoid falls

Question 4

remarks on witnessed resuscitation

Answer 4

Family-witnessed resuscitation gives family members closure and comprehension of the patient’s situation and grave condition

In one study, family members who witnessed CPR had fewer symptoms of posttraumatic stress disorder and less complicated grief 1 year after the death.

A staff member should prepare the family memebers for what they may see during the resuscitation and then remain with them to offer support, answer questions, and explain procedures.*

Question 5

PREDICT score

Answer 5

12 - referral to palliative care team for a noncancer diagnosis
10 - Current diagnosis of cancer
10 - ICU admisison with multiorgan failure
3 - ≥2 medical admissions in the past year
3 - current residence in nursing home
3 - age at ED visit ≥76 y
2 - age at ED visit 66-75 y
1 - age at ED visit 55-65 y

score of ≥14 predicts mortality at 1 year with 95% specificity