How sick is the pt? If she's comatose, my goal is to find familty and then get her on inpt hospice.
If she can talk, I ask her how she feels. Maybe Lasix and/or morphine for SOB. If she feels lousy PO meds (if she can swallow) to control BP solely to keep her out of pulm edema.
My goals would be to make her feel less lousy. Maybe a chest x-ray to r/o pneumonia, maybe labs but I doubt it.
I think a discussion with family and pt (if able to participate) abotu goals of therapy comes first.
2. Ask for smoking as a posible non treatable cause of sudden death.
3. Seek expert consultation, happy.
4. ERP, diuretics arent used on diastolyc disfunction nor dobutamine or dopamine(it will worse). we need to be cautious against too aggressive a diuresis and we have to wait for the priest.
5. betablockers or calcium channel blockers. heck its 103 years old I hope his conduction system is ok. control FA cant be done. too old for that. giving channels blockers is as far as I can get, commorbility asociated can be taken in consideration.
I Have had this elderly patients, on my ER, my first tought is if they die nobody would blame, they are too old. would you treat them if they were too old? would you tell families if it was time to let it go? and refuse treatment. is this any different from a patient with alzheimer disease in advanced stages at their 70s with the same cardiac disease?
you can yet use diuretics and long term nitrates but AT VERY LOW doses, because of BP, DHF treatment can bet tricky is not the same that treating a SHF, still in a patient of that age I m more concerned about the ethical issues.
One of my favorite little old lady pt's (in her 90s) was asked by the admitting hospitalist what she would like us to do "if her heart stopped." She thought for a short while, then answered - "burial, please" She was discharged back to her SNF. -whitecap
Hospice consult.
ReplyDeleteditto--although I was going to phrase it as "comfort care and troubling symptom management" only.
ReplyDeletePattie, RN
Law number 5 of the House of God: PLACEMENT COMES FIRST.
ReplyDeleteconsult spiritual advisor of choice
ReplyDeletetell the family to come say goodbye
ReplyDeleteHow sick is the pt? If she's comatose, my goal is to find familty and then get her on inpt hospice.
ReplyDeleteIf she can talk, I ask her how she feels. Maybe Lasix and/or morphine for SOB. If she feels lousy PO meds (if she can swallow) to control BP solely to keep her out of pulm edema.
My goals would be to make her feel less lousy. Maybe a chest x-ray to r/o pneumonia, maybe labs but I doubt it.
I think a discussion with family and pt (if able to participate) abotu goals of therapy comes first.
Another one bites the dust...
ReplyDelete1. Look for a priest.
2. Ask for smoking as a posible non treatable cause of sudden death.
3. Seek expert consultation, happy.
4. ERP, diuretics arent used on diastolyc disfunction nor dobutamine or dopamine(it will worse). we need to be cautious against too aggressive a diuresis and we have to wait for the priest.
5. betablockers or calcium channel blockers. heck its 103 years old I hope his conduction system is ok. control FA cant be done. too old for that. giving channels blockers is as far as I can get, commorbility asociated can be taken in consideration.
I Have had this elderly patients, on my ER, my first tought is if they die nobody would blame, they are too old.
would you treat them if they were too old?
would you tell families if it was time to let it go? and refuse treatment.
is this any different from a patient with alzheimer disease in advanced stages at their 70s with the same cardiac disease?
what would you do happy?
you can yet use diuretics and long term nitrates but AT VERY LOW doses, because of BP, DHF treatment can bet tricky is not the same that treating a SHF, still in a patient of that age I m more concerned about the ethical issues.
ReplyDeleteHook her up to 4L O2 and pour us both a whiskey on the rocks.
ReplyDeleteHow much much does she and her family have?
ReplyDeleteUm, would no one here diurese the patient if she was in acutely decompensated diastolic heart failure? I would. Am I wrong?
ReplyDeleteI'd help the old broad with some stretching exercises so she could kiss her ass goodbye.
ReplyDeleteOne of my favorite little old lady pt's (in her 90s) was asked by the admitting hospitalist what she would like us to do "if her heart stopped." She thought for a short while, then answered - "burial, please" She was discharged back to her SNF.
ReplyDelete-whitecap