OVERVIEW

Emergency Department Management of Dyspnea in the Dying Patient (Pharmacology CME) is organized by EB Medicine.

Date of Original Release: July 01, 2018
Date of most recent review: June 10, 2018
Termination date: July 01, 2021
CME Expiration Date: July 31, 2021

Target Audience:
This enduring Online CME material is intended for emergency medicine physicians, physician assistants, nurse practitioners, and residents.

CME Credits:
4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAFP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits.

Description:
Up to three-quarters of patients with terminal cancer struggle with dyspnea, and many patients near the end of life will impersonate to the ED inquiring help. For emergency clinicians, the purposes of care for patients with terminal illnesses are very different. This problem reviews what emergency clinicians must know to safely, effectively, and sensitively manage the distressing symptoms of shortness of breath.
• Progress directives explained: What’s the difference between DNR/DNI, living will, and power of attorney?
• Why you should never ask “Do you want everything done?”
• How can you tell how close a patient is to death? Does it matter?
• How can you begin the conversation about palliative care with family members?
• Do opioids hasten death? How do you manage dosing in patients who are opioid-naïve and opioid-tolerant?
• Should you try secretion management, NIPPV, or high-flow nasal cannula?

Objectives:
At the conclusion of this article, you should be able to:
• Recognize the signs of the dying process.
• Design the diagnostic studies and treatment in the ED to optimize patient comfort at the end of life.
• Describe the role of opioids in the relief of acute dyspnea.
• Outline the role of adjuvant therapies in the treatment of acute dyspnea, including benzodiazepines, antisecretory medications, and nonpharmacologic interventions.