Palliative care in the ICU & end of life care clearly explained by Dr. Seheult. Part 1 of this video is free at
Intensive care unit and what we call a terminal extubation or terminal weaning situations where we have done full force stops pulled out and these are on patients who are really sick and have pillar that’s fallen down we’ve supported the pillar of the lungs for because the kidney pillar has fallen down and let’s say that the patient is doing in these situations is the
Patient’s very sick and we’re holding up problem is is that we hold up these areas there’s risks with that right so get tissue breakdown and necrosis in the extremities the longer that the patient the longer the patient is on hemodialysis that can cause infections cause other issues as well and side effects thrombocytopenia elevated lfts to have come up are not coming up
They should be coming out but they’re not know some people have different values than others the family would say look he already been three weeks so we just can’t stand the way he’s suffering and so what we do in that situation is we have to pull back the supports of gonna happen is this roof is gonna fall and the patients get a pass away in the most dignified way that we
Possibly can and the one i want to focus on somebody could cause them shortness of breath and discomfort things that we situation what i tell patients is that look we’ve been here in the intensive better from a bodily standpoint and we haven’t been able to do it so instead of at the same time trying to treat his pain in a way that doesn’t interfere is we’re gonna switch to
Making him perfectly comfortable and not worry and that’s called palliative care so we always want to make sure that patients make patients comfortable have negative side effects for instance they could patient better and we’ve come to that decision then we can concentrate fully we’re going to treat to the fullest extent that the patient is comfortable in consciousness and
Things of that nature so what are the things that we’re at heart rate because sometimes the patient can’t talk to us so we can look of pain we can look at the respiratory rate all sorts of things that we can off things that are not comfortable but are not necessarily starting a morphine drip or a versed drip a fentanyl drip what-have-you and the support so if the patient
Is on ac mode ventilation will start to back off on the rates we may back off on the pressure support and we do it in a facial expressions respiratory rate and if we start to see that those are going expression of pain if there’s respiratory rate that’s going up we stop the pain medication to make sure that those heart rate facial expression pull back the support from
The ventilator until finally in a stepwise always tell family look the purpose here is not to have your loved one pass away is comfortable and i can tell you sometimes in my experience i’ve seen sometimes we’ve seen situations where the endotracheal tube comes out the the point of this is not to have the patient pass away the point of this is to support themselves after
We pull off the support from the ventilator or the support themselves so be it the point is the patient’s going to be and the patient should be in control and and the part of all of this that’s sort autonomy so autonomy is big especially in western culture autonomy means that treatment they should have and what medical treatment they don’t want to this has to be mitigated
With your understanding course of whether or not culture is that patients should have the treatments they have and what treatments they don’t realizing that these uncomfortable so this is a discussion that i think has to be open-minded in is that the medical doctor the medical professional the healthcare professional are going and the family needs to bring in the patient
Themselves if they can the values are of the patient what they would have wanted given those set of with a decision about what the direction is for the patient sometimes i have they don’t feel that the family doesn’t feel that this is a alternative that to bring up these different options in a dignified way so that patients and understanding what dnr means what dni means
Cpr palliative care what it is medical experience in the intensive care unit and your dealings with patients thanks for joining us
Transcribed from video
Palliative Care in the ICU & End of Life Care Explained Clearly By MedCram – Medical Lectures Explained CLEARLY
