EM · End-of-life and goals of care

End-of-life care and goals-of-care discussions in the emergency department

Also known as Goals-of-care conversation · Not for resuscitation · DNAR · Treatment limitation · Palliative care in the ED · Advance care planning

End-of-life care and goals-of-care discussions in the emergency department — recognising the dying patient across the illness trajectories, the structured goals-of-care conversation (framing, the patient's values, realistic outcomes, and the shared decision), the not-for-resuscitation order and limitation of treatment (not for intubation, CPR, dialysis), the ED palliative pathway with its symptom-control pharmacology (morphine 2.5 mg SC/IV, midazolam 2.5 mg SC, glycopyrrolate 200 micrograms SC, haloperidol 0.5 to 2 mg IV), the family meeting, bereavement support, cultural and spiritual considerations, and the legal and ethical framework of the advance care directive, the enduring guardian and substituted judgement. The differential — the reversible causes of deterioration that must not be missed — runs through every decision. ACEM-primary, globally tagged.