Interviewee: David Anderson
James talks to Dr David Anderson about end of life care on the wards.
David in an intensive care medicine fellow at RPA Hospital. His interests include end of life care, medical education and prehospital care. In addition to intensive care medicine he has spent time training in anaesthesia, retrieval medicine and palliative medicine and before qualifying as a doctor he worked as a paramedic.
With Dr David Anderson, Intensive Care Fellow at Royal Prince Alfred Hospital
Junior doctors covering the ward after hours are often called to review patients who are dying, or offer support and counselling to the families and loved ones of patients who are dying.
Case 1 – You are called by the nurses on the ward to review a patient who has arrived on the ward after being admitted with end stage COPD. The nurses call you because the patient has a respiratory rate of 50 and looks unwell. They tell you that whilst the patient was in ED, it was decided that she would not be for medical emergency team calls or arrest calls, but this has not been documented. She asks you to complete a Not for CPR order otherwise she will need to make an arrest call.
Case 2 – You are called by the nurses on the ward to review a patient under the care of the medical oncology team. The nurses tell you that he has a diagnosis of stage IV melanoma with brain metastases and that the team has documented that the patient is for comfort care only, with a valid Nor for CPR order at the front of his notes. The patient is now unresponsive but the family is distressed by his noisy breathing, grimaced face and frequent groans
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