Palliative Care Emergencies in Hospitalized Patients

Most treatment of cancer and other chronic illnesses occurs in the ambulatory setting, and hospitalizations are generally unplanned admissions for acute problems. But what constitutes a real emergency in a patient with far advanced disease and limited disease-controlling options? It is important to differentiate between emergent symptoms, such as acute breathlessness, and an emergent medical condition, such as hypercalcemia, which may not be symptomatic. Emergent uncontrolled symptoms can and should always be reversed but emergent medical conditions need not always be treated in this population. Determining the right kind of response for the individual patient is complex and gets to the heart of palliative medicine as a concept. In this chapter, we focus on these issues in cancer patients. In addition to the traditional oncologic emergencies such as spinal cord compression, imminent pathological fracture, and superior vena caval obstruction, we discuss other emergent problems that may be encountered in palliative care patients such as acute massive hemorrhage, overnarcotization, coding without a DNR order in place, and dealing with an angry family on the floor.