Emergencies in palliative care

Patients with palliative care needs can experience a medical emergency in any setting (eg home, hospice, hospital).

Although it is important to rapidly recognise and respond to an emergency, management in palliative care is contextual and governed by the:

• patient’s preferences and goals of care
• patient’s prognosis
• potential burdens and benefits of management options
• setting, including available expertise (eg carer, paramedic, general practitioner [GP], palliative care physician, emergency physician) and resources (eg equipment, drugs).

Before starting treatment, establish whether an advance care plan is in place to guide management. If this information is not available and urgent management advice is needed, consult the palliative care team or the patient’s GP.

The principles of managing medical emergencies in palliative care are to:

• provide support and relieve distress—whenever possible, stay with the patient
• understand and respect the patient’s preferences and concerns
• establish and follow clear goals and boundaries of care
• provide symptomatic treatment while performing indicated investigations
• ensure early involvement of palliative care services.

In addition to the above principles, these guidelines provide advice on managing the following acute presentations in palliative care:

• catastrophic terminal events
• acute agitation
• acute pain
• major bleeding
• malignancy-related superior vena cava obstruction
• malignant airway obstruction, including malignant upper airway obstruction and malignant central airway obstruction
• malignant spinal cord compression
• seizures
• severe acute breathlessness
• severe nausea and vomiting

Any transition between care settings (eg from home to hospital) can potentially disrupt a patient’s continuity of care (including medication management). For considerations in medication management when moving patients between care settings, see Medication management when moving between care settings.

For information on requests to hasten death, which may be raised in the context of an emergency situation (including approach to managing requests, and voluntary assisted dying), see Requests to hasten death.