criteria for consideration of palliative care consult
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Indications
- heart disease
- symptoms of CHF at rest
- LVEF of < 20%
- new dysrhythmia
- cardiac arrest
- syncope
- stroke
- frequent emergency department visits
- cancer
- metastatic or inoperable disease
- pulmonary disease
- dyspnea at rest
- signs or symptoms of right heart failure
- hypoxia (with administration of O2)
- FEV1 < 30% of predicted
- pCO2 > 50 mm Hg
- unintentional weight loss (> 10% of body weight)
- stroke
- acute phase of stroke unchanged after 3 days
- coma
- absent verbal response
- absent withdrawal to pain
- Karnofsky score < 50%
- recurrent aspiration pneumonia
- dysphagia precluding nutrition
- dementia
- inability to walk
- incontinence
- fewer than 6 meaningful words
- serum albumin < 2.5 or decreased oral intake
- nutritional compromise
- severe medical comorbidities
- frequent emergency department visits
- liver disease
- not candidate for liver transplantation
- prothrombin time > 5 seconds over control
- serum albumin < 2.5 g/dL
- refractory ascites
- spontaneous bacterial peritonitis
- jaundice
- malnutrition & muscle wasting
- renal disease
- not a candidate for dialysis
- creatinine clearance < 15 mL/min
- serum creatinine > 8.0 mg/dL (> 6.0 mg/dL if diabetic)
- amyotrophic lateral sclerosis
- dysphagia requiring a feeding tube
- dyspnea of symptoms of hypoventilation
- forced vitatal capacity of =< 50%
- loss of function in 2 body regions (bulbar, arms or legs)
- pain requiring high doses of analgesic medications
- severe psychological &/or social or spiritual distress or suffering
- failure to thrive
- frequent emergency department visits
- serum albumion < 2.5 g/dL
- unintentional weight loss
- decubitus ulcer(s)
- home-bound or bedridden
More general terms
Additional terms
References
- ↑ Bailey FA Palliative Response http://www.hospice.va.gov/Amosbaileybook/index.htm
- ↑ Childers JW et al, Fast Fact an Concept #141: Prognosis in end-state COPD, Aug 2005, End-of-life Palliative Care Education Resource Center http://www.eperc.mcw.edu
- ↑ Fast Fact an Concept #144: Prognostication in Heart Failure, Oct 2005, End-of-life Palliative Care Education Resource Center http://www.eperc.mcw.edu
- ↑ Norton SA et al, Proactive palliative care in the medical intensive care unit: Effects of length of stay for selected high-risk patients. Crit Care Med 2007, 35:1530 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17452930
Luce JM and White DB The pressure to withhold or withdraw life-sustaining therapy from critically ill patients in the United States. Am J Respir Crit Care Med 2007, 175:1104 PMID: https://www.ncbi.nlm.nih.gov/pubmed/17379853 - ↑ National Hospice Organization. Medical guidelines for determining prognosis in selected non- cancer diseases. Hosp J 1996; 11:47