Spezielle medizinische Probleme am Lebensende

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• 作者：Dr. med. Gesine Benze…
• 关键词：SchlüsselwörterKrisen am Lebensende ; Therapiezieländerung ; Palliativmedizin ; Symptomkontrolle ; Gesundheitliche Versorgungsplanung für die letzte Lebensphase
• 刊名：Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：60
• 期：1
• 页码：62-68
• 全文大小：
• 刊物类别：Medicine
• 刊物主题：General Practice / Family Medicine; Public Health;
• 出版者：Springer Berlin Heidelberg
• ISSN：1437-1588
• 卷排序：60

文摘

Crisis at the end of life are exceptional challenges for patients, relatives and therapists. With respect to the individual treatment goals and the patients’ autonomy, therapeutic action should be commenced in an adequate manner in order to preserve the patients’ quality of life as much as possible. Advance care planning for specific critical scenarios may be helpful in order to treat patients according to their wishes and values even if they are not capable to express themselves. Furthermore, a crisis plan can define the scope of action for therapists in emergency situations. Dyspnea, pain and delirium are symptoms that may often lead to emergency calls. In such cases, pharmacological and other treatment options are available. Options for causal therapy should be checked and performed if adequate. Opioids are used to relieve pain and dyspnea. In a state of delirium, highly potent neuroleptics and atypical antipsychotics are used. For the treatment of anxiety or restlessness benzodiazepines can be prescribed. Sedative medication may reduce stress, for instance in the case of acute catastrophic bleeding. Palliative sedation is an ultima ratio concept for refractory symptoms at the end of life. Clinical practice guidelines (such as the German guideline “Palliative care for patients with incurable cancer”) may provide an overview of the evidence base on symptom-guided therapy at the end of life.