Table 2.

Bedside emergency department approach to patients in extremis, without an advance directive ^a

1. Stabilize the patient Oxygen, positioning, suction, BiPAP Consider endotracheal intubation

2. Attempt to ascertain the patient's wishes From the patient (prior to interventions/intubation) From the family; try to find health care power of attorney or nearest relative

3. Ask the patient/family: What is your understanding or your/your loved one's illness? What is your/your love one's baseline functioning? What do you /does your loved one desire for quality of life? What are you hoping we can do for you/your loved one? What are you/is your loved one most afraid of? What symptoms is your loved one experiencing?

4. Assure that DNR does not mean do not treat. Appropriate interventions may include: Infection: antibiotics Secretions: Suction, glycopyrolate atropine, scopolamine Dyspnea: oxygen, morphine, lorazepam Agitation: lorazepam, diazepam, haloperidol Pain: pain control

5.Do not argue or engage in a power struggle

6.When in doubt, institute‐life saving interventions (may be withdrawn later)

^aAdapted from: Episode 70 End of Life Care in Emergency Medicine. Emergency Medicine Cases. https://emergencymedicinecases.com/end-of-life-care-in-emergency-medicine/, accessed October 17, 2019.