Palliative Care. Cardiovascular.

An 88-year-old female with metastatic ovarian cancer, not on any active treatment, presents to the ED with 2 weeks of decreased oral intake, decreased energy, and 3 days of decreased LOC. She was brought in by her son. He was alerted by homecare workers that his mother’s status was worsening. Unsure what to do, he decided to bring her to the ED. He presents a community DNR form from her fridge. After an initial assessment, she goes into VT, and her ICD starts to shock repeatedly. This causes the patient significant discomfort and the son becomes distressed. The team leader needs to confirm the patient’s goals of care from her son and use a cardiac device magnet to stop the ICD shocks. Comfort care measures are taken, the son is counseled, and the team is debriefed.

Goals and Objectives

Educational Goal:

• To recognize that recurrent ICD shocks are a medical emergency.

CRM Objectives:

• Communicate clearly with the team regarding goals of care and the decision to use a magnet to discontinue painful shock.
• Demonstrate appropriate sensitivity when disclosing death to a patient’s relative.
• Appropriately debrief the team following termination of resuscitation.

Medical Objectives:

• Understand the difference between ICDs, pacemakers, and CRTs.
• Know how to activate an ICD.