commit 7d3a01823fc707703301336f5a7a9cc28bf3b23d
parent 78127a0c434f2a6f02486bc237734b93bfe5c56a
Author: C. Beau Hilton <cbeauhilton@gmail.com>
Date: Thu, 27 Aug 2020 13:05:37 -0500
memex update
Diffstat:
2 files changed, 53 insertions(+), 0 deletions(-)
diff --git a/index.md b/index.md
@@ -82,6 +82,7 @@ Vannevar Bush coined the term "memex" for a system of extending or indexing one'
- [2020-07-06-noon-conference](learn/2020-07-06-noon-conference.md)
- [2020-08-27-grand-rounds](learn/2020-08-27-grand-rounds.md)
- [2020-08-27-coding-billing-yakes](learn/2020-08-27-coding-billing-yakes.md)
+- [2020-08-27-advance-care-planning-yakes](learn/2020-08-27-advance-care-planning-yakes.md)
## blogs (good ones)
diff --git a/learn/2020-08-27-advance-care-planning-yakes.md b/learn/2020-08-27-advance-care-planning-yakes.md
@@ -0,0 +1,52 @@
+# Advance Care Planning
+
+Beth Ann Yakes, MD
+
+## Advance directives (AD)
+
+Advance directives can cross state boundaries.
+
+TN
+- spouse
+- adult children
+- parents
+- siblings
+- other interested family/friends
+
+(this is especially important for commonlaw or other SOs,
+that may fall to the bottom of the list if not explicitly denoted in the AD)
+
+If any part of the AD is not adequate to define your wishes, write it out.
+You can attach as many pages as you'd like.
+
+"If I can eat ice cream AND watch football, keep me alive.
+If I can't do one, the other, or both of these, let me die."
+
+Re tube feeding/IV fluids:
+End of life nutrition is very different than what they feel currently when hangry.
+Tube feeds often have gnarly adverse effects, e.g. gastroparesis leading to emesis leading to aspiration.
+Also, what to do with the output? -> irritation, ulcers, needing debridement, etc.
+IV fluids can lead to edema, more need for catheters, etc.
+
+Re CPR:
+The provision to not resuscitate only comes into effect when the quality of life conditions are met.
+
+(TRIAD study - physicians got the decision to resuscitate wrong ~50% of the time bc they misunderstood AD relative to irreversible conditions)
+
+
+## Physician orders for scope of tx (POST)
+
+Take effect immediately upon signing, unlike AD that only come into play when the outlined conditions are met.
+E.g. healthy 90yo elects to not receive CPR regardless of reversible or irreversible conditions,
+fill out a POST, sign it -> 90yo codes 2 minutes later, do not do CPR.
+
+Put it on your fridge! Make it easy to find if found down.
+
+Anyone who comes in from a group home has to have an active POST
+(may say do everything, but has to exist).
+
+Have to be a physician to sign this form.
+
+OK to provide copies in any requested language,
+but most states require the form be in English to be valid,
+so that any provider can read it.
