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Goals of Care in an Elderly Person with Catastrophic Brain Injury 

Goals of Care in an Elderly Person with Catastrophic Brain Injury
Chapter:
Goals of Care in an Elderly Person with Catastrophic Brain Injury
Source:
Neurocritical Care (2 ed.)
Author(s):

Eelco F. M. Wijdicks

, Alejandro A. Rabinstein

, Sara E. Hocker

, and Jennifer E. Fugate

DOI:
10.1093/med/9780190602659.003.0037

Discussion of do-not-resuscitate (DNR) orders and interpretation of advance directives with family members is a major part of neurocritical care practice. DNR orders may be warranted in catastrophic neurological injuries. The appropriateness of cardiopulmonary resuscitation (full code) depends on the probability of good outcome and absence of life-shortening comorbidity. How to go about de-escalation of care and withdrawing of support and how to provide best palliation is discussed in this chapter. Repeated conversations with family members are extremely important, and time should be reserved to do so in an appropriate way. End-of-life care should include discussions with surrogates using a shared decision model. Decisions should include a broad picture of validated predictors of outcome, previous functional status, coexistent illnesses, and patient’s preferences.

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