Medical Care of Terminally Ill Patients

Robert E. Enck, M.D., is a clinical associate professor in the Department of Medicine at The University of Pennsylvania School of Medicine and editor-in-chief of the American Journal of Hospice and Palliative Care.

• Contents: Preface to the Second Edition List of Abbreviations 1. The Prognostication of Survival Cancer Dementia Motor Neuron Disease Acquired Immunodeficiency Syndrome (AIDS) Central Nervous System Anoxia Advanced Pulmonary Disease Heart Disease Summary I. The Management of Symptoms Common Among Dying Patients 2. General Symtoms of Dying Patients Pain Gastrointestinal Symptoms Nausea and Vomiting Anorexia and Cachexia nutritional Probllmes Hydration Constipation Central Nervous System Symptoms Delirium Depression Systemic Symptoms Dyspnea Urinary Incontinence Pressure Sores Summary 3. Other Problems of Patients with Cancer Malignant Intestinal Obstruction Malignant Dysphagia Neuromuscular Dysfunction Malignant Ulceration Summary 4. Other Problems of Patients with Nonmalignant Diseases Dementia Motor Neuron Disease Acquired Immunodeficiency Syndrom (AIDS) Chronic Vegetative State Advanced Pulmonary Disease Heart Disease Summary 5. Palliative Surgery Principles of Preoperative Care Principles of Operating for Advanced Cancer Principles of Postoperative Care Indications for Surgery Summary II. The Management of Pain 6. An Overview of Pain Management Principles of Pain Management The Ladder Approach Managing the Complications of Pain Treatment Summary 7. Opioids Oral Morphine Parenteral Opioids Alternative Routes of Administration Summary 8. Adjuvant Analgesic Drugs Anticonvulsants Phenothiazines Antidepressants Antihistamines Steroids Antibiotics Amphetamines Butyrophenones Summary 9. Complications of Pharmacologic Therapy Opioids Nonsteroidal Anti-inflammatory Drugs Summary 10. Bone Pain Pathopysiolgoy Radiation Therapy Pharmacotherapy Summary References Index 11. Surgery and Other Nonpharmacologic Interventions to Manage PainSurgery Acupuncture Transcutaneous Electrical Nerve Stimulation Relaxation Techniqu eComplimentary/Alternative Medicine Summary III. The Management of Symptoms During the Last Few Days 12. The Final Moments Terminal Symptoms and Their Managment Drug-Induced Terminal Sedation Summary 13. Issues Concerning the Sustaining of Life Do Not Resuscitate Advance Directives Physician-Assisted Suicide and Euthanasi aSummary References Index

A very well thought out and organized professional book... A thorough book for physicians. -- Carolyn Whitman, M.S., R.N. Inside GCM This Second Edition demonstrates the enormous advances that have been made in the understanding of the treatment of the terminally ill. It provides the clinician with a clear, readable and practical guide to managing clinical problems at the end of life. -- Roger Woodruff International Association for Hospice and Palliative Care Newsletter We can congratulate and thank [Dr. Enck] for adding to the comfort and care of a great many of our fellow human beings as death draws near. Doody's 3-Star Review