[Palliative medicine in emergency medical services]. / Palliativmedizin im Notarztdienst.

The scope of emergency calls for emergency medical services staffed by an emergency physician (EMS-EP) includes calls to patients with life-limiting diseases. Symptom exacerbation as well as psychosocial overburdening of caring relatives are the most frequent reasons for activation of an EMS-EP. Pain crises, acute dyspnea, massive bleeding and/or an impending or overt cardiac arrest are the most frequent symptom exacerbations. Under the conditions of a prehospital emergency physician mission, particular challenges are the evaluation of the overall situation, the prognosis and the presumed will of the patient. Is the goal of treatment still rehabilitative or is the patient in a pre-terminal, terminal or even final condition? Is the goal of treatment the same for the patient, the relatives and the physician? Is it necessary to make the goal of treatment a subject of discussion? It is not unusual that the task of the EMS-EP is to deliver bad news to the relatives, such as the impending death of the patient or even that death has already occurred. Even though it may no longer be required to save a life, the EMS-EP can significantly influence the bereavement of the relatives. Saving life might not be paramount for the EMS when responding to emergency calls from palliative care patients. Nevertheless, it is an important field of activity for the EMS-EP since the burden of symptoms can be relieved and dying with dignity can be made possible.

[Cancer pain management. Basic therapy and treatment of breakthrough pain]. / Tumorschmerztherapie. Basistherapie und Behandlung des Durchbruchschmerzes.

Cancer pain imposes a great burden on patients and results in considerable constraints limiting their quality of life. The basic treatment for chronic pain consists in oral administration of long-acting preparations of various analgesic agents according to a set schedule. In addition to chronic pain, however, about 60% of cancer patients also suffer from breakthrough pain. Rapid-onset and short-acting preparations of highly potent opioids are available for the management of these attacks. To choose the correct analgesic agent, it is essential to take a comprehensive medical history and be aware of the different forms of pain present.