Preplanned participation of paramedics in end-of-life care at home: A retrospective cohort study.

BACKGROUND: Paramedics commonly face acute crises of patients in palliative care, but their involvement in end-of-life care is not planned systematically. AIM: To evaluate a protocol for end-of-life care at home including pre-planned integration of paramedics and end-of-life care wards. DESIGN: Paramedic visits to patients in end-of-life care protocol were retrospectively studied. SETTING/PARTICIPANTS: All of the patients who had registered for the protocol between 1 March 2015 and 28 February 2017 in North Karelia, Finland, were included in this study. RESULTS: A total of 256 patients were registered for the protocol and 306 visits by paramedic were needed. A need for symptom control (38%) and transportation (29%) were the most common reasons for a visit. Paramedics visited 43% and 70% of the patients in areas with and without 24/7 palliative home care services, respectively (p < 0.001); while 58% of all the visits were done outside of office hours. Problems were resolved at home in 31% of the visits. The patient was transferred to a pre-planned end-of-life care ward and to an emergency department in 48% and 16% of the cases, respectively. More patients died in end-of-life care wards in areas without (54%) than with (33%) 24/7 home care services (p = 0.001). CONCLUSIONS: Integration of paramedics into end-of-life care at home is reasonable especially in rural areas without 24/7 palliative care services and outside of office hours. The majority of patients can be managed at home or with the help of an end-of-life care ward without an emergency visit.

[Cancer patient with dyspnoe--remember the possibility of pulmonary tumor microembolism]. / Keuhkojen mikroskooppinen kasvainembolia--syöpäpotilaan hengenahdistuksen alidiagnosoitu syy.

We report two patients with breast cancer who presented with a subacute course of progressive dyspnoe and shortness of breathing, culminating in respiratory failure and cardiovascular collapse from acute right heart failure. D-dimer serum levels were elevated and right ventricle strain (electrocardiogram) and pulmonary hypertension were also present. Clinical investigation and computed tomography of the chest were inconclusive. The autopsy study revealed multiple intravascular carcinomatous emboli in small arterioles of pulmonary vasculature. In the differential diagnosis of unexplained severe dyspnoe and pulmonary hypertension, malignancy should always be kept in mind.