Dr. Vertelney is an emergency medicine resident at the University of California, San Francisco.

Dr. Garcia is a hospice and palliative medicine fellow at Dell Seton Medical Center at The University of Texas at Austin.

Dr. Isaacs is an emergency physician at Zuckerberg San Francisco General Hospital; clinical professor of emergency medicine at the University of California, San Francisco; and immediate past Chair of the ACEP Palliative Medicine Section.

References

1. Shreves A, Marcolini E. End of life/palliative care/ethics. Emerg Med Clin North Am. 2014; 32(4):955-974.
2. Green E, Ward S, Brierley W, et al. “They shouldn’t be coming to the ED, should they?”: a descriptive service evaluation of why patients with palliative care needs present to the emergency department. Am J Hosp Palliat Care. 2017;34(10):984-990. 
3. Barbera L, Taylor C, Dudgeon D. Why do patients with cancer visit the emergency department near the end of life? CMAJ. 2010;182(6):563-568.
4. Vandyk AD, Harrison MB, Macartney G, et al. Emergency department visits for symptoms experienced by oncology patients: a systematic review. Support Care Cancer. 2012;20(8):1589-1599. 
5. Lin KJ, Ching A, Edmonds KP, et al. Variable patterns of continuous morphine infusions at end of life. J Palliat Med. 2015;18(9):786-789.
6. Fohr SA. The double effect of pain medication: separating myth from reality. J Palliat Med. 1998;1(4):315-328.
7. Wang DH. Beyond code status: palliative care begins in the emergency department. Ann Emerg Med. 2017;69(4):437-443.
8. Clemens KE, Klaschik E. Symptomatic therapy of dyspnea with strong opioids and its effect on ventilation in palliative care patients. J Pain Symptom Manage. 2007;33(4):473-481.
9. Sykes N, Thorns A. The use of opioids and sedatives at the end of life. Lancet Oncol. 2003;4(5):312-318.
10. Stephenson J, Davies A. An assessment of aetiology-based guidelines for the management of nausea and vomiting in patients with advanced cancer. Support Care Cancer. 2006;14(4):348-353.
11. Davis MP, Hallerberg G, Palliative Medicine Study Group of the Multinational Association of Supportive Care in Cancer. A systematic review of the treatment of nausea and/or vomiting in cancer unrelated to chemotherapy or radiation. J Pain Symptom Manage. 2010;39(4):756-767.