Acta medica Croatica : c̆asopis Hravatske akademije medicinskih znanosti
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Review
[Palliative medicine--linkage of expert human care for the terminally ill and medical ethics].
Palliative medicine is a new branch of medicine dealing with optimal quality of life and death, and is primarily a medical area of interest. Palliative care is a care provided by interdisciplinary palliative team. Let us remember that palliative care is a specific form of medical care for patients in the terminal phase of life. ⋯ The decisions made in palliative medicine require moral, legal and medical judgments. At the same time, one must strike a balance between clinical aspects of care and the patient's autonomy regarding his wishes, beliefs, and finally decisions about his own medical treatment. Ethical aspects of decision-making cannot be separated from clinical circumstances in the individual case, in the same way as medical decision-making cannot neglect the four (bio)ethical principles: beneficence, non-maleficence, autonomy of the person, and justice.
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Ondine's curse syndrome primarily refers to cases with congenital central alveolar hypoventilation, but the term can also be used for acquired cases and implies central sleep apnea that occurs as a manifestation or complication of focal lesion in the area of the dorsolateral segment of medulla oblongata. It occurs rarely, but can lead to fatal outcome. Based on our own case report, the aim of this article is to review its clinical symptoms, and appropriate diagnostic and therapeutic procedures. ⋯ The treatment of central hypoventilation consists of ventilatory support, but there were also attempts of medicamentous treatment with the common aim of raising alertness and reactibility of the automatic breathing center. It is important to emphasize that patients with the risk of central sleep apnea should not be supplied with oxygen without arterial blood gas monitoring because of the possibility of delaying the right diagnosis. The use of oxygen in patients who already have hypercapnia due to hypoventilation could further intensify hyporeactivity of the breathing center and lead to respiratory arrest.