ABEM HPM case studies
ABEM HPM · Put your knowledge to work in context.
ABEM Hospice and Palliative Medicine (HPM) refers to the subspecialty certification pathway that the American Board of Emergency Medicine lists within the 'Subspecialties' area of its website. Emergency physicians pursue it to document advanced competence in caring for people living with serious, progressive illness - in the emergency department, on inpatient palliative consult services, in hospice settings, and across care transitions. The ABEM HPM case studies are 5 cases and about 3,590 words.
1Advanced Heart Failure, an ICD, and the Question 'How Long?'
L is 79 and lives alone in a second-floor walk-up. He has NYHA class III–IV heart failure with an ejection fraction of 20%, stage 4 chronic kidney disease (eGFR 24), and an implanted cardioverter-defibrillator placed five years ago.
778 words, about 4 min2Myoclonus on Morphine in Advanced Pancreatic Cancer with Renal Impairment
A 58-year-old woman with metastatic pancreatic cancer and peritoneal carcinomatosis reports pain 8/10. She takes morphine extended-release 60 mg PO every 12 hours plus immediate-release morphine 15 mg every 4 hours as needed, and has used four breakthrough doses daily for the past week.
663 words, about 3 min3Recurrent Malignant Bowel Obstruction: Surgery, Venting Gastrostomy, or Comfort Care?
A 67-year-old woman with recurrent ovarian cancer, peritoneal carcinomatosis, and a second malignant bowel obstruction in six weeks has nausea, vomiting, colicky abdominal pain, and no flatus for three days. CT shows multiple transition points, ascites, and tumor encasing the mesentery; there is no single surgical target.
709 words, about 4 min4A Feeding Tube Request in Advanced Dementia and a Divided Family
An 86-year-old woman with advanced Alzheimer disease lives in a nursing home. She is mute, bedbound, and requires total care.
749 words, about 4 min5Terminal Agitation in an Imminently Dying Patient with Renal Failure
A 54-year-old man with metastatic lung cancer is admitted to an inpatient hospice unit with a prognosis of days to hours. He is restless, picking at the bedclothes, moaning, and has diffuse myoclonus.
691 words, about 3 min