Caring for a head-injured patient with terminal agitation in A&E

Nursing case review
First published in this online journal
Declaration of interests: 
Fran Gallosi
Author profile (accurate when this article was originally published): 
Fran Gallosi is Nursing Officer, P&O Cruises. At the time of writing she was working as a Staff Nurse, Emergency Department, St Mary’s Hospital, London. Email:

The predominant culture within accident and emergency (A&E) departments is to save lives. Consequently, end-of-life care (EoLC) may be given low priority in the A&E setting. As death approaches, patients may become restless, agitated or delirious. All potential causes of agitation at the end of life should be considered, assessed and treated if possible. The source of agitation can be difficult to ascertain when a patient is unconscious. Terminal agitation should always be considered a palliative care emergency. This article is based on a case scenario detailing the EoLC provided to a 70-year-old man following trauma-induced cerebral haemorrhage within an A&E department. The assessment and management of the dying process is discussed, in particular, the management of terminal agitation in a patient with severe head injury. The aim of this work is to enable A&E nurses to consider the means by which EoLC can be provided to dying trauma patients in an environment where time constraints and curative treatment models often prevent such care provision. Anonymity of the patient is maintained by the use of a pseudonym (Nursing and Midwifery Council, 2008).

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