The patient will commonly be started on a small dose of sedative (such as a benzodiazepine like midazolam or lorazepam). They may also be given an anti-psychotic (such as haloperidol). Medicines are usually given as injections or through a syringe pump (also known as a syringe driver).
Sometimes, morphine is also given to ease the feeling of shortness of breath. Successfully reducing pain and addressing concerns about breathing can provide needed comfort to someone who is close to dying. Side effects may include confusion, drowsiness, or hallucinations.
Recent guidelines concerning terminal care recommend the use of opioids, hypnotics and antipsychotics to control pain, dyspnoea, agitation, anxiety and delirium10 in the dying phase.
Antimuscarinic medications, such as hyoscine butylbromide, hyoscine hydrobromide and glycopyrronium may be prescribed. These work by reducing saliva production so they can dry out the secretions.
RELAXATION / SEDATION
If agitation is likely to recur; consider adding Midazolam to CSCI. PRN doses: Midazolam is 2.5mg - 5mg 1 - 2 hourly. Larger doses e.g. 5mg - 10mg Midazolam may be needed if patient already on more than 20mg/24hours in syringe driver.
Roxanol (Morphine Sulfate).
Morphine is among the most common hospice medications used to treat pain, with morphine the preferred drug for cancer-related pain. Morphine also is the most commonly used drug for shortness of breath.
Background. Nausea and vomiting are common symptoms in patients with terminal, incurable illnesses. Both nausea and vomiting can be distressing. Haloperidol is commonly prescribed to relieve these symptoms.
Terminal respiratory secretions, commonly known as a “death rattle,” occur when mucous and saliva build up in the patient's throat. As the patient becomes weaker and/or loses consciousness, they can lose the ability to clear their throat or swallow.
Re-positioning the patient in bed may be very helpful, for example 'high side lying' where the patient is positioned more upright with their head tilted to one side to aid drainage of secretions. A fan may also be beneficial.
Noisy Breathing (Terminal Secretions, Terminal Congestion)
The “wet” or “gurgling” sounds are caused by air passing over pooled oral and respiratory secretions the patient is no longer able to swallow or cough up – the patient may still be fully or partially conscious or unconscious.
Terminal agitation is typically seen during the hours or days before death and can be distressing and overwhelming for caregivers.
Haloperidol is used in palliative care symptomatic treatment to ensure quality of life.
Haloperidol (hal-oh-PER-uh-dol) helps reduce agitation and nausea. Known by the brand name Haldol, it also treats certain psychiatric conditions and hyperactivity in children. It should not be given to patients with seizure disorders, because it can increase the frequency or severity of seizures.
Your loved one may sleep more and might be more difficult to awaken. Hearing and vision may decrease. There may be a gradual decrease in the need for food and drink. Your loved one will say he or she doesn't have an appetite or isn't hungry.
When this happens, people lose their appetite and may stop eating and drinking altogether. This can be upsetting because it is our natural instinct to provide food and drink as a way of nurturing those we care for. However, as the body weakens there is less and less need for fluids.
Clinically assisted hydration includes intravenous (into a vein) or subcutaneous (under the skin) infusion of fluids or administration of fluid through a tube into the stomach. What are the benefits and risks of clinically assisted hydration for a patient at the end of their life?
The My Care, My Choices Strategy emphasises three key clinical processes that underpin quality end-of-life care service provision which include: • advance care planning, • comprehensive care, and • terminal phase care management.
suggest ice chips if the patient has difficulty swallowing. help them use saliva replacements or oral gel to keep the mouth moist. gently remove coatings and debris from the lips, tongue and lining of the mouth using a soft toothbrush.
Dry mouth constitutes a significant problem for most patients with grave illnesses and a need for palliative treatment. The main causes are pharmaceuticals, diseases and cancer treatment, which are often associated with increasing age.
During a convulsion, one can not swallow one own saliva due to impaired consciousness. Also, there is heavy breathing, which leads to the formation of froth (bubbles of saliva) at the mouth. Foaming or frothing at the mouth occurs when excess saliva pools in the mouth or lungs and is mixed with air, creating foam.
Dying patients unable to take oral medication
†Midazolam 20mg to 30mg via continuous subcutaneous infusion (CSCI) over 24 hours can be used as maintenance therapy.
The selected case study aimed to evaluate the role of phenobarbital as a drug of choice in end-of-life (EOL) settings. Phenobarbital is efficacious in management of EOL seizures and agitation, can be easily administered via different modes, and utilized in various palliative care (PC) settings.
Palliative sedation is used when traditional opioid-based therapies are either inadequate to control suffering or cause unacceptable adverse effects. Often, PS is used to treat delirium, pain, dyspnea, nausea, or other physical symptoms.