Match the following common end-of-life clinical scenarios or symptoms with their most appropriate initial palliative intervention.
- Refractory dyspnea in a patient with end-stage chronic obstructive pulmonary diseaseLow-dose oral or intravenous morphine
- Excessive, audible terminal respiratory secretions ('death rattle') in a comatose patientSublingual atropine or subcutaneous glycopyrrolate
- Severe, hyperactive terminal delirium with distressing agitationIntravenous or subcutaneous haloperidol
- Focal, severe, well-localized pain from a known vertebral metastasisPalliative radiation therapy
Cevap
Dyspnea matches with low-dose morphine; terminal secretions match with atropine/glycopyrrolate; terminal delirium matches with haloperidol; and focal bone pain matches with palliative radiation therapy.
Each symptom in end-of-life care has a specific targeted therapy. Dyspnea is treated centrally with opioids to reduce air hunger. Secretions are managed by drying agents (anticholinergics). Hyperactive delirium is treated with antipsychotics. Localized bone pain is effectively targeted with localized palliative radiation.
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Anahtar Kavram
First-line pharmacologic and procedural interventions for common end-of-life symptoms.
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