- Dyspnea is a very common symptom in patients with advance illness.
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- There is poor correlation between oxygen saturation and the perception
of dyspnea.
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- Identify reversible causes and treat as appropriate.
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- Interventions should be kept in line with goals of care with dyspnea
relief as one of the therapeutic goals. Benefits and burdens must be
carefully considered.
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- Non-pharmacologic approaches are often useful, readily applicable,
and inexpensive.
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- Morphine is the mainstay of treatment for dyspnea in terminally ill
patients.
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- Opioid titration requires repeated assessments to achieve maximal
benefits and to avoid side effects.
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- The best indicator of moderate opioid toxicity is bradycardia.
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- Respiratory depression rarely occurs when opioids are titrated upward
in a step-wise fashion.
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- Document justification for any dosage increase of opioids.
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- Any change in intensity or quality of dyspnea merits a review of
therapy and possible adjustment of opioids.
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