Dealing with Specific Situations |
Superior Vena Cava Syndrome |
Radiation therapy is definitive treatment for patients with
life expectancy greater than four weeks; otherwise, palliative treatment
with morphine and steroids is more appropriate. |
Lymphangitic Spread |
Characterized by cough and dyspnea. Treatment consists of controlling
cough and giving morphine and steroids for treatment of dyspnea. |
TE Fistula |
Usually poor surgical candidate due to advanced stages of cancer. Endoprostheses
(stent) placement may allow for palliation and occlusion of TE fistula,
permitting oral intake. |
ALS |
BiPAP and full time ventilator support required. When co-morbid medical
complications develop, or patient determined quality of life deteriorates,
ventilator support can be withdrawn and symptom control provided to allow
for a comfortable death. |
Hemoptysis |
Treatment of cough may resolve precipitating factor of hemoptysis.
Massive hemoptysis requires urgent and aggressive comfort measures, including:
- parenteral opioids,
- benzodiazepines such as midazolam or lorazepam for sedation, and
- covering all signs of blood with dark towels to decrease the patient’s
and family’s fear and anxiety.
|
Pleural and Pericardial Effusions |
Whenever appropriate, symptom relief with thoracentesis or pericardiocentesis
should be attempted. |
Dyspnea with normal oxygen saturation |
Patients can experience dyspnea even with normal oxygen saturation
(SaO2).
|
While oxygen supplementation is most beneficial for
patients with decreased oxygen saturation (SaO2), many
terminally ill dyspneic patients may benefit by the use of air concentrators
(Medicare
oxygen rules have specific requirements for prescription oxygen
supplementation. However the Medicare Hospice Benefit will pay for
a room air concentrator for all terminally ill patients). |
|
Respiratory Infections |
Respiratory infections can be diagnosed clinically and managed empirically
with antibiotics with the intention of augmenting comfort in terminally
ill patients. Imaging may not be a feasible option in terminally ill patients
who may be too frail to endure the hospital and clinic visits required for
these procedures. |
Terminal secretions / Death rattle |
Antibiotics are neither indicated nor helpful terminal secretions or death
rattle. |
