Dyspnea
Dyspnea may be an issue especially for someone who is actively dying in the ED. Searching for an underlying cause is what Emerg physicians are good at; however it will be important to determine frankly if sedation and comfort measures are the principal measures desired.
Important Note
There is no evidence for benefit of NEBULIZED opioids, benzodiazepines, or lidocaine for dyspnea alone.
- Oxygen may be helpful IF the patient is hypoxic – otherwise O2 mask may just cause distress; nasal prongs may be better tolerated
- Oxygen may be given for patient comfort alone and can be seen as a “symbol of support and care” – however the emphasis should be on NOT titrating to O2 saturation level and avoiding continuous O2 monitoring in this circumstance
- Benzodiazepines (IV/PO lorazepam, midazolam) may be helpful to descrease anxiety
- Opioids:
- Opioid-naïve (unlikely): Morphine 1 – 2.5 mg po q6h and 1 mg po q2h prn for breakthrough dyspnea or 0.5-1 mg subcut q6h regularly and 0.5 mg subcut q1h prn for breakthrough dyspnea. Start with small doses and titrate slowly.
- Opioid-tolerant: Increase the patient’s regular dose by 25%
- Furosemide may be considered in patients with end-stage heart failure causing pulmonary edema, however evidence is limited
Also consider your non-pharmacological measures if appropriate. Examples include: using a fan; sitting the patient in an upright position; avoiding exacerbating activities; teaching breathing control or relaxation techniques.
Discussion: Dyspnea
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k
mos4 helps with resp drive
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monitor medication and respiratory depression
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adietrich
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I agree with the use of O2 NP, many patients find the mask too distressing
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good info.
Good information
Dyspnea is shortness of breath
non-pharmaceuticals are important to consider
very helpful
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thank you for the info
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good point
non pharmacological measures also available
k
good
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oxygen helps
It was many years ago but I remember nebulized morphine being ordered for SOB. The rationale being that the oral route would give more direct relief and not be as systemically sedating?
2L/min oxygen via nasal prongs
thanks
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Interesting that nebulization is not supported. Also, O2 therapy whether it helps the patient or not often eases the minds of the family, in that they feel that something is being done.
Palliative really knows the tricks of comfort care
Sometimes clients decline narcotics for SOB, in which case I would try O2
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o2 is not necessary
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o2 its not necessary
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Not sure if O2 is necessary. Opioids should be given as needed!
xxxxxx
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oxygen
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A fan can also be helpful.
I find O2 is helping.
I agree with the use of O2 NP, many patients find the mask too distressing
even though there may be no evidence often the dying get very anxious increasing dyspnea symptoms I have found ativan helpful for the dying and the family not to watch there family member die in distress
it seems 02 can act as a comfort measure not just for the patient but for the families. Even at end of life you still seem to be doing something even though there is little benefit.