Consider having a portable suction machine in the house and show the family how to use it.
Ensure the patient is comfortable, which is usually in the sitting position leaning forward with the head and neck well supported. Use green towels to mask the amount of blood lost.
Ensure all those involved with such a traumatic death have chance to talk about the events and their feelings.
A clear explanation to the family (and the patient) about the cause of the secretions may helps to minimise the impact of the noise on the family.
The secretions can often be managed by adjusting the patient’s position in bed.
Occasionally the use of gentle suction may help, but this will stimulate more secretions to form and so has to be an ongoing process.
Hyoscine butylbromide (Buscopan) will dry up the production of secretions although it will not get rid of secretions already formed. Give a stat, subcutaneous dose of 20mg, which can be repeated after 15minutes if no effect. A subcutaneous infusion via a syringe driver will need to be set up within the next four hours to ensure control is maintained. Use 60 -100mg of hyoscine butylbromide over 24hours.
Hyoscine hydrobromide (hyoscine) may be used in a similar way to hyoscine butylbromide, but it is more sedating and can occasionally cause paradoxical agitation so should be used as a second line agent.
Care needs to be taken that both the doctor and the nursing staff are aware of which formulation of hyoscine they are using and why. It is easy to draw up the wrong formulations of hyoscine as the vials are similar.
