‘How people die lives on in the memory of those left behind’ (Dame Cecily Saunders). No matter how well pain and other symptoms are controlled, agitation and restlessness occur as a pre-terminal event in the final hours or days of life in about 10% of patients. Respiratory tract secretions can also accumulate in the final hours or days of life. This is more likely to happen with lung pathology, whether primary or secondary and those who have cardiac problems. Such secretions cause distress to the relatives and occasionally to the patient and may need to be actively managed.
Exclude treatable causes for agitation:
Urinary retention – palpable bladder?
Faecal impaction – loaded rectum?
Increased or under treated pain – has the patient had their usual analgesics? Is the syringe driver working?
Opioid toxicity – is there evidence of myoclonus, twitching, cognitive impairment including hallucinations?
Correct any treatable causes where possible and where the intervention is acceptable to the patient and family.
If opioid toxic, reduce the opioid dose by 50% and review the effect. Consider the use of haloperidol as outlined below.
Dostları ilə paylaş: | 
