Sunday, December 19, 2004

Dyspnea at End-of-Life

Dyspnea :

"Assessment Dyspnea at end-of-life may be present during the Syndrome of Imminent Death . . . or occur earlier in the disease trajectory. Looking for simple problems is always warranted: is the Oxygen turned on?, is the tubing kinked?, is there fluid overload from IV fluids or TPN?, is dyspnea part of an acute anxiety episode, severe pain, constipation or urinary retention?; is there a new pneumothorax or worsening pleural effusion?. Understanding 1) where patients are at in the dying trajectory and 2) their identified goals of care, is essential to guide the extent of workup seeking reversible causes. If the patient is clearly dying, and the goals of care are comfort, then pulse oximetry, blood gas, EKG, CXR, etc. are not indicated. "