Question

A 72 year old man with metastatic colorectal cancer develops noisy respiratory secretions (the so called death rattle) in the last hours of life. He is unconscious and appears comfortable but family members are distressed by the sound. According to palliative care guidance, what is the most appropriate management?

Accepted Answer

Reposition the patient and consider an antimuscarinic such as subcutaneous Glycopyrronium

Answer

Perform deep suctioning of the airway repeatedly

Answer

Increase intravenous fluids to thin secretions

Answer

Intubate and ventilate to control secretions

Answer

Give high dose opioids to abolish the noise

Practice question