Death Rattle Management — RACP Adult Medicine MCQ

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ModerateRespiratoryDeath Rattle ManagementRACP Adult Medicine

A 60-year-old man with end-stage COPD is dying. He has distressing respiratory secretions (death rattle) that are audible and causing family distress. He is unconscious and not distressed by the secretions. What is the most appropriate pharmacological management?

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Correct answer: E — Hyoscine hydrobromide SC 400 μg q4h

Audible respiratory secretions in the dying patient (death rattle) are managed with anticholinergic agents (hyoscine hydrobromide or glycopyrronium) to reduce new secretion production. Suctioning is generally avoided (distressing, ineffective at deep secretions, and may stimulate more secretion). Repositioning (semi-prone) may help. Family reassurance is important — the patient is typically unconscious and not distressed.

Reference: PCA – 2024 – Terminal Phase Care; eTG Palliative Care 2024