Pearls

Pearls Road Sign
  • Dyspnea is a very common symptom in patients with advance illness.
  • There is poor correlation between oxygen saturation and the perception of dyspnea.
  • Identify reversible causes and treat as appropriate.
  • Interventions should be kept in line with goals of care with dyspnea relief as one of the therapeutic goals. Benefits and burdens must be carefully considered.
  • Non-pharmacologic approaches are often useful, readily applicable, and inexpensive.
  • Morphine is the mainstay of treatment for dyspnea in terminally ill patients.
  • Opioid titration requires repeated assessments to achieve maximal benefits and to avoid side effects.
  • The best indicator of moderate opioid toxicity is bradycardia.
  • Respiratory depression rarely occurs when opioids are titrated upward in a step-wise fashion.
  • Document justification for any dosage increase of opioids.
  • Any change in intensity or quality of dyspnea merits a review of therapy and possible adjustment of opioids.

 

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