Dealing with Specific Situations
| Superior Vena Cava Syndrome | Radiation therapy is definitive treatment for patients with life expectancy greater than four weeks; otherwise, palliative treatment with morphine and steroids is more appropriate. | |
| Lymphangitic Spread | Characterized by cough and dyspnea. Treatment consists of controlling cough and giving morphine and steroids for treatment of dyspnea. | |
| TE Fistula | Usually poor surgical candidate due to advanced stages of cancer. Endoprostheses (stent) placement may allow for palliation and occlusion of TE fistula, permitting oral intake. | |
| ALS | BiPAP and full time ventilator support required. When co-morbid medical complications develop, or patient determined quality of life deteriorates, ventilator support can be withdrawn and symptom control provided to allow for a comfortable death. | |
| Hemoptysis | Treatment of cough may resolve precipitating factor of hemoptysis. Massive hemoptysis requires urgent and aggressive comfort measures, including:
|
|
| Pleural and Pericardial Effusions | Whenever appropriate, symptom relief with thoracentesis or pericardiocentesis should be attempted. | |
| Dyspnea with normal oxygen saturation | Patients can experience dyspnea even with normal oxygen saturation (SaO2).
|
|
| Respiratory Infections | Respiratory infections can be diagnosed clinically and managed empirically with antibiotics with the intention of augmenting comfort in terminally ill patients. Imaging may not be a feasible option in terminally ill patients who may be too frail to endure the hospital and clinic visits required for these procedures. | |
| Terminal secretions / Death rattle | Antibiotics are neither indicated nor helpful terminal secretions or death rattle. |
While oxygen supplementation is most beneficial for patients with decreased oxygen saturation (SaO2), many terminally ill dyspneic patients may benefit by the use of air concentrators (
