Emergency management of dyspnea in dying patients

Many terminally ill patients seek care in the emergency department. Understanding how to elicit goals of care from dying patients and initiate basic palliative measures is well within the scope of emergency medicine. While a wide variety of factors drive patients at the end of life into the acute-care setting, dyspnea is one of the most distressing symptoms experienced by dying patients, and it is a common reason for such patients to seek care. Many underlying disease states and acute illnesses account for shortness of breath at the end of life, and management tends to be symptomatic rather than diagnostic, particularly in those for whom comfort is the most important goal. Opioids are the most effective and widely studied agents available for palliation of dyspnea in this population, while adjuvant therapies such as oxygen, noninvasive positive pressure ventilation, and fans may also play a role. Other medications (eg, benzodiazepines and low-dose ketamine) may also be useful in select patients. The early involvement of palliative medicine specialists and/or hospice services for dying patients can facilitate optimal symptom management and transitions of care.