Been a Hospice nurse for a while. Had a patient die last week. She had vocalizations at end of each respiration, which were originally responsive to increased O2 and oral morphine. The vocalizations came back the next day, they were not responsive to lorazepam and morphine (patient was on huge doses of fentanyl and MSO4 anyway for rectal Ca with a stent in bowel.
Next day we tried ABHR suppository. No good there either.
Third day went out with oral phenobarbital- we are on the frontier, literally here- no other formulation available and she died right after I gave it to her.
Do any of you have guidelines to help know when to jump to barbiturates? I am so sad for this little gal and her family.