Terminal Agitation

[bluegeegoo2]

I recently had a young resident mercifully die after the worst case of terminal agitation that I have ever seen. I gave her everything, including the kitchen sink to try to get her comfortable as often as she could have it. I got orders changed for more and different meds several times through my shift. My efforts finally paid off and she was restful for approx 2 hrs before she passed. It was awful, though, and is haunting me.

I can't divulge her dx for fear of HIPAA, but suffice it to say she literally suffocated to death. Slowly. Over days.

She was wild-eyed, gasping for air, pulling off her NC, combative and continuously repeating "I can't breathe! I can't breathe!" over and over and over. She rec'd massive amounts of Haldol, mso4, a benzo (not Ativan. It seemed to cause more agitation), and a couple other drugs and nothing seemed to relieve her anxiety and air hunger until the very end.

What bothers me the most is the kind of death she had, not the fact that she passed. The hospice nurses were very good with new orders and everyone made a valiant effort to ease her suffering, but it was just so bad. To witness someone suffering so greatly like that is emotionally scarring to me. I feel like I failed her even though I know I did everything that I could to help.

I don't know what I'm looking for here, other than to just put it out there and get it off my chest to other nurses who know what it's like. I just hope I never have to attend another dying process like that, but I'm almost certain to. I hope I'll be ready for it when it comes.

[Red Kryptonite]

I agree that patient probably was a good candidate for palliative sedation. I haven't seen it used often, and it shouldn't be, but it can be a blessing when nothing else works.

[canter1221]

once had a youngish (50's) lady dying--badly-- breast CA; had perforated bowel & refused intervention other than pain med...took 5 days to die... terrible...despite utmost attention to trying to medicate pain away...was on huge amounts continual morphine iv, myoclonus started increasing, continual Ativan iv infusion started for those (started at 1mg/hr...went up to 8 mg/hr by day 3)...the doc consulted with national level palliative care specialists for more input... then put her on alternating morphine/dilaudid drips to cut metabolites which did stop the myoclonus from getting worse (but they didn't leave).... everything kept being titrated UP for symptom management (120 mg/hr dilaudid with 120mg bolus q 15 min prn)...

(a day later, finally they put her on a versed drip--this was several years before I saw any articles on terminal sedation--only after ethics committee emergency meeting etc---which was the only thing that gave her a little peace before she died....& her family as well, since they had been with her 24/7 in the hospital for the duration....)

I haven't worked in palliative care of the acute sort since shortly after then (not because of this situation) .... none of the LTC patients dying have every approached this level of suffering.... but I really feel for you, because it takes a whole different level of skill, compassion, etc to start to cope with that extreme agitation or suffering that isn't soothed by interventions available....