Last Days and Hours of Life

Abstract

Most dying patients take a peaceful road to death, progressing from sleepiness to lethargy to coma to death, without substantial agitation. Although many dying patients experience fever, hypotension, and tachycardia, no combination of physical signs accurately predicts death. Noisy respiratory secretions should be prevented and treated by discontinuing artificial hydration and nutrition and by prescribing anticholinergic drugs such as glycopyrrolate or a scopolamine patch. Delirium at the end of life is not generally evaluated with blood tests or imaging but is treated with nonpharmacological measures or with haloperidol. Teach the family what to expect as death approaches. Be prepared with a systematic approach to declaring death and comforting families in the early stages of grief and bereavement.