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Identifying the actively dying patient

Identifying the actively dying patient
Profound progressive weakness
Bed-bound state
Sleeping much of the time
Indifference to food and fluids
Difficulty swallowing
Disorientation to time, with increasingly short attention span
Low or lower blood pressure not related to hypovolemia
Urinary incontinence or retention caused by weakness
Loss of ability to close eyes
Hallucinations involving previously deceased important individuals
References to going home or similar themes
Changes in respiratory rate and pattern (Cheyne-Stokes breathing, apneas)
Noisy breathing, pooling of airway secretions
Mottling and cooling of the skin due to vasomotor instability with venous pooling, particularly tibial
Dropping blood pressure with rising, weak pulse
Mental status changes (delirium, restlessness, agitation, coma)
Reproduced from: Bicanovsky L. Comfort Care: Symptom Control in the Dying. In: Palliative Medicine, Walsh D, Caraceni AT, Fainsinger R, et al (Eds), Saunders, Philadelphia 2009. Table used with the permission of Elsevier Inc. All rights reserved.
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