End-of-life dyspnea

76-year-old man from HOME, lives with spouse and receives palliative care for metastatic lung cancer, reports worsening dyspnea and anxiety. Wishes to remain home if symptoms controlled. Goals-of-care plan reviewed.

Primary survey shows increased work of breathing with patent airway. Patient found upright in hospital bed, alert and communicating. Serial vitals, oxygen baseline, lung findings, pain and distress documented. No unexpected trauma or bleeding.

Differential considerations: 1) expected progression of terminal lung disease, 2) pleural effusion or infection, 3) pulmonary embolic or cardiac event. Symptom crisis in context of documented goals.

Comfort-focused care and prescribed symptom medications provided within guideline and plan. Response and preferences reassessed. Hospice/clinical consultation completed; agreed disposition, safety net and non-conveyance or transfer documented.