Clinical Pearls

"The Last Impression": Secretions, the Death Rattle, and Anticholinergics

Kevin Craig, MD MSPH HMDC FAAFP FAAHPM

As our team approached the patient’s room on rounds, I could hear the patient gurgling from the door. Having been extubated to comfort care, our team was consulted to assist with medical management due to the patient having respiratory distress and excess secretions. Intravenous glycopyrrolate had been administered several times with no improvement. Our attending physician stated, “Giving glycopyrrolate to someone with fluid overload is like spitting in the ocean.” We recommended intravenous furosemide, and after a few doses, the patient’s secretions resolved. The family and clinicians caring for him in the unit expressed gratitude and relief that the patient no longer appeared to be suffering.