Breathless, and done with hospitals

A 69-year-old with advanced lung cancer is admitted, again, gasping, and asks you to make it stop.

69-year-old manWard 2, side roomFictitious educational patient

Metastatic non-small-cell lung cancer, on best supportive carePrior right-sided effusion, pleurodesedCOPD, moderate

Day 0 · 19:40

The evening call

Admitted this afternoon with worsening breathlessness. Oncology has documented that disease-directed options are exhausted. The evening nurse calls: he is sitting bolt upright, breathing 28, terrified. His wife is at the bedside. The chart shows this is his third admission in two months for the same thing.

Vitals

HR104BP128/76RR28SpO291% (2 L NP)T36.9

Examination

Chest: Reduced breath sounds right base (known, pleurodesed); scattered wheeze; no new focal signs.
General: Cachectic, anxious, speaking in short phrases; accessory muscle use.

Reversible contributors are assessed and treated (bronchodilators given, no new effusion on the bedside scan, no pneumonia on the film). His breathlessness remains severe. What is the correct next treatment?

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