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Dexamethasone (p69) can be useful for assuaging breathlessness in some circumstances Refractory/extreme breathlessness Refractory/extreme breathlessness in the dying affected person is distressing and frightening for sufferers and their households After discussion with the affected person and family, a syringe driver with opioid +/anxiolytic could also be wanted* the purpose is to realize the required stability between sedative side effects and the management of breathlessness and nervousness; according to affected person's wishes * For specialist use or after specialist advice only 27 Return to contents page Decisions about air flow When a patient could also be vulnerable to respiratory failure, the risks/advantages of mechanical ventilation (invasive or non-invasive) ought to be thought of and, the place applicable, discussed with the affected person so as to keep away from disaster selections about air flow It could also be helpful at this stage to debate stopping rules Careful documentation of the decision is critical For sufferers with progressive neuromuscular situations, early dialogue with the respiratory staff/specialist palliative care is advised* Sudden main airway obstruction within the palliative care setting this can be a palliative care emergency [url=] hiv infection medications buy valacyclovir 500 mg on line[/url]. 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