acute terminal events in palliative care

Last reviewed 01/2018

Seek expert advice when planning for the management of acute terminal events.

Distressing acute terminal events such as massive haemorrhage or airway obstruction are rare. They can often be anticipated and the patient, the carers and the professional can plan ahead to minimise distress.

The main ams of drug treatment are to:

  • reduce pain
  • reduce fear
  • reduce the level of awareness of the patient

The event is frightening and distressing for everyone (patients, carers and professionals). Since most such events cause death within minutes the most important aspect of care is for someone to stay with the patient.

The principles of management of most distressing acute terminal events are similar irrespective of the type of event or the cause.

Drugs used in the management of acute terminal events

Benzodiazepine Opioid

diazepam 10-20mg PR


diazemuls 5-20mg IV


midazolam 5-10mg IM/IV

diamorphine - use double the current equivalent 4 hourly opioid dose or 10mg IM/IV if opioid naive

If the patient is already receiving benzodiazepines, e.g. midazolam sc infucion, a bigger dose may be required.

Drugs should be administered IV or IM to speed absorption.

When there is a strong possibility of an acute, distressing terminal event (e.g. tumour fungating over a major blood vessel), it is useful to ensure that the necessary dugs are readily available. A specific 'emergency box' within the home is a helpful way of planning this.


  1. West Midlands Palliative Care Physicians (2003). Palliative care - guidelines for the use of drugs in symptom control.