A 72-year-old female with metastatic breast cancer presents to the Emergency Department with worsening breathlessness over the past 48 hours. She has been receiving palliative care, and morphine 10mg QDS has been ineffective in managing her dyspnoea.
Past Medical History:
- Breast cancer with lung and bone metastases diagnosed 2 years ago
Medications:
- Morphine 10mg QDS
Vital signs:
- Respiratory rate: 28/min
- Oxygen saturation: 96% on room air
- Heart rate: 102/min
- Blood pressure: 138/82 mmHg
- Temperature: 37.1°C
What is the most appropriate next step in management?
A
Start glycopyrronium 200 mcg SC TDS
B
Add lorazepam 1mg PO PRN
C
Increase oxygen flow rate to 15L/min via non-rebreather mask
D
Add dexamethasone 8mg IV
E
Start nebulized salbutamol 5mg stat