Let’s be honest — no one leaves med school truly prepared for end-of-life care. The first time I managed a palliative patient from Nok Kundi, I fumbled through the syringe driver settings like it was a bomb defusal attempt. Thankfully, Dr. Basit Khan walked in just in time and handed me a simple mnemonic that stuck ever since:
End-of-Life Symptoms Mnemonic: “P.A.N.D.A”
| Letter | Symptom | Management Tips |
|---|---|---|
| P | Pain | 💉 Diamorphine 2.5 mg SC hourly PRN; titrate as needed. |
| A | Agitation | 🧠 Midazolam 2.5 mg SC hourly PRN — especially in terminal restlessness. |
| N | Nausea/Vomiting | 🤢 Haloperidol 0.5–2 mg QDS PRN, Cyclizine, or Levomepromazine 3.125–6.25 mg SC. |
| D | Dyspnoea | 😮💨 Low-dose morphine regularly; steroids or diazepam for associated anxiety. |
| A | Airway Secretions | 💦 Hyoscine butylbromide 20 mg SC TDS PRN — for the “death rattle” (and family anxiety). |
💡 Clinical Experience From Quetta
I once had a 70-year-old patient from Mashkel, end-stage lung cancer, non-verbal but clearly in distress. His son kept asking if he was “in pain or just breathing like that.”
Pain? Midazolam helped.
Secretions? Hyoscine kicked in.
Ten minutes later — calm, dignified, human.
You don’t need heroics at the end of life. You need the right meds, in the right doses, at the right time.
Happy learning! 🙂
Dr. Aurangzaib Qambrani
MBBS, PLAB, MRCP-UK
General Medicine | Gastroenterology | CCU
Sheikh Khalifa Bin Zayed Hospital, Quetta
