Terminal respiratory secretions (or simply terminal secretions), known colloquially as a death rattle, are sounds often produced by someone who is near death as a result of fluids such as saliva and bronchial secretions accumulating in the throat and upper chest. Those who are dying may lose their ability to swallow and may have increased production of bronchial secretions, resulting in such an accumulation. Usually, two or three days earlier the symptoms of approaching death can be observed as saliva accumulates in the throat, making it very difficult to take even a spoonful of water. Related symptoms can include shortness of breath and rapid chest movement. While death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex, such as brain injuries.
It is sometimes misinterpreted as the sound of the person choking to death, or alternatively, that they are gargling. In hospice and palliative care, drugs such as glycopyrronium, hyoscine hydrobromide (scopolamine) or atropine may be used for their anticholinergic effects to reduce secretions and minimize this effect.
- Clinical Working Party (December 2010). "Guidelines for the management of respiratory secretions in an imminently dying patient" (PDF). Eastern Metropolitan Region Palliative Care Consortium (Victoria). Retrieved 13 April 2014.,
- Cobbs, Elizabeth L; et al. "When Death Is Near". MSD Manuals. MSD Manuals (Consumer Version). Retrieved 14 March 2016.
- Katherine Bickel; Robert Arnold MD. "# 109 Death Rattle and Oral Secretions, 2nd ed". Fast Facts. End-of-Life/Palliative Education Resource Center. Retrieved 13 April 2014.
- Wee, B.; Hillier, R. (2008). Wee, B., ed. "Interventions for noisy breathing in patients near to death". Cochrane Database of Systematic Reviews (1): CD005177. doi:10.1002/14651858.CD005177.pub2. PMID 18254072.
- Hipp, B.; Letizia, M. (2009). "Understanding and responding to the death rattle in dying patients". Medsurg Nursing. 18 (1): 17–21, 32; quiz 22. PMID 19331295.
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- East Tennessee State University - pulmonary breath sounds page with a death rattle sound clip