A death rattle, known clinically as terminal respiratory secretions or simply terminal secretions, is a sound often produced by someone who is near death when fluids such as saliva and bronchial secretions accumulate 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 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.
- 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