10th January 2024

A 50-year-old patient with metastatic melanoma presents to the hospital with pleuritic right-sided chest pain

A 50-year-old patient with metastatic melanoma presents to the hospital with pleuritic right-sided chest pain. She reports a significant recent cough. She is bed-bound but now cannot sit comfortably due to chest pain. Examination reveals breathlessness and reduced air entry at the right-hand side. She is alert and awake.

She takes 30mg Morphine MR twice daily for back pain related to spinal metastasis. She normally requires no breakthrough analgesia but has been taking 10mg of immediate-release morphine every 4 hours for the last 3 days. She is tolerating her oral medications. She has a DNACPR and has been labelled for ‘best supportive care’.

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