Opioids are the principle treatment for pain in terminally ill patients.
Be cautious with morphine in terminally ill patients who have renal impairment as this can lead to opioid induce neurotoxicity.
Use hydromorphone or fentanyl.
Morphine: 4mg IV x 1 and IV folus q 15 minutes PRN
Hydromorphone: 1mg IV x 1 and 1 mg IV bolus q 15 minutes PRN
Fentanyl: 25mcg IV x 1 and 25 mcg IV bolus q 15 minutes PRN
If pain is unrelieved for 30 minutes, increase bolus dose by 50-100%
If not opioid-naive, give up to 20% of total daily opioid dose.
Referral to<unk>  Care for refractory to pain control despite appropriate medications.
Use hydromorphone or fentanyl.
Palliative medicine
Poison control
Blister chemical agents
Hyperbaric medicine
Toxicology 
Tactical field care
Biologic immunomodulators
Christiana Care Health 