Q&A on Cough and Difficult Cough

Summary

In this medical transcript, a discussion on pediatric respiratory health focuses on the appropriate use of cough medications and the management of children's coughs. The dialogue emphasizes the importance of identifying the cause of coughs before treatment, the cautious use of mucolytics in young children, and the protective role of coughing. It also touches on the use of nebulized medications, the application of mechanical insufflation-exsufflation (MIE) devices, and the treatment of chronic coughs, advocating for a patient-specific approach and the avoidance of unnecessary medication.

Takeaways

• 👨‍⚕️ Doctor ISO emphasizes the importance of identifying the cause of a child's cough before administering any medication.
• 💊 Mucolytics, such as eucalytic, can be used to thin mucus but should be used cautiously in children under 2 years due to their inability to handle secretions properly.
• 🚫 Doctor ISO advises against suppressing a cough as it is a protective reflex and should be treated with caution, especially with antitussives.
• 🌿 For persistent coughs, especially in children with asthma, bronchodilators may be considered, but they are not beneficial for non-asthmatic patients.
• 🧪 The use of nebulized medications like hypertonic saline (3% NaCl) and NSS (Normal Saline Solution) is discussed, with a focus on proper dosage and frequency for different age groups.
• 🛑 Caution is advised when using nebulized medications, especially in young children, to avoid complications like secretions causing aspiration or airway obstruction.
• 💰 The cost of MIT (Mucus Clearance Therapy) devices is mentioned, with a range of approximately 120,000 pesos, and their effectiveness in treating patients with neuromuscular disorders.
• 🔄 The importance of proper technique and settings when using MIT devices is highlighted, including the initial settings for inspiratory and expiratory pressures.
• 🍼 For children with dry coughs, especially those associated with upper airway cough syndrome, oral antihistamines may be recommended over other cough preparations.
• 🌱 The script discusses the use of over-the-counter medications and the need for judicious use, similar to antibiotics, to avoid unnecessary side effects.
• 🏥 The role of supportive treatment and management for acute coughs in children is emphasized, including increasing fluid intake and monitoring the progression of the cough.

Q & A

What is the general approach to treating cough in children according to the transcript?

The general approach involves identifying the cause of the cough before administering any medication. It's important not to suppress the cough reflex as it is protective. For very young children, caution is advised with the use of mucolytics due to their inability to handle increased secretions.

Why is it crucial to identify the cause of a cough before prescribing medication?

Identifying the cause allows for targeted treatment, ensuring the cough is addressed effectively and safely. Suppressing the cough without addressing its cause may lead to complications, especially in young children.

What are the concerns with using mucolytics in very young children?

Mucolytics thin out mucus, and in very young children, there is a risk they may not be able to handle the increased secretions, potentially leading to aspiration or airway obstruction.

What is the role of cough and cold preparations in treating coughs?

The speaker mentions there is no evidence for the effectiveness of cough and cold medications, especially in children. It is more important to address the underlying cause of the cough rather than just treating the symptoms.

What is the significance of a cough being a protective reflex and why should it not be suppressed?

A cough is a protective reflex that helps clear irritants from the airways. Suppressing it may prevent the body from effectively clearing these irritants, potentially leading to more serious respiratory issues.

What are the considerations when using bronchodilators for children with cough?

Bronchodilators are generally recommended for asthmatic patients, not for all children with cough. They should be used cautiously and only when there is a clear indication, such as asthma, to avoid unnecessary medication.

What is the recommended approach for treating a dry cough in children?

For dry coughs associated with upper airway cough syndrome or allergic rhinitis, oral antihistamines may be given. However, for psychogenic cough, no treatment is recommended as it does not alleviate the cough.

What is the youngest age a MIT (Mechanical In-Exsufflator) device has been used according to the speaker's experience?

The speaker mentions using a MIT device in a patient as young as 3 months old, with the patient now doing well at 9 years old.

What are the initial settings recommended for the inspiratory and expiratory pressures in a MIT device?

The initial settings recommended are around -10 to -15 cm water for both inspiratory and expiratory pressures, adjusted based on the patient's tolerance.

What is the role of epinephrine when added to NSS for mobilization post-excavation?

Epinephrine is mixed with NSS and used post-excavation to help with the medical management for a period of 24 hours at intervals of every six hours, aiding in the treatment process.

What are the key safety considerations for using a mechanical ventilator or MIT device in patients with neuromuscular disorders?

Key safety considerations include checking the initial settings, ensuring patient tolerance, verifying the device's functionality, monitoring cough flow, and combining treatments like chest physiotherapy and suctioning for effectiveness.

How long can oral antihistamines be given to pediatric patients with allergic rhinitis according to the guidelines?

Oral antihistamines can be given for up to 2 weeks, after which a review is necessary. However, in certain cases, they may be used for a month, depending on the patient's condition and environment.

Outlines

00:00

🤔 Pediatric Cough Medication Caution

The speaker, Dr. ISO man, discusses the cautious use of cough and cold preparations in children, emphasizing the lack of evidence for their efficacy. He suggests identifying the cause of the cough and mentions the use of mucolytics with caution, especially in children under 2 years old due to their inability to manage increased mucus production. He also addresses parental concerns about suppressing coughs and highlights the importance of not suppressing this protective reflex, preferring to avoid antitussives in most cases.

05:01

💊 Considerations for Pediatric Medication Use

This paragraph delves into the specifics of using medications like Lagen de Cyril and NRF in children, noting their potential eucolytic and bronchodilator effects. The speaker advises caution with powerful mucolytics in young children due to the risk of respiratory obstruction and emphasizes the importance of identifying the cough's cause to avoid unnecessary medication.

10:06

👶 Safety and Effectiveness of MIT in Young Children

The discussion centers on the use of MIT (Mechanical Insufflator-Exsufflator) therapy in children, including the youngest patient treated at 3 months old. The speaker shares personal experience with MIT settings and the importance of patient tolerance. There is also a mention of the cost of the machine and its long-term benefits compared to traditional treatments.

15:10

💨 MIT Settings and Contraindications for Pediatric Use

The speaker provides guidance on the initial settings for MIT, including recommended pressures and the importance of patient rest between cycles. They also discuss the use of MIT for sputum collection and the challenges of training patients in effective cough techniques, especially in children with special needs.

20:10

🍼 Management of Acute Cough in Infants and Children

This section focuses on the management of acute cough, particularly in non-asthmatic children. The speaker advises against the use of over-the-counter cough medications and instead promotes identifying the cause of the cough. They also discuss the role of increased fluid intake and the potential use of oral antihistamines for upper airway cough syndrome.

25:11

🌫 Nebulized Medications and Their Combinations

The speaker addresses the use of nebulized medications, such as cellutamol and NSS, in treating patients with different conditions. They discuss the importance of considering the patient's condition when mixing medications and the recommended frequency and volume of nebulizer use in children of different weights.

30:12

🌬 Safety of Steam Inhalation and Inhalation Additives

The paragraph discusses concerns regarding steam inhalation in children, citing potential risks such as lung injury. The speaker advises caution with inhalation therapies and emphasizes the importance of using plain water or isotonic solutions. They also share a case study involving a child with lipoid pneumonia caused by inhaling oil-based additives.

35:13

🛠 Key Safety Practices for Mechanical Cough Assist Devices

This section outlines safety considerations and best practices for using mechanical cough assist devices in patients with neuromuscular disorders. The speaker highlights the importance of initial settings, patient tolerance, and the combination of treatments such as chest physiotherapy and suctioning for maximum effectiveness.

40:14

🌿 Allergic Cough Management and Treatment Options

The speaker discusses the management of allergic cough, including the use of oral antihistamines and nasal steroids. They differentiate between allergic cough and other types of cough and emphasize the importance of identifying environmental triggers and conducting necessary tests for chronic cough cases.

45:15

💡 Persistent Dry Cough Evaluation and Treatment

The final paragraph addresses a specific case of a 7-year-old with a persistent dry cough. The speaker advises on the necessary investigations such as chest X-ray and spirometry and discusses treatment options including oral antihistamines and nasal steroids. They also highlight the importance of considering the underlying cause and the environment in managing chronic cough.

🚱 Epinephrine Use in Nebulized Saline Solution

In this closing paragraph, the speaker discusses the use of epinephrine mixed with NSS for post-excavation treatment, providing specific dosage instructions. They also mention the use of epinephrine in the absence of a pre-made hypertonic solution and the importance of solution freshness, with a 24-hour shelf life.

Keywords

💡Cough Medication

Cough medication refers to a class of drugs used to treat coughing. In the video's context, it is mentioned that there is no evidence for the effectiveness of over-the-counter cough medications in children, emphasizing the importance of identifying the cause of the cough before treatment.

💡Mucolytics

Mucolytics are medications that thin or liquefy mucus in the respiratory tract, making it easier to expel. The script discusses the use of mucolytics, such as NRF (not specified in the transcript), with caution in young children due to their inability to handle increased secretions effectively.

💡Asthma

Asthma is a chronic respiratory condition characterized by inflammation and constriction of the airways. The script mentions that bronchodilators, which are typically used to treat asthma, may not be beneficial for patients with cough who do not have asthma.

💡Protective Reflex

The term 'protective reflex' refers to the body's natural defense mechanisms. In the context of coughing, it is highlighted in the script that suppressing a cough, which is a protective reflex, can be harmful, and it is important to understand the cause of the cough rather than just treating the symptom.

💡Antitussives

Antitussives are medications that suppress the cough reflex. The script advises against the use of antitussives in children, especially in the absence of a clear indication, due to the potential risks and the fact that coughing serves a protective role.

💡Expectorants

Expectorants are substances that promote the removal of mucus from the respiratory tract. The script discusses the potential issue with using expectorants in young children who may not have the ability to effectively expel the increased mucus.

💡Nebulizers

Nebulizers are devices that convert liquid medication into a fine mist inhaled into the lungs. The script discusses the use of nebulizers for administering medications like hypertonic saline and bronchodilators in the treatment of respiratory conditions.

💡Neuromuscular Disorders

Neuromuscular disorders affect the peripheral nervous system and the muscles it controls. The script mentions the use of mechanical insufflation-exsufflation (MIE) devices in patients with neuromuscular disorders to assist with clearing secretions from the airways.

💡Allergic Rhinitis

Allergic rhinitis is an inflammation of the nasal passages caused by an allergic reaction. The script connects allergic rhinitis with upper airway cough syndrome and suggests the use of oral antihistamines as a treatment option.

💡Chronic Cough

Chronic cough is a persistent cough that lasts for more than eight weeks. The script advises on the investigation of chronic cough with tests such as chest X-rays and spirometry to identify underlying causes and guide treatment.

💡Inhalation Therapy

Inhalation therapy involves the administration of medication or therapeutic gases through inhalation. The script discusses the use of different solutions for inhalation, such as hypertonic saline, and the caution required when adding substances to inhalation mixtures.

Highlights

The importance of identifying the cause of a cough before administering any medication.

Mucolytics thin out mucus, but caution is advised for children under 2 years old.

Cough is a protective reflex and should not be suppressed without proper cause.

Antitussives are not favored for children due to the risk of suppressing a natural reflex.

Legan de Cyril is suitable for children with asthma but not recommended for all children with cough.

NRC (N-acetylcysteine) is a powerful mucolytic but can be dangerous for young children.

The necessity to reassess medication needs for very young children due to their limited ability to handle secretions.

The role of over-the-counter medications in treating cough and the emphasis on judicious use.

The recommendation against using codeine in children due to potential side effects.

The use of oral antihistamines for treating upper airway cough syndrome associated with allergic rhinitis.

The approach to treating psychogenic cough in children and the importance of reassurance and monitoring.

The youngest age for using MIT (Mucus Clearance Therapy) in children, with a case mentioning a 3-month-old patient.

The cost of MIT devices and their long-term benefits for patients with respiratory issues.

The initial settings for inspiratory and expiratory pressures in MIT and the need for patient tolerance assessment.

The use of epinephrine post-excavation in combination with NSS for medical treatments.

The creation of a 3% hypertonic solution when a pre-made version is not available, and its shelf life considerations.

Safety considerations and best practices for using mechanical insufflation-exsufflation (MIE) devices in neuromuscular patients.

The duration and monitoring of oral antihistamine use in pediatric patients with allergic rhinitis.

Transcripts

starting off with our first question

this is for Doctor ISO man

what is the right what is the right age

for us to use new politics in kids

and in an outpatient basis

can you hear me moi yes ma'am can hear you

oh okay

I was having problems with my earphones earlier okay

um

like I mentioned in the lecture

the cough and cold preparation in review uh

there are no evidences for

for or again this cough medication

so first

it's really have to look for the cause of the cough

uh

identify what is causing the cough before we can apply

or give any cough preparation

but uh mucolytics in general

what do they do they thin out the mucules

so if you think that in your assessment

you really need that medication

I personally have also

tried giving eucalytics to patients

uh but uh

you have to be cautious

especially for very young children

those less than 2 because they might not be able to

know how to handle their situation

but as much as possible

if there is really no need then and for a cute cause

then we don't really have to give them anything

right now but I know it easier said than that yes ma'am

especially when we have faced parents are very um

concerned on how they could address and suppress

I think that's what they want

for the path to be suppressor

that's why they are asking for really medications

real politics antitrusives that would okay

make their let me just let me just uh mention also moi

doctor moi that uh

give them that a cough is really a protective reflex

so it is important for us not to suppress this

so among the cough preparation uh

I don't really give anti to sage

okay

sorry

sorry about that

okay you can hear me now sorry

so like I said

coffee is a protective reflex and as much as possible

we don't suppress it

uh

so it is really important that for us to know the cause

so among the cough preparations

I personally

I'm not a fan of giving antituitive circum to present

and even expectancy

yes ma'am I agree

but in common sense

I said your parents would really ask for it

so I know I know

we really have to reassure the parents that they

don't need one

especially if it's a good path because it's a way of um

protective reflex

I will protect their um and um

it's um clear of the irritant in the early

okay man in um

question your next question Mark in coral

Coralite to the first one is um

is Legan de Cyril okay for children with dog and uh

also NRC system can we get that

also work on uh lagoon beer

in study have been shown to have eucolytic

and bronchodilator effect

and I know that the studies on that are done

in children with asthma

so like um

most guidelines will tell you that bronchodilators

confirm no benefit for patient with cough

but who are not asthmatic

so uh if I'm if ever I'm going to give Laboon d

it will be figuro for an asthmatic patient

but not for all children

now the NRF is a very powerful mucolitic agent

and the problem with giving it to young children is

they might not again

be able to handle their secretions

once you have light them not

to the point that these secretions may even drown them

or contribute to area obstruction

that's why again for very young children especially

please be cautious in giving this medication

so it is really important

I guess the bottom line is really

to identify what is causing the call

because if there is a specific cost

and we treat that specific cost

then we will be treating the cost

I don't know if you remember

there is an advertisement that uh

they use their tagline is uh

you target what is causing the cough in Tagalog

ever besides it's something like that

so it is true we have to identify what is causing it

I'm sorry to be a party pooper

but uh for the safety of our patient

we really have to consider what we are cheating

before we start giving them all sorts of medication

I agree but she go to Adnala

the good thing about over the counter medications maman

is you must side effects device except for the codeine

you know the effect dreams you want to go to like a

your mama targeting the cough cancers

you will side effects

Manila are there's tasting a man is your profile

the state safety profile is quite wide

and so you are

birth event or side effects is tolerable

and not really harmful or not free though

but we still have to use it judiciously

just like antibiotics

really do not prescribe those new politics and um

and I do since for our patients

especially those less than two years

because as what was explained by non patients

especially the NSS system

um if they do not have that capability to our fully

of out and uh

the uh

mechanism of action with that would utilize the um

the secretion so uh

we might end up having a patient um receive

we receive at the emergency room because of um

aspiration aspiration of the um

celebrity industry that lies by the NSF assistant

thank you for that ma'am

so one more question about a tough medication um

what tough medication can we give or drive

and if ever at what age is

is it um safe to uh give this negative

okay for dry cough um

if you remember in the second category

of your approach to cough in children

most

patients with dry cough

really have the upper airway cough syndrome

and this is usually associated with allergic rhinitis

so if this is

the kind of cough that you are addressing

then I would say we can give an oral antihistamine

and oral antihistamines are

I

don't know if I can

ordinary

is some course of dry cough which is psychogenic cough

no treatment is recommended

and no treatment will ever alleviate the cough

if the child is still suffering from a traumatic cop

syndrome

psychotherapy yeah psychotherapy no

but remember there are no important to the firm

we tell a guy to our attendance

you really have to monitor and diffuse

and reassure the parent

because a dry cough can also convert into a wet cough

the bar so after 2 weeks dry

so again review the history made on a bunk

aggression in the history

how about your physical examination findings

are there now more abnormal signs

then you can give the medication accordingly

depending on the course that you are thinking of

the next question I think this is for mom Wiggs okay

mom Wiggs so your question is

what is the youngest age that we could use the MIT

um uh based uh literature um

they can start now with 4 years but

but based on my experience I've done it uh

so SMA one patient 3 month old

so I started with the initial setting

and now patient is about 9 years old

and uh we're in the back setting of Wati

cm water and patient is um

doing good now

so our youngest to date man that we have used the MIT

yes in a 3 year old 3 month 3 month old sorry yeah

3 months old and ma'am

I would also like to know how much this

the machine cost

um

but I don't know

so I just don't know but the the one that um

she bought around hundred twenty thousand

so it's around 120,000

white rice

for our natural very effective no man Pusha

so advantage is someone could telegram patient

SMB it up a telegram very beneficial admission four

to

six times a day

we have to take in the um the um

the effects the benefit over the the price signals

the long run we will um Mayornal to go to mafiro

I in the long

run invest in the um Miu

okay so regarding the tough assist um reads

um again is the initial setting

uh of uh what's the initial setting

um recommended for the inspiratory pressure

and the expiratory pressure

and um do do we need uh

to compete for this um settings

so the no cigarette man

how they are going to order it in the chart

the um

the machine and the um specifications of the um

settings

um yes

really because it is based on the patients tolerance

her initial setting as I have mentioned earlier

is around a negative 10 to negative 15 for pediatrics

for the expiratory and for the inspiratory pressure

it's negative 10 to negative fifteen

so uh

as I discussed earlier

um young force you have to do do it um

after each cycle

you have to rest with around 2 to 3 seconds

and then you give another cycle

so you want

full cycle is one inspiratory and one inspiratory

so you have to set also the delivery time for pressure

so if you set let's say

let's start dial 9 10

then we set it at two seconds

so it's pretty fast one to

deliver automatically so the pressure will go by metal

don't be afraid of setting it up until um

40 graduated the money you start low

and you check for your patient's tolerance

so if it is tolerated

then you can increase gradually by 5 cm water

then you'll see the

the benefit that the secretions can be uh

cut off easily

so this it

can be used to get specimen persputone

yes ma'am provided the artist can

can manage to collect the disputum for suction

so it's the artistic skill now getting the body can

I am a international mom that um special difficult

um um you know supplement collection uh huh

it's uh for patients with specially promoted

so that will help us so for the 4 isomer

can you give me on the contradictory preparation

such as dinas dinatasin because it has um

its components

uh detrimental plan as well as via fantasy

um

again uh

I'm not really a fan of extra metal or fun and white

anything combination

um because Textile Matter Fund is an undictentive

and why of anything is an expectorant

so combining them you know

one is for pressing the cough

but the other one makes you cough and expect to run

cafe has also mukolithic property

especially for young children who cannot expect to eat

so why should we even expect to run people

so it's just going to add to their discomfort

so like I said among the cop preparations

we have antitrusters

expect to run and you could be fixed

personally I need more for giving

you could be fixed rather than the other two

and for the reasons that I

mentioned earlier

for the plan and No. 2 demand expect to run

it's so hard to give somebody an expect to run

when that person that patient cannot even uh

doesn't have the ability to expect the rate

expect to rate at least

10 years old and above it

so it's difficult so the answer is I don't really give

if I'm going to give a combination car preparation

I will look at the

individual ingredients of the cough preparation

so if there's some euquility

fine if there's an antihistamine

a decongestant I use

especially if it's really there's nasal congestion

but again for younger children a croissant

no so that's the most that I will give but the other

storytelligant I don't

but I think we really have to explain that

well to the parents because

especially someone at clinics

for if we do give medications

or if we do not give or that advice medications

and we just give advice them

supportive treatment or management

they would again insist on

um becoming the doctor the doctor happy man

no but I think you know

um informing that they

I know this is again a challenge to us

but I think educating the parents

and teaching them that it can even be harmful

for their child I think they will be able to understand

and just reassure them that you are here

that by most of the time

I ask them to follow up and see me again after a week

knowing that

acute cough may last anywhere from one to three weeks

the say you should need to file

obtaining seven on the seventh day

or getting a feeling

so there's nothing really to worry about

in only 10% of children you remain coughing by

by the third week

most of them will recover on the 10th day 50%

so in connection to that ma'am

what uh are the effective

supported management options

that can be advised to parents

with golfing infant and child versus a child

uh okay to go to your pertaining to an acute cough

so acute cough like I said

most common

Lily is a viral upper respiratory tract infection

so um if the child is an asthmatic

then we can really give one for daily tours

we buy to assist

but other than an asthmatic child okay

and another child patients with allergic thraitis

and an upper respiratory trap infection

you know that there's an infection

because there's already fever

but you know that this is not allergic thinaitis

plain and simple then you can give an anti

okay um

but all the other cough preparations

like I said at the at the moment

you know if my back is pushed against the wall

I will give a new commitment

that's the only thing that I will give

now

if the child is big enough that I can talk to them now

all you need to increase your fluid intake intake

then I don't give necolitics anymore for

for older children no

I'll just tell them

you just have to drink and then you'll see

and then you'll monitor

so that is for an oil feed and for all the others

you know Doctor Moy and Riggs and all our attendees

there really are a lot of guidelines

goth guidelines as early as the 9090s

and then early 2000 and the most recent is 2020

and there's an article

I read the unmet needs into the article

the article came out only 2023

and you know there is still a lot of evidence

for the use of over the counter medicines

and for the uh

the appropriate treatment for acute coffee in children

elegant that is the reality that we have

so among the many ingredients

I chose this approach presented to you

that's why I use it because it is relatively easy

easy for our brains to remember so you

if you are faced with a cough patient with cough

you will be assured that's okay

this is what's going to happen

if the second category in a month

then I can try and unpaid the mean but if

if the patient belongs the third category

the coffee is already four weeks or more

and there are already specific pointers

underlying pointing to an underlying cost

then you have to investigate and feed the cost

very well simple it's the

every assurance that we have to give our parents

especially so that um

most of the fact that we can talk at the outpatient is

that's a good are of viral origins

so I'm a part in Bush um supported management

so that's um I think that's um

the assurance and education that's uh

the most important that um

we give our parents okay

so this I think is for one reads

so is there a basis for mixing nebulized medications

like combining cell cellutamol with uh

BNSS and your uh not with VNSS now

um

your basis for

depends on the current condition of your patient

if your patient has really dried up

you can give nap

you'll make sure no cell vitamins right with NSS um

usually we give it

that would treat here um

so for the hypertonic usually if our patients are um

has epileptices we do a hypertonic is 3% and ACL

so we give it um Q4 to Q6 for 24 hours

since the mixture will only last for 24 hours

then we do we couple it with chest tapping

so it is not only hypertonic solutions that we give

we couple it

it will kill um drainage on the cell your um NSS

we sell them to NSS nowadays cause um

the teacher go for sale and go cost pasta

most of the time so it

was

what is um Q6 to Q8 every

every 6 hours to every 8 hours

then uh

it depends for if it's uh going to be given in the Q

we give it a point one

but if it's given for a bigger children

we can give into a point five and not so

Doctor Mui I have a question for MAMRI yes

please go ahead

there is some doctors who still at NSS to tell you

the mall

personally can say I don't know you comment on this

personally can say I only

but for the nebulizer to work that

but at least the volume is 2M m or more yes

yes so

and for uh

children less 10 kilos and less lower weight

uh huh uh we just use one half of the selvitamol

the bottom point

one milligram per kilo be back for those

so it's going to be 1 ML now

so we add 2 ML of NSS

so that for the nebulizer to be able

to prepare by the medication

so is that is that really uh correct

is is that okay

cause that's all 1/2 of Vita more plus 2 m L N s s

that's for the nebilization for children

10 kilos or left

um doctor if your order is half Soviet evolved

so that's why I'm already set the complete uh

America set driving to profit to propel napping

and so so we only add 1C C to make it 2C C

let's say if we add okay

2C C of NSS the solution affected

okay yes so that we can deliver

5% 5% of the known

so for all the children 31 abused state

yes Ma no more ID no more ID okay

so this is again for you mum dicks but I think um

quantum expand along

for comparing the use of paper to make

versus your normal C line in a bronchal drainage

among patients

you have I said mentioned earlier

so um

we frequently wish now at least 30% very effective

especially if our patients are at telepathically

they will wait for 24 hours

then coupled with chest outing also

so every 4 to um I'm sorry every 4 to 6 hours yes

that 3% coupled with chest outing

or if you have precautors

you can do that and then we partialed the initial

then we asked

we asked for the doctors to depict the X ray

24 hours post the 3% um

negligent shot a week N s

s is really not much is only for if you want um

hydration right

just to hydrate but if it's really a dry puff we do um

for with the USM we have USM Autosonic and musation

are we doing that better

be careful with the nap solution

I say uh within 30 minutes um

so make sure that the art is still on that side

for dark like next 30 minutes especially if it's um

um hyper to meet is a more common use nowadays

and because also NSS has the side effect of having the

focus

focus

so how effective amount is um

just happening in 1/2 expectation

um of China

so for bigger children it is very effective

cause we do sputum collection

and we are successful with that

so um

we do chest coughing and then we ask them of course

we teach them how to do the proper

proper coughing reflex or coughing technique

we are able to collect for us

if your patients are cannot um really calm then um

it's it's affected the VHS stop being uh

per area of affect affected lung around uh

3 to 5 minutes

the area of affected lung and then we suction

the patient from smaller to larger areas than collector

this people so far we're doing it

chest stopping

and

getting suction

read the suction in your post suspicion therapy

all the time

all the time the same body depicts nominium purpose

if you do not do everything else so we do that on this

thank you mom reeds so um

I think this question is from one of

when we were still in the pandemic because um

especially in the uh

with I think it's that in the desires region that uh

people would uh use the suit of so of oh

steam inhalation if I'm correct man

the so also is it really advisable in children

and uh what are the other ingredients that we can um

use at food that we could best uh

mixed with water before there uh

really the death of in children

okay uh

you say Uncle Glemogen you if you use hot water

the bottom is steam so my concern there is uh

they might we I know that we have already seen

and I was the resident at PTMC

Young Bandy

and the coronavirus causing injury because of that

so I know that

uh perhaps a nebulizer will be a better uh option no

and I

don't know

either hypotonic or hypertonic

a solution for inhalation burial isotonic

if NSS is isoconic then physiological neither

but while I'm a shadow reaction and all

but still if it's going to light the mucus to a point

that it can you know

be strong enough

a predator like a shangma my drown Humana

but at the situation

so I'm not really sure about inhaling clean water

Cassana steam

because of that doesn't Tony city and play become

a Corona Bronco contraction

and the child cough

and every obstruction will be worse

but that's one if you're just using plain water

that was papa anything and then now No. 2 number

adding substances for inhalation

and then go Maramian in the market

but you know when I was a fellow

my case report was on my point pneumonia

and no kidding

this child unfortunately died on us is he

she was

she was already 5 when you saw her at one year of age

in a Garmit Manganyan Nagy

inhale skin inhalation using oil and and combination

you know the things that you can buy in

on the drugstore used to hang up on us from Italy

now this mixture has an oil

oil and oil ingredients and you know

oil will not evaporate from the lung

water will but oil will not

and so the microphages need to settle in the airways

in the of your life and the microphages will attack

and these children will present a recurrent pneumonia

so it's only my our particular patient we sent

we had a biopsy done and to enough

it came out of slight point pneumonia

so what am I saying

if you have to make them inhale something

you just bear in mind plain water guide nothing

a luan and using the skin can be harmful

getting a isotonic sharp now if you add salt I'm

problematic

we'll be NSS

the cyan NSF you sustain a month in

dequania advice to be used as an inhalation

outside the hospital

it's really very important so I hope I agree doctor

yeah

available

available

to for

but I think I agree we

should be careful and sort of

shy away from using the suburb anymore

and because I think we had that news mum

during the pandemic that there was a child in Sydney

where this was done and was brought to the hospital

because that the child sustained

I think it's infant months old

only

where they perform because the child tested positive

so they they had the suit of and the child assisting

we wish not to shy away from doing the suit of nipple

so uh for our next um restaurant so hormone rigs

um what are the key safety considerations

and best practices for using a mechanical escalator

your

or MIT device in patients with neuromuscular disorders

for safety practices

of course we are guided with initial setting

that's number one

and then you have to check if the patient really

can tolerate it

so it's about safety is the one I mentioned

that we really have to check on the device

that the patient is using

so I I have told you go treat your and if you can

if it's uh patient is oxygen

then you can do breathe in in your safety practices

I don't know you can deliver it oh

well then you have to check also for the coffee flow

which I've said earlier cause if you don't

do not assume with it more than 160 degrees per minute

then your cough is actually effective

so you have to take note of that

then of course you will um uh one more thing is uh

you have to make sure that there are some

that you have done all the treatments

you going on top on top of that

you do cuff assist because if you only do cuff

cuff assist alone this may not be that effective too

so usually it's covered really with that abilization

or chest staffing and then you do um

suctioning and then the cuff assist again

we have combination of yes

for it to be really effective yes

so for mom a son so

is there a rule for oral cell vitamin

in upper airways of syndrome

for faster healing form

okay upper area of syndrome is a

young post nasal drift on the wagon

so it is outside the airway

so and it is associated with other degree nighties

so if you have to give something

you can give an oral antihistamine

oral antihistamine

they're already studied that you can use it for Ibah

weekdays

we buy in the safety profile is still

and all is still wide or also beautiful

like I said it's not recommended anymore

if we need to give so beautiful

than we prefer it in healed

except to go to for the dire

situation where there is really no nebulizer around

you know and you have to give a Bronco day later

again for a child with asthma

and since that is a rescue medicine

then that's the only time that probably I will say yes

you can give or else I'll give some more

point 1 milligram to point 15 milligram per

give a per dose

if you really need to give

but you give it only for patients with asthma

so it can follow up restaurants literally

so is there really um allergic thoughts

allergy cough

is there an allergic cough

is that a question

yes ma'am hello

ah okay

ah yes

the female allergic post nasal grip

from your allergy crying like you

and usually this coffee is dry

you know and it has

if you dig into the personal and family history

there will be a history of eczema

of Apple P and of allergic cri 90s

and also there may be triggers

so many triggers can usually the environment

you know smoke dust

irritants powder in onion

some are bad that strong sense animal hair

so you ask about that

you ask about the environment for

for patient for our coughing

because if it is an allergic

cough then you can give oral anti symptoms

now for allergic granitis

if you if you are convinced that the patient has

allergic granitis

the nasal steroid also are recommended

thank you for that it's

really that

I think I'll I I have to ask the question

from our attendee from Mauritius okay

she's asking for an advice because she she has

I said a son 7 years old who is having dry bath

ever since um

since I'm sorry since um

April 7 and she has used many different topics

factorent already

so she is asking for advice what to do with the

I think that's persistent

okay so if the cough

the dry cough has been there for more than 4 weeks

the chronic cough nashia

are there red flags

if there are no red flags

then I think we already have to do some tests

just x ray and sperometry to find out if uh

what the cost is so if the test x ray is normal

and the spironmetry is also normal

then like I said

your consideration is still upper area cough syndrome

what have you tried have you tried giving Naco steroids

aside from the cough preparation

because that is already the No. 1 recommendation

for allergic ray

90 and uh

plus or minor oral antihistamine

now if the cough uh is chronic and there are red flags

so what are the red flags

what is your physical examination findings

are there abnormal lungs now

is your child having hypothermia

difficulty of breathing um what else

and the chest x ray is abnormal already

or the spirometery test

then you can take it from there

just x ray is abnormal than what is it

is it pneumonia then we give an antibiotic oh

I forgot what craft was crafted

bacterial bronchitis

is now the second most common cause of chronic coffee

children but it is an isolated webcar

so if the patient cough is dry

uh maybe I'm going to suggest

doing some investigations now

because it has already been there for 8 weeks

for 2 months at the minimum chest X ray and Spiron

noted on that

very helpful the categorization show

so and the need for investigation

for the investigation for your son and mom

and I hope we uh

have helped you in your dilemma as to how to um

and the advice that we've given will help you uh

on the 3rd on further uh evaluation of your child

so yeah you could understand they're lying uh

etiology as to do um chronic talks of your son

thank you thank you for that man

so again now this is for you um

can we give a propatoral for thought or for asthma

and for and for asthma

look after all is a Bronco daily door

so if the patient has asthma yes

we can give for hospital but previously

it has been marketed as long acting data to it

but now it's already being used

even as a short acting data to argument

so for patients with asthma you can use for particles

but like I said the cornerstone

of asthma treatment is still inhale steroid

so if your child is the patient uh

qualified for in health steroids already

uh that will be a better option

rather than giving for Adderall alone

uh especially if uh the need for this

it's already uh very frequent

like almost every week

or even two to three times a month

that's already considered frequent

because our goal is

in asthma treatment is zero need for Bronco diagnosis

thank you um

yes this is

for you how long can we give oral antivistamin

in pediatric patients with allergic vitamins

um if you look at the area guidelines

you can give it for 2 weeks or 2 weeks

and then you want it or and review

but personally I have had patience on that for a month

especially if the offending agent is there

there they cannot move houses

and the house is under construction or

you know there is the best that they cannot uh

donate or the state with them

then we give

we can I give an antihitamine for a slot one month

but then we have to again monitor and review

because your patient might already need an anti

inflammatory to control the allergy chroninitis

so you can choose between an anti

you could try in agony anti

you could try in medication or inhaled steroid

but I'm sorry nasal nasal steroid is now the No. 1

recommendation for allergic green ID

so I think this will be

last question

there are similar questions

and I would ask already easily

uh this last question for my needs

um why is a penis ring

uh added sometimes to NSS and uh used for mobilization

um we use epinephrine here post excavation usually

so um it's give

it's it's always mixed with um NSS

so we give 1 c C of etin free and 1 c

C of etins s to deliver the medical station

post excavation for 24 hours

and an interval of every six hours

so it depends can be four just for 6 hours

depends on the doctor's orgy

but that's usually the only time

that we use up in a female delusation

and if if our patients for the health group

you have group patients

you use affinity to do an abilization

I say it's called the bath

so the inflammation very very much absent

same box the third thing

I just answer one question I saw earlier

you um or anything of process of 3%

so if you don't have a 3%

hypertonic solution in your place

you can mix it just get 2.5

mix of sodium Chloride and then your 50 CC MSS

then you aspirate 7.5 of NSS

point nine MSS from the 50 m L

and then aspirate 7.5 also from the 2.5 max and mix it

but make sure once you mix it

you are you

you be conscious of the time um

because the shelf life of this um

solution that you just made is for 24 hours

you have to discard it it's time and beast

so if you if you made it nine PM

then tomorrow nine PM you have to discard it