Q&A on Cough and Difficult Cough
Summary
TLDRIn 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
🤔 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.
💊 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.
👶 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.
💨 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.
🍼 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.
🌫 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.
🌬 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.
🛠 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.
🌿 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.
💡 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.
Mindmap
Keywords
💡Cough Medication
💡Mucolytics
💡Asthma
💡Protective Reflex
💡Antitussives
💡Expectorants
💡Nebulizers
💡Neuromuscular Disorders
💡Allergic Rhinitis
💡Chronic Cough
💡Inhalation Therapy
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
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