Hello Jay (Dr. Pershad) and other participants.
Regarding Dr. Jay Pershad's remarks:
<<I am not enthused with the idea of lidocaine aerosols for severe cough
as Dr. Gerardi suggested, without addressing the primary etiology.>>
I agree that we should look for the etiology. Good thoughts on sinusitis,
etc. However, in the ED, my primary goals are always to always stabilize,
always relieve symptoms, always reassure, sometimes make a diagnosis, and
sometimes cure. Most coughs are due to bronchitis/asthma and people need
relief that oral cough suppressants, albuterol, etc have not provided.
is a protective airway mechanism which, unless I am intubating someone,
would hate to suppress for fear of aspiration etc.>>
I agree ...I keep the patients NPO until gag re-appears. Peole can still
cough but now it is a bit more controlled. Sometimes protective mechanisms
are too exaggerated - fever, pain, cough, histamine release, etc - hence the
reason we intervene for patient comfort with tylenol, antihistamines, NSAIDS,
<< Moreover, this is only a short term measure for what, an hour or less I
would imagine? What happens when the patient is discharged and back to square
one with his severe cough.>>
As is the case with most symptomatic treatments, relief is temporary and
treatments have to be repeated - e.g. albuterol. However, relieving severe
cough sometimes aborts reactive airway disease exacerbated by the cough. The
patient can breath without coughing for the first time in hours. They realize
that they may not die and the short respite allows other longer-acting
modalities to kick in. Patients and their parents are more relaxed and
appreciative. It also gives time for some oral cough suppressants to work when
they are indicated and prescribed.
Have a good weekend, everybody.
Anyone heading to the National Congress on Childhood Emergencies in D.C. this
weekend? If so, see you there.
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