Cough-Assist

It is useful to define the disease category in order to predict the natural history and specific intervention. It is well known that patients with primarily restrictive disorders can have both inspiratory and expiratory muscle weakness, and apart from noninvasive ventilation (NIV), they also need cough assistance (4,5). On the other hand, patients with obstructive disorders rarely need mechanical expiratory aids except when they have a severe infectious exacerbation at which time difficulties in clearing copious secretions can occur (4,6,7). 

How to care fca and change a tracheotomy How to suction or use cough assistance devices... 

Bach and colleagues reported on the use of NTV to treat 257 patients with severe chronic respiratory failure and intact bulbar function (3). NIV was used for approximately 10 years with 144 patients receiving NTV > 20 hr/day. Sixty-seven patients were successfully switched to NTV from IPPV. In a subsequent retrospective observational study, Bach noted that the hospitalization rate and days in hospital for 24 patients with Duchenne s muscular dystrophy (DMD) treated with NIV and cough assistance was significantly lower than for 22 DMD patients treated with invasive ventilation (5). NTV has also been applied for up to 24 hr/day over several months in patients with amyotrophic lateral sclerosis (6). 

Mechanical insufflator-exsufflators (Cough-Assist, J. H. Emerson Co., Cambridge, Massachusettes, U.S.A.) deliver deep insufflations (at positive pressures of 30 to 50 cmH20) followed immediately by deep exsufflations (at negative pressures of -30 to -50 cmH20). The insufflation and exsufflation pressures and delivery times are independently adjustable (71). With an inspiratory time of two seconds and an expiratory time of three seconds, there exists a very good correlation between the pressures used and the flows obtained (72). 

Marchant WA, Pox R. Postoperative use of a Cough Assist device in avoiding prolonged intubation. Br J Anaesth 2002 89(4) 644-647. 

Assistant Regulate the Lung-Qi, stop cough strengthen the Middle-Jiao in order to assist the chief herbs in expelling wind-cold... 

The assistants can remove phlegm and stop cough and they also focus on regulating the Lung-Qi to assist the chief and deputy herbs ... 

Herbs that regulate the Lung-Qi so as to assist the herbs that clear wind-heat as well as stop cough are often used. 

He Zi serves as assistant and is used to preserve the Lung-Qi that is dispersed widely by the intense cough. 

Bei Sha Shen, Chuan Bei Mu and Li Pi serve as assistants. Bei Sha Shen can moisten the Lung and generate the fluid Chuan Bei Mu and Li Pi can moisten the Lung, stop cough and remove phlegm. 

An asthmatic patient using inhaled budesonide and salbutamol developed an acute asthma attack. Despite emergency treatment the patient deteriorated, requiring endotracheal intubation and assisted ventilation, and there was no improvement until the glucocorticoid was withdrawn, after which there was steady improvement. Skin prick tests with prednisolone, sodium hemisuccinate, and 6-methylprednisolone-sodium hemisuccinate were positive. Thirty minutes after intradermal 6-methylprednisolone-sodium hemisuccinate 4 mg, the patient developed a dry cough, dyspnea, and wheezing and a 17% fall in FEVi. 

Cloves are more often used to assist the action of other herbal remedies rather than alone. When not available, allspice is substituted. It is spicy, warming, stimulant, anodyne, anaesthetic (topical), antiemetic, antigriping (added to other herbs), vermifuge, uterine stimulant, stomachic, aromatic, carminative, antiseptic, antiviral, antibacterial, antifungal, antispasmodic, expectorant, aphrodisiac and promotes salivation and digestive juices. The oil is expectorant, anaesthetic, emmenogogue it affects the kidney, spleen and stomach and has preservative properties. Tea made from clove bud (other herbs/spices can be used or added to cloves, such as allspice, bay, cinnamon and marjoram) has been used to relieve bronchitis, asthma, coughs, a tendency to infection, tuberculosis, altitude... 

Decontamination and Treatment Remove animal from affected areas. If any coughing or respiratory distress, monitor blood gases and Sp02- Provide oxygen and assisted ventilation as needed. Nebulized beta agonists and possibly corticosteroids can be used to treat bronchospasm. Monitor electrolytes and PCV as there can be fluid shifts out of the vasculature (Goldfrank et al, 2002). Urine arsenic levels may be measured, but are not clinically useful due to the lag time before results are obtained. Watch for liver and kidney failure. 

Move into fresh air. Monitor animals for respiratory distress. If cough or dyspnea develops, administer supplemental oxygen. Assisted ventilation may be required. 

In cases of inhalation exposure, the victim should be moved to fresh air and monitored for respiratory distress. If cough or difficulty in breathing develops, the victim should be evaluated for respiratory tract irritation, bronchitis, or pneumonitis. Supplemental oxygen (100% humidified) should be administered with assisted ventilation as required. 

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