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Nebulized Lidocaine for Severe Cough

Patrick Bafuma, PA
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06:17
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN
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01:10

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EM:RAP 2016 December Written Summary 910 KB - PDF

Let’s face it, we’re pretty limited when it comes to treating cough. Maybe some bronchodilator will help, but usually not. What’s next? You could try an OTC cough suppressant, an opiate, tessalon perles, or honey. But what if none of that works? Patrick Bafuma says, consider nebulized lidocaine.

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Ian L., Dr -

For severe unremitting cough in children I have diagnosed later age croup and a coarse of Cortisone has been on several occasions very efficacious .
Like 2 days of unremitting cough in an 8 year old girl oral cortisone syrup better in a few hours .
Bordertella Pertussis has to be excluded .

Patrick B. -

I think peds may be a little different, and I'd probably try steroids in peds first anyway... But if theyre more than 3-5 days out, sound miserable, and it's hard to get them out the door or the parents to agree to dc without the kitchen sink, I'd consider it.

Drew G., M.D. -

Unless you hate your partners, want them to hate you or are trying to increase your ED volume and return visits I would suggest you do NOT try this. We had a partner several years ago who used this and we saw a near 100 % return of the patients. It did work - like a miracle. When it wore off in several hours they were right back in ED demanding a repeat treatment and a home lido neb. I was pretty uncomfortable prescribing this at home knowing they would use it over and over - potentially to toxicity. This therapy is too effective initially, last only hours in a disease process that is going to last days to weeks.

Patrick B. -

Impressive results! For that terrible, horrible, no good cough, most of my patients have been ecstatic to have just a few hours of relief so they could get some sleep (though many have had complete relief). To that end, managing expectations in the initial scenario is paramount so that either they do not come back every few hours, or their PMD/pulmonary manages an outpatient neb.

I'd look at a return visit as a testament to the initial providers empathy to go above & beyond. The patient came completely miserable and was given relief by your group that no one else considered doing. I have not had the return visit issue, but have seen it "wear off" in ~20% of patients. Published data for durability is all over the board - as short as a few hours, as long as "until the next time you get sick". As for toxicity, there are some online protocols for people to use this at home Q 4-6hrs, albeit in COPD & palliative care, so it may not be a stretch to see some PMDs/pulmonologists using this in select situations the future.

Josh P. -

I've been using the nebulized lidocaine for severe cough for years. A crusty old RT during residency taught me the trick, and I love it. The biggest drawback to it's use in my anecdotal experience is that its effect seems short-lived and I am not comfortable discharging the patient home with lidocaine to nebulize.

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