Lidocaine for cough?

    Previous

    Lidocaine for cough?

    Whether it’s asthma, a U.R.I., or post nasal drip as the cause, cough is a common enough complaint encountered by emergency physicians everywhere. Of course you must always rule out the dangerous causes of cough (PNA, Measles, PE, Heart failure, CHF, lung cancer PVCs ) but once thats done, you still have to treat the patient. Given it’s ubiquitousness, you’d imagine that there’d be a myriad of effective ways to treat a cough.

    Alas, I’m certain one day in the low acuity area of your ED, during December, would certainly make you scrutinize the use of the word effective. I’ve heard of everything being used from guaifenesin to albuterol, from tessalon perles to hycodan, but effective isn’t the word I’d use to describe these treatments. Usually, I default to telling a patient it’ll all clear  up in a week or so, (kicking the can down the road and hoping this becomes the problem of their primary care doc). But is there something that can be used in the ED for “effective relief?”

     

    How about Lidocaine?

    Image result for lidocaine

     

    Yes, that the stuff.

    Lidocaine is a local anesthetic that is used in a whole host of procedures. In the ED, we know its uses well, but here’’s one you may not have heard of before.

    Nebulized lidocaine for cough relief. Nebulized lidocaine is often used in bronchoscopy to  increase comfort of patient and allow for further visualization of the airway. There is some literature (mostly case reports), that show although nebulized lidocaine is not first-line therapy in intractable cough and asthma, it may provide an alternative treatment option in patients who cannot tolerate or are unresponsive to other treatments (1,2).

    The main concern over lidocaine is surrounding it’s toxicity. Concentrations of serum lidocaine over 5 mg/L can lead to lightheadedness, tremors, hallucinations, and even cardiac arrest (3.)

    Also, patients suffering from hepatic disease should be monitored closely because of decreased drug metabolism and elimination rates.

    So here’s how to do it:

    Start with 100 and 200 mg of liquid lidocaine (about 5 mL of 4% or 10mL of 2%) topical lidocaine solution (equaling approximately 200 mg) and to nebulize it, squirt it into the nebulizer chamber, connect to wall o2 at 10 LPM, and have the patient breathe it in. This is believed to numb the airway and stop bronchospasm, thus stopping the cough. Be sure to warn the patient that it doesn’t taste great and it can sometimes cause a slight burning sensation. Patients should experience relief within 10 minutes if successful. Hopefully it works, if not, there’s always the PMD follow up.

    Here’s to having one more tool in the arsenal.

    ______________________________________________________________

    Work Cited:

    1. Slaton, Thomas & Mbathi (2013) Slaton RM, Thomas RH, Mbathi JW. Evidence for therapeutic uses of nebulized lidocaine in the treatment of intractable cough and asthma. Annals of Pharmacotherapy. 2013;47:578–585. doi: 10.1345/aph.1R573
    2. Shirk MB, Donahue KR, Shirvani J. Unlabeled uses of nebulized medications. Am J Health Syst Pharm. 2006;65:1704–1716.
    3. Langmack, Esther L. et al. Serum Lidocaine Concentrations in Asthmatics Undergoing Research Bronchoscopy. CHEST , Volume 117 , Issue 4 , 1055 – 1060
    4. More Emergency ‘MacGyver’ Tips for Physicians. https://www.medscape.com/viewarticle/912367
    • Welcome! This is the website for the Mount Sinai Emergency Ultrasound Division. It serves as an information resource for residents, fellows, medical students and others seeking information about point-of-care ultrasound. There is a lot ofRead more

    • Measles redux!

      A quick search of sinaiem.org for the keyword measles brings up a solitary post from 2015, and it’s not actually about measles. With all the attention that measles has been getting in the news recently,Read more

    • The Apple Watch Heart Study

      Disclosure: I’m a huge Apple Fan. Unless you’ve been living under a rock, you’ve heard about the Apple watch, many of you reading this are wearing one right now. On April 24th, 2015 it joinedRead more

    • Peritonsillar Abscess I&D…Can you ditch the endocavitary probe?

      Today’s post is inspired by real-life events and comes with a video (consent given by the patient and providers). The case: 29M presents with dysphonia, odynophagia, and drooling. He is hypertensive, with a low-grade fever,Read more

    • Look into my seeing EYE ball

      THE EYE EXAM Keep it basic… APD Intra-ocular Pressures: Tono-pen v Applanator (Goldmann) Visual Acuity or be a Slit Lamp KWEEN Move outside in: Lids → Eyeball Lids: ducts, eyelashes, orbital lesions or findings EYE:Read more

    • Oh no baby WHAT IS U DOIN’?

      Neonatal Resuscitation. (Some descriptors for reference: Terrifying. Scary. Fear-inducing. Horrific. Chilling.) But fear not! Your TR pearl today is brought to you by the NICU rotation + Jillian Nickerson/T.Webb doing some excellent preparatory work for/withRead more

    • Amanita Muscaria

      For those of you who remember Super Mario Bros… how awesome was it to gobble up that red and white mushroom gliding along the ground and get huge for a few seconds? The result of consuming thisRead more

    • ED Postpartum Hemorrhage

      So you’re in the ED and a G9P8 patient at 40w2d rolls in with contractions every 3 minutes. Before sending the patient upstairs you do a brief examination and you see this…   You deliverRead more

    • Lewis Leads & Invisible P’s

      You ever have a tough time visualizing P waves on EKGs? Have no fear, a Lewis Lead EKG might just be the thing you need! The Lewis Lead (aka S5) is a modified EKG obtained in a mannerRead more

    Previous