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RESPIRATORY MANAGEMENT IN SPINAL CORD INJURY: BREATHING AND THE RESPIRATORY SYSTEM IN SCI: TREATMENTS FOR RESPIRATORY TRACT COMPLICATIONS: ASSISTED COUGH

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Assisted Cough
(Quad Cough)

   By having someone assist you in coughing, your cough will be more forceful and productive and you will be able to both prevent and treat some respiratory complications by bringing up secretions normally present in the lung. Indications for an assisted cough are:

  • Weak or ineffective cough, and/or
  • Excessive secretions

Reasons to avoid an assisted cough are:

  • Pain
  • Internal problems, such as abdominal complications, where pushing on the abdomen could cause more complications
  • Chest injury ( broken ribs)
  • Flail chest, where the chest has excessive mobility, usually due to paralysis of the muscles which control it.

Following is the procedure for an assisted cough:

  • Place the fist of one hand, immediately below the breastbone, and the heel of the other hand on top of the breastbone. The hands need to be over the diaphragm area.

  • The hand position may vary from the illustration, but the hands must be below the ribs.

  • Take a breath and cough as you exhale the air. Your assistant should push inward and upwards as you cough. NOTE: If you are on a ventilator, your assistant should push during inhalation. An ambu-bag may be substituted for the ventilator for a stronger cough.

  • Repeat, as necessary, with rest periods, as needed, between efforts

   Assisted coughing can be used while in bed or sitting up. Be sure the brakes of your wheelchair are locked before assisting cough.

   If lung congestion is present, assisted coughing is more effective when combined with postural drainage.

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