From the Guidelines
If a patient is coughing after swallowing a pill incorrectly, the first priority is to ensure their airway is clear, and they can breathe and speak normally. To achieve this, encourage the patient to continue coughing gently to clear their airway, as this is a natural reflex to expel foreign objects 1. It's also crucial to have them sip water slowly to help move the pill down if it's stuck in the throat, which can sometimes irritate the esophagus and cause a cough reflex. Key considerations include:
- Assessing the patient's ability to speak, breathe, and swallow normally
- Looking for signs of severe distress such as inability to speak, blue lips, severe difficulty breathing, or stridor (high-pitched sound when breathing)
- Seeking emergency medical attention immediately by calling 911 if any severe symptoms are present
- Preventing future issues by advising the patient to take pills with plenty of water, sit upright, and use the "lean forward technique" to minimize irritation to the esophagus. In the context of managing cough, as outlined in the ACCP evidence-based clinical practice guidelines 1, it's essential to consider the timing and characteristics of the cough, as well as the patient's medical history, to determine the best course of action. However, in the immediate situation of a patient coughing after swallowing a pill incorrectly, the primary focus should be on ensuring the patient's airway is clear and they are not in distress, rather than exploring underlying causes of cough as suggested by the guidelines 1.
From the FDA Drug Label
In cases of acute overdosage, the stomach should be emptied by vomiting or lavage, though little drug will likely be recovered if more than an hour has elapsed since ingestion. Because the drug is acidic and is excreted in the urine, it is theoretically beneficial to administer alkali and induce diuresis In addition to supportive measures, the use of oral activated charcoal may help to reduce the absorption and reabsorption of ibuprofen tablets.
The patient should be given supportive measures. Since the patient is coughing, it is likely that the pill has entered the airway. The patient should be monitored closely for any signs of respiratory distress.
- The stomach should be emptied by vomiting or lavage if the patient is seen soon after ingestion.
- Oral activated charcoal may be administered to help reduce absorption.
- Alkali and induced diuresis may be beneficial due to the acidic nature of the drug. 2
From the Research
Immediate Action
- The patient should be assessed for any signs of respiratory distress or difficulty breathing.
- If the patient is experiencing severe respiratory distress, call for emergency assistance immediately.
Potential Causes
- The patient's symptoms could be related to aspiration pneumonia, which can occur when foreign substances enter the respiratory tract 3.
- Aspiration syndromes can be classified into three sets of disorders: large airway mechanical obstruction, aspiration pneumonitis, and aspiration pneumonia 4.
Positioning
- Elevating the patient's head to a more upright position may help decrease peri-intubation complications and improve respiratory function 5.
- Dangling the patient, or having them sit up with their legs hanging over the side of the bed, can help prevent orthostatic intolerance when moving from a supine to a standing position 6.
Management
- The patient's agitation and coughing should be managed with strategies to support clinicians, including early recognition and treatment of the underlying etiology, rapid control of the behavior, and prevention of harm to the patient and personnel 7.
- Nurses should use validated techniques, such as frequent and sufficient reality orientation, validation therapy, and strategies that improve the individual's quality of life, to calm the agitated patient 7.