Which technique would most effectively augment coughing in a patient with a high-level spinal cord injury?

Which technique would most effectively augment coughing in a patient with a high-level spinal cord injury?

• A. Pursed-lip breathing
• B. Manual pushing against the upper abdomen
• C. Positioning the patient in prone
• D. Interrupting the expiratory air stream

Answer: (B)

High-level spinal cord injuries weaken the muscles used to generate a strong cough, so increasing the expulsive pressure during expiration is the most effective way to clear secretions. Applying manual pressure to the upper abdomen just below the diaphragm during expiration boosts intra-abdominal pressure, which translates into a stronger peak expiratory flow and a more forceful cough. This abdominal compression takes advantage of the abdominal muscles’ contribution to coughing, compensating for their weakness. Pursed-lip breathing slows exhalation but doesn’t provide the necessary extra expulsive force for a cough. Prone positioning doesn’t specifically enhance the cough mechanism, and interrupting the expiratory air stream would disrupt coughing rather than augment it.

High-level spinal cord injuries weaken the muscles used to generate a strong cough, so increasing the expulsive pressure during expiration is the most effective way to clear secretions. Applying manual pressure to the upper abdomen just below the diaphragm during expiration boosts intra-abdominal pressure, which translates into a stronger peak expiratory flow and a more forceful cough. This abdominal compression takes advantage of the abdominal muscles’ contribution to coughing, compensating for their weakness. Pursed-lip breathing slows exhalation but doesn’t provide the necessary extra expulsive force for a cough. Prone positioning doesn’t specifically enhance the cough mechanism, and interrupting the expiratory air stream would disrupt coughing rather than augment it.