Hi! I’m Joanie, I’m one of the technicians here at DoveLewis. Today we’re going to nebulize and coupage this patient with aspiration pneumonia. This is my little nebulization unit that I have pre filled with saline. This patient doesn’t need any additional medications with his nebulization we are just using saline and oxygen to run through so that he can stay on oxygen while he’s receiving his treatment since he is oxygen dependent. Once the air runs through the saline it’s going to come out the nozzle in a fine mist he’ll inhale that and it will spin out the secretions in his lungs and make it more likely for him to be able to get those out. The nebulization is just the first part. Once those secretions are thinned out then we perform coupage which is a firm percussion on his chest to help loosen up those secretions and help him cough those out. So we try to keep the patient as sternal as possible and keep them in a comfortable position while we nebulize them and they we want them to breathe in this mist for about five to ten minutes helps thin out as much as those secretions as we can and give them the best opportunity to get out. So it’s now been about 10 minutes and so we are going to switch to coupage. ‘Coupage’ is named because of the cup that your hand makes when you percuss on their chest. You want to have them as sternal as you can possibly get and you want to do it evenly on both sides you’re going to make a nice cup with your hands you’re going to make some percussions on each side pretty firmly you want to get vibration in there that is what’s going to break up the mucus and help him be able to cough it out. So I usually try to get the whole of their chest but I will try to do forward motions with it start from the back and go forward and try and help him expel it out. So that’s how we do nebulization and coupage here at DoveLewis.