How long does immobilizer inhalation take? Compressor nebulizers have several types of chambers. Preparation for inhalation

Inhalations are used in the treatment of acute respiratory viral infections, bronchitis, laryngitis, bronchial asthma and other diseases respiratory system. There are different types of inhalations. They differ in the device used, type medicine and the temperature of the solution used.

Inhalation using improvised means

Despite the availability of such medical devices as nebulizers, many continue to do inhalations using a kettle or saucepan, pouring herbal decoctions into the container. A widely used method is to pour a hot decoction of herbs or soda solution and, inserting a paper cone into the spout of the kettle, inhale liquid vapor through it. The second method is to inhale the vapors coming from boiled potatoes or water with essential oils. In this case, you need to cover yourself with a towel or blanket and bend over a container with warm liquid.

Such inhalations have a right to exist, but they must be carried out with caution. When using these methods, you need to remember some rules:

● do not inhale steam from boiling liquid - this is a direct way to get burned;

● should not be carried out steam inhalations children under 3 years old;

● you cannot bend over a container with hot contents lower than 20-30 cm.

Inhalation using a portable nebulizer

If children or adults in the family are often sick, home nebulizer will significantly speed up the healing process. Modern inhalers are good because they are compact and easy to use. With their help medicinal solutions under the influence of compressed air they turn into aerosols with microparticles medicinal substance, which can enter lower sections respiratory system.

There are several types of portable inhalers, including ultrasonic, compressor, and membrane. Choice certain type depends on the purpose of the procedure and on what solutions will be poured into the device. Cannot be used in some nebulizers oil solutions and herbal decoctions, so when purchasing, you need to carefully read the instructions for the device.

There are a number of contraindications to the use of an inhaler.

●Hypertensive patients and people with respiratory failure 3rd degree.

●It is prohibited to carry out inhalations if there are pulmonary or nasal bleeding, as well as a tendency to them.

●Contraindications to inhalation are heart failure, recent heart attack and stroke.

● If during a cold the body temperature is above 37.5°C, inhalations are not carried out. You should wait until the temperature returns to normal.

● Inhalations should not be used for diseases complicated by cerebrovascular accidents.

● Purulent sore throat is a contraindication to inhalation.

Rules for inhalation

Whatever method of inhalation is used, there are general rules:

● At least an hour should pass between meals and inhalation.

● Immediately after inhalation, you should not go outside, and it is better to refrain from eating and drinking for 20-30 minutes after the procedure.

● It is necessary to follow the recipe of solutions.

● Inhalation time for children is 3 minutes, for adults - from 5 to 10 minutes.

● Throughout the procedure, you need to breathe calmly, without taking too deep breaths.

● If you use a nebulizer, do not forget to rinse it with running water after each use and periodically disinfect it.

● If the patient is prescribed a set of physical procedures, inhalations are carried out after light therapy and electrotherapy.

● The solution for inhalation must be sterile and freshly prepared.

● If the doctor has prescribed several medications to get rid of a cough, then first inhalation is done with a medicine that dilates the bronchi, and after 20-30 minutes, inhalation is carried out with an expectorant.

Inhalations are used not only to combat respiratory diseases, but also to maintain immunity, to treat fungal infections of the mucous membranes. The range of diseases that can be treated by inhalation is wide, but only a doctor determines the treatment regimen and the composition of the inhalation solution.

Alesya Rogalevich

To get the maximum effect from treatment, you need to store and use the nebulizer correctly.

So, how to use a nebulizer correctly:

1. It is necessary to wash your hands with soap.
2. According to the instructions, assemble and connect it to the compressor.
3. Immediately before inhalation, you need to fill the device with medicine. The medicine must first be warmed to room temperature in a water bath. IN pure form it cannot be used, it must be diluted sterile water for injection or saline using only a sterile syringe. The flask should be filled with the drug to a volume of 2-5 ml, depending on the model of the device. And first it pours in saline, and then the medicine is added.
4. After priming the device, you need to connect the face mask, nasal cannula and mouthpiece to it.

If you use a nebulizer for coughing, then first breathe in a bronchodilator solution (a drug that dilates the bronchi), and after 20 minutes. you need to inhale medicine to remove sputum. Afterwards, you should use an antibacterial or anti-inflammatory drug.

The effectiveness of using a nebulizer directly depends on the choice of medication and compliance with the dosage. List of possible medications used:

• bronchodilators - Berotek;
• mucolytics, expectorants, secretolytics – , Mucaltin, Lazolvan
• hormonal agents -;
• anti-inflammatory drugs – alcohol tinctures calendula, eucalyptus, propolis;
• antibacterial agents - Chlorophyllipt solution, Miramistin, Furacilin.

The choice of medication should be made by a doctor.

How to do inhalation?

Before inhalation, you need to wear clothes that do not restrict breathing, for example, a jacket without a neck.

How to properly inhale with a nebulizer:

• carry out inhalation no earlier than 1.5 hours after meals or exercise;
• when using a nebulizer, sit still, relax, do not talk;
• inhale slowly and deeply, rapid breathing will cause dizziness;
• After the procedure, try to talk less, do not go outside, stay in a warm room.

How to breathe correctly through a nebulizer for diseases of the nasal cavity? Inhale and exhale through your nose. Breathing should be smooth, do not make efforts.

How to use an inhaler for diseases of the throat, bronchi and lungs? Inhale through your mouth and exhale through your nose. Before exhaling, be sure to hold your breath for 2 seconds.

Instructions for using the nebulizer:

1. Turn on the device and start inhalation. When steam stops emitting, turn off the compressor.
2. After the procedure, pat your face dry with a dry cloth. If you inhaled a solution of a hormonal drug through a nebulizer, then rinse your mouth boiled water. Small children can be given something to drink.
3. Wash all parts of the nebulizer with boiled water or 15% baking soda solution.
4. If you have used the device more than a week, then sterilize it with steam or boil for at least 10 minutes.

Store the nebulizer wrapped in a clean towel.

How many minutes does it take to inhale with a nebulizer? The procedure should not last more than 7-10 minutes. It is not necessary to note the time, since during this time period it will be used up medicinal solution.

How often can inhalations be done? The frequency of inhalations is determined by the doctor. The course ranges from 6 to 15 procedures. On average, 8 sessions are enough.

Instructions for use in children

How to inhale with a nebulizer for a child? The procedure is carried out in the same way as for adults, but it can scare the baby. A nebulizer in the form of a toy is popular for young children. To remove fear, you need to give the child a device so that he can examine it. Inhalation should be carried out in the form of a game, after the baby stops being afraid.

You should sit the child in your arms and try to distract him. We need to do everything we can to stop him from crying. Turn on a cartoon or show toys.

The baby needs to choose a mask that fits, otherwise they will big losses medicine.
A small child can be inhaled while sleeping. To do this, it is worth using electronic mesh devices.
Need to call urgently ambulance if the child has the following symptoms after inhalation:

• chest pain;
• attack of suffocation;
• dizziness;
• loss of consciousness.

What can't you do?

In order for the device to last for a long time, you must use only approved medications. The following medications should not be used:

• oil solutions;
• suspensions that contain fine particles, for example, decoctions of medicinal herbs;
• solutions of Papaverine, Diphenhydramine, Eufillin and other drugs with a similar effect.

Cannot be used for hormonal drugs and antiseptics.

Before the procedure, it is forbidden to rinse oral cavity antiseptic solutions or use expectorants. Also, 1 hour before and after inhalation you should not smoke. You should avoid eating and drinking during this period.

Medicines need to be diluted only with saline solution or suspension for injection. Boiled water, and especially not using tap water.

If after the start of inhalation there are discomfort, then it is better to refuse the procedure or postpone it for a while.

Before purchasing a nebulizer, be sure to read the rules for its use. These inhalation devices are simple and easy to use; the main thing is to use them carefully.

Useful video on how to use a nebulizer

Inhalation is an effective way to treat the respiratory system. Unlike syrups and antibiotics, the method delivers medicine faster to the source of inflammation and combines medication and physiotherapy. The duration of inhalation with a nebulizer depends on the type of disease and the solution used. The procedure is recommended even for small children, but first consult with your doctor regarding the therapy regimen.

Inhalations (inhalation of vapors of medicinal solutions) are indicated for dry tracheitis cough, which develops due to acute respiratory viral infection. This symptom is accompanied by damage vocal cords and sore throat. Inhalation helps eliminate swelling of the larynx.

Wet cough is also treated with nebulizer inhalation. In the process of treating this type of cough, they achieve dilution of sputum and removal from the bronchi. The following are drugs that are used with a nebulizer for different types cough.

When dry or moist cough, then Ambrohexal is used. It is a mucolytic - it thins viscous sputum and helps the appearance of mucus. Also, in order to improve expectoration, inhalations are carried out on the basis of Fluimucil.

For pathologies respiratory tract, which are accompanied by the release of viscous sputum, inhalation with the drug Ambrobene is prescribed. Indicated for disinfection.

How to do it right

Before you begin, wash your hands to prevent germs from entering. Next, following the instructions, connect the two parts of the device. After this, the required amount of medicine is poured into a special container of the device: first a saline solution, and then a medicine or other medicinal agent. Clean syringes and needles are used for refilling. After preparation, put on the mask and begin inhalation.

The procedure is carried out until the medicinal solution is used up. This takes 8-10 minutes. It is advisable not to increase the duration of treatment.

Upon completion of the procedure, rinse both parts of the nebulizer hot water with soap (do not use brushes or other means). It is also important to sterilize the device once a week. This procedure is carried out by boiling (from 10 minutes, and if the instructions suggest this), or in a special thermal disinfector. It is important to store a clean and dried device in a napkin or towel.

Execution order

It is equally important to know how long the inhalation procedure lasts, as well as some rules. On average, the duration of the event reaches 10-15 minutes, and it is advisable not to go beyond this time frame. However, with small children it will not be possible to sit for longer, since it is difficult to make them obey. But you need to breathe for at least 5 minutes, otherwise there will be little effectiveness.

It is easy to understand how much time has passed, since some nebulizers have built-in nebulizers that are triggered through specified interval time. For example, 5 ml of medicine is sprayed in 5 minutes, so you have to control not the time, but the solution in the container. The instructions indicate whether the device has such a function.

Initially, you can reduce the time of the event to 3 minutes. If the child calmly endures the procedure, is not nervous or capricious, then the time is extended. When using one nebulizer by several family members at the same time, take a break of 30 minutes between procedures so as not to damage the nebulizer.

When inhaling, sit and the mask should fit tightly to your face. At this time, you should also not talk, but rather breathe deeply.

Recipes for solutions

How long the event should last is stated above. The following are recipes for inhalation for a child.

Alkaline

The solution helps eliminate phlegm. To prepare 0.5 liters of Essentuki mineral water, heat to 45 degrees. The child inhales through his mouth and exhales through his nose. The duration of the procedure is 8-10 minutes. Repeat 4 times a day.

Oil

If your baby has a runny nose, prepare oil solutions. 14 drops fir oil dilute with 200 ml of saline solution. For each event, fill the nebulizer with 3 ml of liquid. Repeat 3-4 inhalation procedures per day. For bronchitis, mucolytics and expectorants (for example, Lazolvan) are useful. Tussamag effectively fights against cough. Berodual is also popular. To treat a child, mix saline and the drug, taking 2 drops each. After filling the nebulizer container with the composition, breathe for 10 minutes.

Saline

Saline solutions give results if you breathe 5-6 times a day. Take 3 g per 10 ml of saline solution sea ​​salt. Inhalation time is 10 minutes.

With propolis

Propolis is known as a remedy for many diseases. Inhalations are also used for children. Mix 20 ml of saline solution and 1 ml of propolis tincture. For each inhalation, pour 3 ml of the prepared product into the nebulizer.

For inhalation with a nebulizer, a calendula-based solution is perfect. For 40 ml of saline solution, take 1 ml of alcohol infusion of medicinal marigolds. Pour 4 ml into the nebulizer. Do inhalation 2-3 times a day every day until complete recovery.

At respiratory diseases useful. Dilute 1 tablet in 100 ml of saline solution. Each procedure requires 4 ml of medication.

It is gaining popularity because it is convenient and effective for childhood diseases. It is important to first consult with a doctor, who will determine the time of inhalation and how many times a day to do it.

For respiratory diseases, inhalations are effective local treatment. They help moisten dry coughs, thin mucus, facilitate its easier removal, and relieve sore throat. Doctors recommend inhalation for asthma to eliminate spasms, it is useful this procedure and with such complex diseases, such as pneumonia and tuberculosis. However, most often these procedures are used for colds, pharyngitis and bronchitis.

Indications for treatment

Inhalation has been used in the treatment of colds since time immemorial, and it has always been effective remedy treated cough, and viral diseases helped stop the progression of the disease “inside the body.” Previously, inhalations were usually done:

• if you have a dry cough during a cold;
• if the cough is wet, but sputum discharge is difficult.

This list has now been expanded, and home inhalations are also shown:

• for bronchitis to thin sputum;
• for sore throats, pharyngitis, laryngitis to relieve inflammation and relieve pain;
• during asthma attacks (only with special inhalers);
• during rehabilitation after suffering from pneumonia.

However effective inhalation will only happen if you comply certain rules its implementation. Sometimes this simple procedure can significantly worsen the patient's condition.

Types of inhalations at home

At home, the easiest way is to inhale over steam. Also sold in pharmacy chains a large number of nebulizers suitable for home use. When performing inhalation over a saucepan or kettle, the patient breathes hot steam, the steam particles are large and they can only penetrate the mucous membranes of the nasopharynx. Such procedures moisturize and lubricate the upper respiratory tract; inhalations are effective for colds, flu, laryngitis, and pharyngitis.

If a nebulizer configured for medium particles is used, then the drug mixtures reach the small bronchi and bronchioles. This type of inhalation is indicated for bronchitis. Treatment of the lower respiratory tract and lungs is carried out in a hospital setting, and the use of procedures with a nebulizer setting for small particles is indicated only after consulting a doctor.

Mistake No. 1. Using a nebulizer for other purposes is one of common mistakes home treatment. The regulator needs to be correctly adjusted to the size of the particles that penetrate the bronchi during the treatment of colds.

Suitable for carrying out the procedure at home:

• Steam inhalation over a pan of hot steam. They are indicated for colds, laryngitis, pharyngitis. Warm steam moisturizes dry mucous membranes, helps to liquefy and remove mucus, which makes coughing easier and relieves painful sensations in the throat.
• Inhalation over the spout of the kettle. They are carried out for laryngitis, acute respiratory viral infections, and influenza. They are designed to moisturize the nasopharynx, tonsils, and disinfect the oral cavity from microorganisms.
• Inhalations with a nebulizer ( steam inhaler) are cold procedures. Here the patient breathes not steam, but a split suspension of water and medicine, their temperature is not higher than +30 °C. The place of humidification is selected using a regulator: when set to large particles, the medicinal suspension enters the nasopharynx, with medium particles it reaches the bronchi, and when set to small particles it enters the lungs.

Both home-prepared formulations and medications, purchased at a pharmacy.

Mistake No. 2. Using homemade formulations for the nebulizer. They clog the atomizer and, when using essential oils, make it difficult for the patient to breathe.

The general rule is this: for steam inhalations take homemade compositions, for nebulizers - pharmaceutical drugs, diluted in saline solution.

Among the frequently used and effective compositions for inhalation over steam are:

• Baking soda. For the procedure you need to take 4 tsp. substances for every liter of water. The mixture is brought to a boil, and then removed from the heat and inhaled. The composition thins mucus, removes inflammation, and eliminates attacks of dry cough.
• Alkaline mineral water (still). It is used in the same way as soda solution.
• Boiled potatoes. This classic version inhalations, which are used for colds. You need to take medium-sized potatoes in their skins and boil them in boiling water. Then grind it into a puree along with the peel, and sprinkle the paste with dry soda on top. Breathe over the steam until the hot mixture releases it.
• Onion juice. Add onion juice to boiling water (one medium onion per 1 liter of water) for flu, all types respiratory infections, viral pharyngitis and laryngitis. The remedy is used at the very beginning of the disease, before fever appears.
• Garlic juice. For inhalation, you need 3-5 peeled and crushed cloves for every liter of boiling water. Directions for use: same as onion juice. This recipe is used for prevention during epidemics. For preventive purposes, inhalations are carried out for no longer than 7 minutes.
• Essential oils. For steam treatments Cedar, eucalyptus, sandalwood, bergamot, anise, fir, spruce are suitable, you need to take one type or 2-3 at the rate of 3 drops for every 200 ml of boiling water. Such procedures are good for relieving inflammation and hyperemia in case of sore throat, and soothing cough.

Error No. 3. Inhalation when the temperature rises above 37.2 °C. In case of illness with fever (temperature above +37.6 °C), steam inhalation is prohibited. This worsens the patient's condition.

Features of steam procedures

When carrying out the procedure, the following rules are observed:

• The pan is placed on the table when sitting at the table, or on the knees if on the bed, but in both cases a folded cloth is placed under it (the bottom is hot).
• The lid is not opened until they cover themselves with a towel and begin to breathe.
• Do not bend too low over the hot steam, so as not to burn the mucous membranes of the nasopharynx.
• While breathing over the steam, cover your head and shoulders with a bath towel or blanket (required).
• The procedure takes no more than 15 minutes for an adult.
• During inhalation, if the throat is being treated, then inhale through the mouth and exhale through the nose. If you have a nose, then, on the contrary, inhale through the nose and exhale through the mouth.

For inhalation with a nebulizer, use only saline solution and pharmaceutical products. Do not fill the tank with herbal decoctions or soda solution. Among the products that can be used with a nebulizer at home are:

• Saline solution. An excellent moisturizer that relieves itchiness and redness.
• Alkaline mineral waters: Essentuki (4, 17), Borjomi. They are indicated for sore throats, colds, and pharyngitis.
• Soda buffer. Special soda for inhalation with a nebulizer. Suitable for colds, pharyngitis and flu. Helps remove mucus and moisten the throat.
• ACC (aminocaproic acid). Quicker prophylactic, which is prescribed for colds in complex treatment.
• Immunomodulators: Interferon, Derinat. Used at the very beginning of the disease: ARVI, influenza, viral rhinitis and laryngitis, as well as for prevention.
• Pharmacy alcohol tinctures of chamomile, sage, St. John's wort, Rotokan, Tonsilgon N, Malavit. Treat colds, bronchitis, pharyngitis.
• Antiseptics: Miramistin, Chlorophyllipt, Decasan. They are used for rhinitis, tonsillitis, laryngitis and pharyngitis.
• Mucolytics: Ambroxol, Lazolvan, Fluimucil, ACC. Used for bronchitis, they help to liquefy viscous mucus and remove it.
• Bronchodilators: Berodual, Berotek. Prescribed to relieve asthma attacks and prevent the development of bronchospasm in false croup.
• Antibiotics: Dioxidin (the most popular), Ceftriaxone. They are also used to treat the upper respiratory tract and bronchi. However, these drugs are used even when other drugs have not helped get rid of upper respiratory tract diseases.
• Glucocorticosteroids: Pulmicort, Dexamethasone, Cromhexal. Used to relieve spasms. Inhalations with Pulmicort effectively stop attacks false croup(it affects children under three years of age).

Medicines are always diluted with saline; the ratio is determined by the doctor in each specific case. For children, consultation with a pediatrician is required before inhalation.. Many drugs are not used in pediatric practice. Medicines prescribed for children differ in dosage and duration of the procedure.

Features of inhalation with a nebulizer:

• Before using the device, be sure to read the instructions.
• Fill the reservoir with medication for one procedure.
• Treat children under the supervision of an adult.
• During the procedure you cannot talk, read, or watch TV.
• After the end of the session, all removable parts, the mask and the reservoir are washed with boiled water and dried. This must be done after each procedure.
• Cannot be used in a nebulizer essential oils and other homemade compositions, the device may deteriorate.

Before use, you should check the regulator settings.

Inhalations for children

The use of an inhaler is indicated for babies up to one year old; at this age, special masks are used for them, which allow the procedure to be carried out lying down, while the baby is sleeping. Adults provide the child with peace during the period of manipulation. For example, they read a book, or just talk to him if the child is not sleeping.

The duration of the procedure for children depends on the drug and the age of the baby.

For small child up to three years of age, it is carried out only after consultation with a pediatrician. The doctor determines the remedy itself, the dosage and duration of the procedure for each specific case, and will tell you how to carry out the treatment correctly.

Mistake No. 4. Self-prescribing therapy for a child in best case scenario will not help, and at worst, it will provoke a more complex disease.

Steam inhalations for children up to three years old are not carried out due to high risk the occurrence of laryngospasm. For older children, they are done if the procedure is well tolerated by the child. Adults must be present with children during the procedure.

Duration of steam manipulation for children preschool age is up to 5 minutes, for junior schoolchildren- up to 10 minutes, for teenagers - up to 15.

Parts of the nebulizer that need to be washed

When manipulation is not done

Sometimes inhalation can be harmful. To the reasons that don't allow you to breathe medicinal mixtures, relate:

• the patient's temperature is above 37.2;
• high blood pressure;
• the presence of seizures in the baby;
• systemic blood diseases;
• epilepsy or other diseases of the central nervous system;
• internal bleeding;
• suffered a stroke or heart attack.

The procedure is carried out 30 minutes before meals or an hour after meals. At the end of the inhalation, the patient is changed into dry clothes. He is not allowed to drink, eat, smoke or talk for the next hour. Bed rest must be observed for two hours after the procedure; at the same time, you should not go out into the cold.

Mistake #5: Non-compliance bed rest after inhalation. This behavior does not contribute to healing, but leads to a worsening of the patient’s condition.

Inhalations are effective way get rid of cough, choking and sore throat, but treatment must be carried out correctly, observing all the rules and restrictions. IN otherwise not only will it not have the desired effect, but it may also cause harm to the patient.

Other diseases. For quick treatment They use rinses, compresses, inhalations, popular home procedures and folk remedies.

Treating a sore throat with gargles

• Boil a small onion in a glass of milk.

Rinse warm several times a day. When coughing, take 1 tbsp orally every 2 hours.

• Grind 3 tbsp. onion peel. Boil in a glass of boiling water, leave for 4 hours, strain.

Gargle to relieve sore throat.

Recipe 5 (folk remedy):

• Mix 2 parts of flowers, one part, chop. Brew 1 tsp. mix 300 ml of boiling water in a glass container, leave for half an hour, strain.

Rinse warm 4-5 times a day.

Recipe 6 (to get rid of a sore throat during a cold):

• rinse with a 3% solution 3-4 times a day for a week.

• At severe pain To relieve the condition, gargle with a strong infusion of rose hips.

Strawberry leaves:

• Stir in equal parts leaves of strawberry, sage, chamomile, calendula. Brew 2 tbsp. mixture with a glass of boiling water, leave, strain

Rinse several times a day. The effectiveness of sage in treating the throat is confirmed by research.

Home treatment for a cold throat

• Drink warm mineral water Borjomi without gases.

• Dip the pieces of bread into hot milk, let cool a little, and eat.

Repeat the procedure 3-4 times a day. When treated with this method, a sore throat quickly goes away, since the hot pieces linger longer and warm up better than if you just drink milk.

Method 3 (yoga exercise to treat sore throat):

• Get on your knees, open your eyes wide, stick out your tongue to create a slight effort, for seven seconds.

Repeat the exercise seven times, preferably in the evening.

Method 4. The larynx area is located at the base thumbs hands Therefore, for sore throat and hoarseness, use the following technique:

• stick strips of pepper plaster onto the phalanges of your thumbs.

The throat will recover in 1-2 days.

Method 5 (hot beer):

• Mix a glass of yarrow juice and 1 liter of hot beer (heat glass bottles in a container of hot water, carefully open over the sink).

Take a glass three times a day, wrap yourself well.

• Beat a fresh egg and pour into a glass of warm water.

Treat the throat with gargles 5-6 times a day.

• Clear fresh root from the skin, put a small piece in your mouth. When the burning stops, chew and swallow the slice.

Method 8 (treatment of throat in children):

• Scald with boiling water, cut into slices, add honey or sprinkle with sugar.

Give to the child for resorption. The effectiveness of using honey to treat colds in children is confirmed by runny nose and cough. You can use onions instead of garlic.

Balm Golden Star:

• Lightly lubricate a piece of bandage with the composition, place it in a teapot, and inhale the vapors.

Compresses for a sore throat

To cure the sick sore throat, apply Apple vinegar.

Place a damp cloth on your neck apple cider vinegar room temperature. As it warms up, replace the compress with a cool one.

Place a cloth moistened with apple cider vinegar on bottom part legs to draw blood there. Your feet will soon become hot.

Place a cloth moistened with apple cider vinegar on the stomach and periodically replace it with cool cloth. Place a compress soaked in water on the throat cool water, cover the rest of the body.

Compress cabbage leaves . Sore throat wrap with fresh cabbage leaves and tie a warm scarf on top. Replace the leaves after two hours; they can be pre-soaked in hot milk.