When a patient presents with cough we often jump to the respiratory system, but we need to keep a broad systems-based approach
A: ABCDEFGHIJKLMN
- Anaphylaxis
- Croup
- Diphtheria
- Foreign body
- Inhalation
B
- Collapse: pneumothorax
- Hyperinflate: asthma/COPD
- Effusion
- Sick: pneumonia
- Tumour
C: CARDIOVASCULAR
- RV strain: PE usually doesn’t present with cough, but can be cause of COPD exacerbation
- Dysfunction LV: CHF
D
E
F
G: ABDOMINAL
- Dyspepsia: reflux
H
I: INTOX
- Ingest: cocaine
- Treatment: ACE inhibitor
J
In summary, cough often comes from the lungs and we need a thorough exam, aided by bedside ultrasound and CXR. But we also need to consider airway pathology, cardiovascular diseases and exposures
- A: assess for airway compromise and history of allergen/foreign body/inhalation; consider epinephrine IM for anaphylaxis or nebulized for croup
- B: listen and look with bedside ultrasound/CXR to assess need for needle, bronchodilators, thoracentesis, antibiotics
- C: ECG if cardiac or PE risk factors; consider trop and Dimer+/- CT
- D
- E
- F
- G: is there chronic GERD
- H
- I: ask about meds/drugs