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