approach to cough

cough

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

cough

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