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Is it acute or chronic? Acute onset of a cough would suggest an acute URI, viral pneumonia, or bronchopneumonia. A chronic cough is more suggestive of pneumoconiosis, chronic bronchitis, emphysema, bronchiectasis, tuberculosis, carcinoma of the ... DIAGNOSTIC WORKUP
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Is the patient an adult or a child? If the patient is a child, acute epiglottitis, acute laryngotracheitis, foreign body, congenital laryngeal stridor, laryngismus stridulus, and a retropharyngeal abscess should be considered. ... DIAGNOSTIC WORKUP
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... Wheezing is classically due to bronchial asthma, but there is a danger in jumping to that conclusion because it occurs in a few other conditions as well. The wheezing of bronchial asthma is heard primarily on expiration, whereas the wheezing of tracheal or... DIAGNOSTIC WORKUP
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Stridor is characterized by a high-pitched grating sound on inhalation or exhalation, but it is caused by narrowing or obstruction of the upper airway. Wheezing is a high-pitched musical sound on inhalation or exhalation that is due to... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Initial history of cough should include an assessment of the production of sputum. Additionally, associated history and physical findings, with particular attention to the quantity, quality, and circumstances surrounding coughing episodes and social... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Initial history of cough should include an assessment of the production of sputum, and the quantity, quality, and circumstances of the sputum production and coughing episodes. Additionally, associated history and physical findings, with... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Priority of stridor evaluation is based on history and clinical presentation. A child with new stridor and respiratory distress requires immediate intervention. The most common cause of chronic stridor in infants is laryngomalacia. Synchronous airway lesions need to be... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Breath sounds are made by air flow through airways. Normally they are fairly quiet and somewhat louder during inspiration as air flows toward the stethoscope. Wheezing is defined as continuous breath sounds that are more prominent during expiration and often... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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A cough occurs by increased intrathoracic pressure against a closed glottis (Valsalva maneuver), followed by the abrupt opening of the glottis and a sudden expulsion of air. Increased intrathoracic pressure leads to dynamic compression of the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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In adults, “chronic” is often defined as more than 3 months of coughing in 2 years, but chronic cough is not as well defined in children. In general, for children, cough of more than 3–4 weeks’ duration will be brought to the attention of caregivers as &... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... The differential diagnosis of cough is best developed with the use of anatomy. Cough may arise from an irritative focus anywhere along the respiratory tract. The irritation may be intrinsic, in which case it is usually inflammatory, neoplastic, or toxic, or it may
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... Both these symptoms are the result of the same pathophysiologic mechanism: obstruction in the upper air passages. That obstruction may be due to any one of the etiologies recalled by the mnemonic MINT.
M—Malformations that may cause snoring or
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... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. It's most prevalent in the fall and may recur in the same child.
GENDER... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations
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... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn't yield sputum or blood. It's one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary protective mechanism... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Productive coughing is the body's mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn't remove. It's a sudden, forceful, noisy expulsion of air from the lungs that contains sputum, blood, or both. The... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... A loud, harsh, musical respiratory sound, stridor results from an obstruction in the trachea or larynx. Usually heard during inspiration, this sign may also occur during expiration in severe upper airway obstruction. It may begin as low-pitched “croaking”... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Wheezes are adventitious breath sounds with a high-pitched, musical, squealing, creaking, or groaning quality. They are caused by air flowing at a high velocity through a narrowed airway. When they originate in the large airways, they can be heard by placing an... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Pictures
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... Acute
Viral upper respiratory infection
Pharyngitis
Rhinitis
Tracheobronchitis
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... Asthma
Extrinsic
Intrinsic
Exercise- or cold-induced
Drug-induced
Aspirin
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... 1. Samiy AH, Douglas RG, Barondess JA (eds): Textbook of Diagnostic Medicine. Philadelphia: Lea & Febiger, 1987.
2. Fraser RG, et al. (eds): Diagnosis of Diseases of the Chest, 3/e. Philadelphia: WB Saunders, 1989.
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... Central Causes
Voluntary hyperventilation
Anxiety, pain
Hypoxia
Fever
Salicylate toxicity
Head trauma
Brain tumor
Central nervous system infection
Cerebrovascular accident
Pregnancy
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... Central Nervous System Disorders
Drug intoxication
Sedatives
Tranquilizers
Analgesics
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... Neuromuscular Causes
Ingestion or overdose (e.g., tranquilizers, sedatives, anesthetics, anticholinesterases)
Cerebral, brainstem, or high spinal-cord injury or infarct
Primary neuromuscular disease
Guillain-Barré syndrome
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... Whooping cough, also known as pertussis, is a highly contagious respiratory infection usually caused by the nonmotile, gram-negative coccobacillus Bordetella pertussis and, occasionally, by the related similar bacteria B. parapertussis and B. bronchiseptica. ... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... In patients with essentially normal lung tissue, acute respiratory failure (ARF) usually means partial pressure of arterial carbon dioxide (PaCO2)above 50 mm Hg and partial pressure of arterial oxygen (PaO2) below 50 mm Hg. These limits, however, don’t apply to... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Infant respiratory distress syndrome (IRDS), also called hyaline membrane disease, is the most common cause of neonatal mortality. In the United States alone, it kills 40,000 neonates every year. IRDS occurs in premature neonates and, if untreated, is fatal within 72 hours of birth... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Signs and Symptoms Rapid, shallow breathing; dyspnea, crackles, rhonchi; hypoxemia; bilateral infiltrates on chest X-ray
Treatment (Tx) Treatment of underlying disorder, supportive care (oxygen, mechanical... Pictures
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... Signs and Symptoms Shallow or deep respirations (or both), air hunger, cyanosis, adventitious breath sounds, confusion, decreased level of consciousness, tachycardia, pulmonary hypertension, irritability, decreased reflexes ... Treatment (Tx)
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... Signs and Symptoms Deep, rapid breathing; dizziness; agitation; circumoral and peripheral paresthesia; carpopedal spasms; twitching; muscle weakness; seizures; arrhythmias
Treatment (Tx) Treatment of underlying
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... Respiratory syncytial virus (RSV) infection results from a subgroup of the myxoviruses that resemble paramyxovirus. RSV is the leading cause of lower respiratory tract infections in infants and young children. It's the major cause of pneumonia,... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... The respiratory system distributes air to the alveoli, where gas exchange — the addition of oxygen (O2) and the removal of carbon dioxide (CO2) from pulmonary capillary blood — takes place. Certain specialized... External respiration
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... Severe acute respiratory syndrome (SARS) is a viral respiratory infection that can progress to pneumonia and, eventually, death. The disease was first recognized in 2003 with outbreaks in China, Canada, Singapore, Taiwan, and Vietnam, with other countries —... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Signs and Symptoms Confusion, apprehension, asterixis, coma, headache, dyspnea, tachypnea, papilledema, depressed reflexes, tachycardia, hypertension or hypotension, arrhythmias, vasodilation
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... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. Croup syndrome is most common in boys and most prevalent in the fall; it may... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations
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... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn’t yield sputum or blood. It’s one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary protective mechanism that clears... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Productive coughing is the body’s mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn’t remove. It’s a sudden, forceful, noisy expulsion of air (from the lungs) that contains sputum or blood (or both). The sputum&rsquo... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... A loud, harsh, musical respiratory sound, stridor results from an obstruction in the trachea or larynx. Usually heard during inspiration, this sign may also occur during expiration in severe upper airway obstruction. It may begin as low-pitched “croaking” and progress to... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Pictures
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... Wheezes are adventitious breath sounds with a high-pitched, musical, squealing, creaking, or groaning quality. They’re caused by air flowing at a high velocity through a narrowed airway. When they originate in the large airways, they can be... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Désirée A. Lie
Cough is among the top 10 reasons for visits to family physicians in the United States. It accounts for 200 to 400 million episodes of illness per year. Three causal conditions increasing in frequency over the past two... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Alexandra Duke and Tahany Maurice-Habashy
Stridor is a common type of wheezing (Chapter 8.9). It is characterized by a harsh, raspy, medium-pitched sound produced as air flows through a partially blocked airway. It is usually seen in early... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Thomas C. Bent
Wheezing is one of the most common respiratory complaints to present to primary care physicians. Although most often caused by asthma or chronic obstructive pulmonary disease, there are multiple causes. The correct... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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... Differential Overview
Wheezing
❑ Asthma
❑ Reactive airways disease
❑ Pulmonary edema
❑ Pulmonary embolism ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Viral upper respiratory infection
❑ Asthma
❑ Sinusitis
❑ Mycoplasma bronchitis
❑ Pneumonia
&... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Upper respiratory infection
❑ Allergy
❑ Asthma
❑ Chronic bronchitis
❑ Chronic... Diagnostic Approach ... Clinical Findings ... Pictures
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... In patients with essentially normal lung tissue, acute respiratory failure (ARF) usually means a partial pressure of arterial carbon dioxide (Paco2) greater than 50 mm Hg and a partial pressure of arterial oxygen (Pao2) less than 50 mm Hg. These... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Caused by alveolar hyperventilation, respiratory alkalosis is a condition marked by a decrease in partial pressure of arterial carbon dioxide (Paco2) to below 35 mm Hg. Uncomplicated respiratory alkalosis leads to a decrease in hydrogen ion concentration, which... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Also called hyaline membrane disease and infant respiratory distress syndrome, respiratory distress syndrome is the most common cause of neonatal mortality.
Respiratory distress syndrome affects 10% of premature infants while rarely affecting... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... A subgroup of the myxoviruses resembling paramyxovirus causes respiratory syncytial virus (RSV) infection. RSV is the leading cause of lower respiratory tract infections in infants and young children; it’s the major cause of pneumonia, tracheobronchitis, and... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... An acid-base disturbance characterized by reduced alveolar ventilation and manifested by hypercapnia (partial pressure of arterial carbon dioxide [Paco2] greater than 45 mm Hg), respiratory acidosis can be acute (from a sudden failure in... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. Croup syndrome is most common in boys. It’s most... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Productive coughing is the body’s mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn’t remove. It’s a sudden, forceful, noisy expulsion of air (from the lungs) that contains sputum,... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... A loud, harsh, musical respiratory sound, stridor results from an obstruction in the trachea or larynx. Other causes include foreign-body aspiration, croup syndrome, laryngeal diphtheria, pertussis, retropharyngeal abscess, and congenital... Assessment ... History ... Physical assessment ... Pediatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Wheezes are adventitious breath sounds with a high-pitched, musical, squealing, creaking, or groaning quality. They’re caused by air flowing at a high velocity through a narrowed airway. When they originate in the large airways, they can be... Assessment ... History ... Physical examination ... Pediatric pointers ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
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... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. Croup syndrome is most common in boys and most prevalent in the... History ... Physical assessment ... Medical causes ... Special considerations ... Patient counseling ... Pictures
... READ EXCERPTS »
... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn’t yield sputum. It’s one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Productive coughing is the body’s mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn’t remove. It’s a sudden, forceful, noisy expulsion of air (from the lungs) that contains sputum or blood (or... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... A loud, harsh, musical respiratory sound, stridor results from an obstruction in the trachea or larynx. Usually heard during inspiration, this sign may also occur during expiration in severe upper airway obstruction. It may begin as low-pitched “croaking... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
... READ EXCERPTS »
... Wheezes are adventitious breath sounds with a high-pitched, musical, squealing, creaking, or groaning quality. Also known as sibilant rhonchi, they’re caused by air flowing at a high velocity through a narrowed airway. When they originate in the large airways,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Definedas sound that occurs on sudden release of air under high pressure,which is generated by forceful contraction of expiratory musclesagainst a closed glottis. Clinical dilemma is to determine whethercoughing is associated with mild... Principal Causes of Cough ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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...Wheezing is a high-pitched musical soundthat is usually produced by narrowing of the segmental bronchi andbronchioles. May be heard during inspiration, expiration, or both. Principal Causes of Wheezing Asthma ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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...Signs of respiratory distress include tachypnea,dyspnea, nasal flaring, grunting, retractions, and cyanosis. Apneais an extreme form of respiratory distress. Respiratory distress(neonatal and postneonatal) is discussed in the first part of thechapter and apnea in the second part.... Principal Causes of Respiratory Distress (Neonatal) ... Clinical Features and Diagnosis: Respiratory Distress (Neonatal) ... Principal Causes of Respiratory Distress (Postneonatal) ... Clinical Features and Diagnosis: Respiratory Distress (Postneonatal) ... Diagnostic Approach: Respiratory Distress ... Principal Causes of Apnea ... Clinical Features and Diagnosis: Apnea ... Diagnostic Approach: Apnea ... References
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... Stertoris noisy, snoring-type breathing that results from airway obstructionin the nose, nasopharynx, or oropharynx. The sounds are heard onlyduring inspiration. Stridor is a low- to medium-pitchedsound that signifies airway obstruction... Principal Causes of Airway Obstruction ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. It's most prevalent in the fall and may... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn't yield sputum or blood. It's one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary protective mechanism that clears... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Productive coughing is the body's mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn't remove. It's a sudden, forceful, noisy expulsion of air from the lungs that contains sputum, blood, or both. The sputum's color,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... A loud, harsh, musical respiratory sound, stridor results from a partial to near complete obstruction of the trachea or larynx. Usually heard during inspiration, this sign may also occur during expiration in severe upper airway obstruction. It may... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Wheezes are adventitious breath sounds with a high-pitched, musical, squealing, creaking, or groaning quality. They're caused by air flowing at a high velocity through a narrowed airway. When they originate in the large airways, they can be heard by... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
...
Both these symptoms are the result of the same pathophysiologic
mechanism: obstruction in the upper air passages. That obstruction may be
due to any one of the etiologies recalled by the mnemonic MINT.
M—... Pictures
... READ EXCERPTS »
...
The differential diagnosis of cough is best developed with the use of
anatomy. Cough may arise from an irritative focus anywhere along the
respiratory tract. The irritation may be intrinsic, in which case it
is usually... Pictures
... READ EXCERPTS »
... Debra Boyer
Approach to the Patient with Cough
I. Definition of the Complaint
Cough is one of the most common presenting complaints to pediatricians. Cough is
not a disease itself, ... Pictures
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... I. History of Present Illness
A 7-week-old boy presented to his pediatrician with a 3-week history of
rhinorrhea, congestion, and cough; previously he was in good health. He had no
history of fever. A chest roentgenogram demonstrated ... Pictures
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... I. History of Present Illness
A 7-month-old girl was well until 4 days before presentation, when she developed
a cough with fevers to 40.5
°C. On the day of presentation, she developed wheezing and a rash ... Pictures
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... I. History of Present Illness
A 4-month-old boy, who was born prematurely at 28 weeks' gestation, presented with a 1-week history of a cough. Over the next 4 days,
his mother reported an increasing cough with no history ... Pictures
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... I. History of Present Illness
A 14-day-old, full-term male infant was transferred from a local community
hospital for further evaluation and management of sepsis and
hyperbilirubinemia. He had been
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... I. History of Present Illness
An 8-day-old girl presented to the emergency department after an episode of
irregular, rapid breathing followed by stiffening of her body and shaking of
her
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... I. History of Present Illness
A 10-day-old boy was well until the day of admission, when he was noted by his
mother to have the sudden onset of left arm and leg shaking while sleeping. The
episode lasted about 1 minute ... Pictures
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... Margaret McNamara, MD Cough - BASICS Cough - description The result of a high-velocity expiration, which removes airway secretions, is generally reflexive, but may sometimes be voluntarily initiated or suppressed. Cough - pathophysiology ... Cough - DIAGNOSIS ... Cough - TREATMENT ... Cough - FOLLOW UP ... Cough - bibliography ... Cough - CODES ... Cough - FAQ
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... Laura K. Brennan, MDLouis M. Bell, Jr., MD
Pertussis - BASICS
Pertussis - description
Pertussis is a classic “whooping cough” syndrome of prolonged paroxysmal coughing spells with a characteristic inspiratory... Pertussis - DIAGNOSIS ... Pertussis - TREATMENT ... Pertussis - FOLLOW UP ... Pertussis - bibliography ... Pertussis - CODES ... Pertussis - FAQ
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