Cough & Dyspnea Diagnostic Approach
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- Originally a defense mechanism of the respiratory tract.
- Some diseases can stimulate the cough reflex.
- Chronic cough:
- Reflux (46.1%)
- Asthma (38.7%)
- Rhinitis (15.2%)
- Sensation of not having enough breath.
- Condition of painful and/or difficult breathing.
- Is a type of symptom ;
- Must be distinguished from increased work of breathing (labored breathing/tachypnea) which is a type of sign.
- Subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. - The American Thoracic Society.
- Uncomfortable awareness of breathing.
- Pulmonary System
- Non-Pulmonary System
- MI - Myocardial infarction
- Acute lung edema
- Cardial dyspnea
- CNS infection
- Thyroid crisis
- Panic disorder, etc.
- Acute or chronic
Top ten Cough & Dyspnea in Sardjito Hospital.
- Chronic or acute?
- Acute onset: Decide first whether it's cardial or non-cardial (pulmonary)
- Usually chronic are of pulmonary cause, except embolism and foreign body.
- Young or old (>50 years old)?
- Old man + acute: consider CARDIAL first.
- Pulse: if irregular, refer patient to ICCU.
- Trial Nitrate Sublingual: if patient's condition gets better → cardial cause.
- Febrile or non-febrile?
- Acute + febrile = lung infection.
- Acute + febrile + old man = worse.
- Refer to emergency room
- Oxygen first
- Consider any comorbid factor
- Renal impairment
- Chronic disease
Comorbid factor--> refer to emergency room.
- Oxygen 3-5 L/min with cannula or mask.
- Fowler's position.
- Determine :
- Pulmonary or Non-pulmonary
- Cardial or Non-cardial
- Presence of any comorbid factor → refer to emergency room.
- Give treatment for underlying cause.