Upload
manoj-prabhakar
View
15
Download
0
Embed Size (px)
Citation preview
APPROACH TO COUGH
BY : Dr. Mahesh Yadav
Cough is an explosive expiration that provides a normal protective mechanism for clearing the tracheobronchial tree of secretions and foreign material.
DEFINITION
The bronchi and trachea are so sensitive to light touch that excessive amounts of foreign matter or other causes of irritation initiates the cough reflex.
Coughing may be initiated either voluntarily or reflexively
As a defensive reflex it has both afferent and efferent pathways
The afferent limb includes receptors within the sensory distribution of the trigeminal, glossopharyngeal, superior laryngeal, and vagus nerves.
The efferent limb includes the recurrent laryngeal nerve and the spinal nerves.
COUGH RECEPTORS RECIDES IN PHARYNX, PARANASAL SINUSES, STOMACH AND EXTRA-AUDITORY CANAL
CAUSE OF COUGH MAY BE EXTRAPULMONARY.
MechanismAbout 2.5L of air is inspired
Epiglottis closes, vocal cords shut tightly to entrap the air within the lung
Abdominal muscles contract forcefully, pushing against the diaphragm
Internal intercosatal muscles also contract forcefully
Pressure in the lungs rises to 100mmHg or more. Markedly positive intrathoracic pressure causes narrowing of the trachea.
Vocal cords and epiglottis suddenly open widely .
Air is expelled at velocities ranging from 75 to 100 miles/hr.
The shearing forces that develop aid in the elimination of mucus and foreign materials
Cough is therefore PROTECTIVE
MECHANISM OF COUGH
• How Do We Cough_ - The Mechanism of Coughing - Cough Reflex Animation - Learn Human Body.mp4
Thus..• From the mechanism..
• Presence of significant COUGH- irritation of cough receptors..
HOW WE NARROW OUR DIAGNOSIS WHILE APPROACHING
?????
STILL THINKING
MAY BE NEXT SLIDES WILL HELP
ASK THESE QUESTION
ONSET
PRODUCTIVE ?
CHARACTER AND TIMING
VARIATION
D/D
• Onset- sudden onset after choking episode- foreign body, recurrent- atopic type, chronic- TB, bronchiectasis
• Productive- older children with early morning severe expectoration- Bronchiectasis, non-productive and only when awake- habitual
• Character- Barking- croup, spasmodic- atopic type• Variation- nocturnal and early morning- atopic
type, lying down- GERD
ETIOLOGY
ACUTE
•1.INFANT •2.TODDLERS•3.CHILDREN•4.ADOLESCENT
RECURRENT
•1.INFANT•2.TODDLERS•3.CHILDREN•4.ADOLESCENT
CHRONIC >3WEEK
S
•1.INFANT•2.TODDLERS•3.CHILDREN•4.ADOLESCENT
ACUTE
•INFECTION•ASPIRATION•FOREIGN BODY
RECURRENT
•REACTIVE AIRWAYS•CF•GERD•ANATOMIC ABNORMALITY•PASSIVE SMOKING
CHRONIC
•REACTIVE AIRWAYS•CF•ASPIRATIONS•PERTUSSIS•ANATOMIC ABNORMALITY•PASSIVE SMOKING
ACUTE
•INFECTION
RECURRENT
•REACTIVE AIRWAYS•CF•GERD•PASSIVE SMOKING
CHRONIC
•Tuberculosis/ Bronchiectasis•REACTIVE AIRWAYS•CF•GERD•PERTUSSIS, MYCOPLASMA•PSYCHOGENIC•ANATOMIC ABNORMALITY •PASSIVE SMOKING
CAUTION• Pneumonia- involves
parenchyma• Cough receptors may not be
involved in the early stages
• Hence cough may be a late feature of lobar pneumonia- Fever with tachypnea +/- retractions is diagnostic of pneumonia
SPUTUM Productive cough: significant amount of
sputum; Blood- hemoptysis; smell- putrid smell- lung abscess
Color of sputum- no bearing on the diagnosis
Large amounts:-a)regular coughing up-bronchiectasis b)Single occasion-lung abscess,empyema
c)Pink frothy-Pulmonary edema
PURULENT SPUTUM
RUSTY SPUTUM
BLOODY SPUTUM
VARIATION
SEASONAL
DIURNAL
NO VARIATION
POSTURAL
1.Diurnal variationCough which gets worse in night and
early morning :- Asthma
2.Postural variation Bronchiectasis, Lung abscessLying down- postnasal drip, GERD,
cardiac cause- pulmonary congestion
3.Seasonal variationAsthma, C/c bronchitis
Aggravating & Relieving factorsCold,smoke,dust,exertion: asthma Cough and choking on swallowing of
liquids: Neuromuscular disorders- affects swallowing
Solids- Oesophageal motility problems Otogenic cough: impacted wax or
foreign body in external auditory meatus- subsides with removal of cause
Associated symptoms Fever: Pneumonia, lung abscess- clubbing also+ Chest pain: Pneumonia with pleuritis
Pleuritic chest pain: lateral part of chest with associated splinting- increases on deep inspiration/ cough- Pleurisy, pleural effusion, bronchiectasis
Frequent hawking of throat, Nasal discharge, snoring, tickling sensation in throat- Post nasal drip
Cough with associated dyspnea on exertion/ palpitations- Cardiac cause
Stridor: FB, Laryngeal nerve involvement
Hoarseness of voice: Laryngeal nerve involvement
Heart burn, regurgitation: GERD
NOT TO FORGET TO NOTE
.Laryngeal inflammation:-cough, hoarseness of voice,stridor
.FB:-cough,stridor,history
.WHOOP SOUND-pertussis• ALL DAY NEVER DURING SLEEP-habit cough
INFANT WITH WHOOPING COUGH
• My Movie.wmv
BABY WITH CROUP STRIDOR BARKING COUGH
• My Movie 2.wmv
.Post nasal drip;-nasal discharge… mucoid or mucopurulent,tickle in throat
.GERD:-cough,heart burns, regurgitation
6.Tuberculosis:-cough (dry…purulent …blood streaks in sputum), anorexia,LOW, night sweats, evening rise of temperature
•APPROACH TO TUBERCULOSIS
APPROACH TO FOREIGN BODY
APPROACH IN CHILD