# 90yoF dry cough



## SanDiegoEmt7 (Mar 4, 2013)

You AOS to find a 90yoF laying supine on top of her bed fully fully dressed, per family she has had an ongoing dry cough for a month, she has seen her doctor who diagnosed it as a postnasal drip, today she had a sudden episode of SOB after lunch, family wants her revaluated.

She appears to be resting comfortably, GCS 14 baseline, she has clear lungs all fields, pulse of 70-80 normal sinus on monitor with 6-10 PVCs a minute, BP 190/100, family states normal compliance with htn meds, Pt denies and CP or SOB and does not know why you are there.


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## truetiger (Mar 4, 2013)

Going to need a bit more info......

What exactly happened according to family? Med hx? SpO2? 12 lead? Meds?


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## medichopeful (Mar 4, 2013)

SanDiegoEmt7 said:


> family states normal compliance with htn meds



What HTN medication(s) would that be?  Does it possibly end in -pril?


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## VFlutter (Mar 4, 2013)

medichopeful said:


> What HTN medication(s) would that be?  Does it possibly end in -pril?



Damn you beat me to the ACE cough.


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## fma08 (Mar 4, 2013)

truetiger said:


> Going to need a bit more info......
> 
> What exactly happened according to family? Med hx? SpO2? 12 lead? Meds?




Ditto. Too soon to chalk it up to a bit of increased bradykinin.

Does she have any complaints? What did she lose the point on the GCS for? Did they change her meds a month ago? What meds is she on? PMH? Any other signs/symptoms in the last month? What did family mean by an episode of SOB? What do you have for an exam with the clear lung sounds? 12-lead?


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## medichopeful (Mar 4, 2013)

Chase said:


> Damn you beat me to the ACE cough.



That won't ever happen again Chase! :rofl:



SanDiegoEmt7 said:


> She appears to be resting comfortably, GCS 14 baseline, she has clear lungs all fields, pulse of 70-80 normal sinus on monitor with 6-10 PVCs a minute, BP 190/100, family states normal compliance with htn meds, Pt denies and CP or SOB and does not know why you are there.



On a separate but related note, I'd be much more concerned with the BP than the alleged shortness of breath.


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## Summit (Mar 4, 2013)

medichopeful said:


> On a separate but related note, I'd be much more concerned with the BP than the alleged shortness of breath.



Indeed... and ACE was a thought that immediately crossed my mind as well, but I then set it aside until I had a proper picture to build the list.


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## mycrofft (Mar 5, 2013)

The "sudden shortness of breath" is the alarm puller here.
What's with these PVC's? Heck, atrial fib can be interpreted as occasional PVC's with the right software loaded on.


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## Melclin (Mar 12, 2013)

Post-streptococcal glomerulonephritis. Kidney failure. Pulmonary oedema. 


Really though, I considered beta blocker cough but I didn't know ACE inhibitors were involved as well. 

If this weren't a scenario though, I'd be pretty uninterested in the cough and very much more interested in the sudden onset SOB. 

Arrythmia?


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## SanDiegoEmt7 (Mar 15, 2013)

history is frequently changing, but consistency in duration 1 month, intermittent in severity, weaker than normal, today became SOB, unprovoked lasting "few moments" but resolved, EKG "abnormalities not acute frequent pvcs" per the machine, no obvious ST elevation, some q wave, no med changes, can't remember the htn meds. 

In triage at hospital pt goes into bigeminy.


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## mycrofft (Mar 15, 2013)

Ruled out a neoplasm impinging on the trachea? Any dysphagia too?


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## Rialaigh (Mar 15, 2013)

She's comfortable, 

Nothing alarming about the BP given the history of HTN
Nothing alarming about a dry cough lasting a month given age or where she lives, especially if she was a smoker or worked in an industry in which lung damage is frequently caused. Could be allergies, could be a million other things that aren't serious.
Nothing alarming about the heart rate or PVC's.


Honestly I would be thinking a piece of food that she didn't swallow all the way at lunch, caused some coughing or SOB. Or a bit of sudden indigestion caused a bit of chest tightness and SOB. If the PT does not know why you are there then I'm not going to trust that she had only SOB with no other symptoms at all after eating, I'm more inclined to think the two are related. If she has been having a cough for a month and only had SOB one time today right after eating I  have to think those aren't related. 


From an EMS standpoint, airway is fine, vitals are fine, patient looks fine = patient is fine, I see an ER discharge after sitting for a couple hours, clear chest X-ray, good vitals, reccomendation to follow up with Family practice doc regarding BP


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## mycrofft (Mar 15, 2013)

_" Honestly I would be thinking a piece of food that she didn't swallow all the way at lunch, caused some coughing or SOB"_
(facepalm) I didn't think of that.

 Does she have dysphagia, not with pain, but with difficulty getting food to go down? (Lazy esophagus). A little side salad could get her coughing for an hour or more, and with coughing comes valsalva etc. Maybe even gastroesophageal  (GE) reflux.


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## Rialaigh (Mar 15, 2013)

mycrofft said:


> _" Honestly I would be thinking a piece of food that she didn't swallow all the way at lunch, caused some coughing or SOB"_
> (facepalm) I didn't think of that.
> 
> Does she have dysphagia, not with pain, but with difficulty getting food to go down? (Lazy esophagus). A little side salad could get her coughing for an hour or more, and with coughing comes valsalva etc. Maybe even gastroesophageal  (GE) reflux.



They are really beating it into us in P-class right now. Exhaust ALL "BLS" solutions before even thinking about ALS stuff. They then follow that up by saying, Exhaust ALL "even an idiot would think of that, common sense" solutions before considering BLS solutions.


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## SanDiegoEmt7 (Mar 15, 2013)

I didn't treat anything because the patient was asymptomatic with me, triage MICN ordered an EKG because of the PVCs, found to have a undertmined age NSTEMI, unknown what follow up care was done.


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## Rialaigh (Mar 15, 2013)

SanDiegoEmt7 said:


> I didn't treat anything because the patient was asymptomatic with me, triage MICN ordered an EKG because of the PVCs, found to have a undertmined age NSTEMI, unknown what follow up care was done.



also as a side note I have tried to get the bug off my screen multiple times <_<


I actually put my hand on my screen last night


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## Clare (Mar 15, 2013)

Damn it boys you are too good, you beat me to saying her cough was from ACE inhibitor! 

I hear that some people who get a cough from ACE inhibitors are now being put on angiotensin receptor blockers such as -sartin drugs.


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## mycrofft (Mar 15, 2013)

Have a protocol for cough syrup?


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## Rialaigh (Mar 16, 2013)

mycrofft said:


> Have a protocol for cough syrup?



lol, don't you get ID'd for that at the walgreens, hell we would prob have to call online medical control for that here


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## mycrofft (Mar 17, 2013)

Opioids are cough suppressants. Includes Vicodin.


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