Makindo Medical Notes

History Taking

• Onset and Duration:
  • When did the cough start? Was it sudden or gradual?
  • How long has the cough been present? Acute (<3 weeks), subacute (3-8 weeks), or chronic (>8 weeks)?
• Character of the Cough:
  • Is the cough dry, productive (with sputum), or barking?
  • Is there a "whooping" sound (consider pertussis)?
  • Is it worse at night (asthma, GERD) or after feeding (GERD)?
• Associated Symptoms:
  • Fever (suggests infection such as pneumonia or viral URTI)?
  • Shortness of breath, wheezing (asthma, bronchiolitis)?
  • Nasal congestion or rhinorrhea (viral infection, allergic rhinitis)?
  • Chest pain (pneumonia, pleuritis)?
  • Vomiting after cough (pertussis, GERD)?
  • Recent choking episodes (foreign body aspiration)?
• Past Medical History:
  • Any history of recurrent respiratory infections or asthma?
  • Any known allergies or history of eczema (suggests atopic disease)?
  • Exposure to smoking or environmental allergens?
• Vaccination Status:
  • Is the child up-to-date on immunizations, especially pertussis (whooping cough) and influenza vaccines?
• Family and Social History:
  • Any family history of asthma, allergies, or tuberculosis?
  • Exposure to sick contacts (school, daycare)?

Physical Examination

• General Appearance: Does the child appear in distress, fatigued, or comfortable?
• Respiratory System:
  • Auscultate for wheezing, crackles, or decreased breath sounds (pneumonia, asthma, bronchiolitis).
  • Check for stridor (croup, foreign body aspiration).
  • Observe the work of breathing: nasal flaring, chest retractions, or grunting (indicates respiratory distress).
• Vital Signs: Check for fever, tachypnea, and oxygen saturation levels.
• ENT Examination: Inspect for nasal congestion, throat redness, or post-nasal drip (allergic rhinitis, viral URTI).
• Cardiovascular Examination: Evaluate heart rate and rhythm, ruling out cardiac causes of cough such as heart failure.

Causes

Investigations (If Indicated)

• Chest X-ray: To assess for pneumonia, foreign body aspiration, or other lung pathology.
• Pulmonary Function Testing: Consider in older children for asthma diagnosis.
• Nasal Swabs: For viral PCR, especially in suspected cases of pertussis or viral bronchiolitis.
• Complete Blood Count (CBC): To assess for infection if pneumonia or a bacterial cause is suspected.
• Allergy Testing: If allergic rhinitis or asthma is suspected.

Management

• Supportive Care: Ensure adequate hydration, rest, and symptomatic relief (e.g., paracetamol for fever).
• Treat the Underlying Cause:
  • Antibiotics for bacterial pneumonia or pertussis.
  • Inhaled bronchodilators and corticosteroids for asthma.
  • Humidified air or steroids for croup.
  • Removal of foreign body through bronchoscopy if foreign body aspiration is suspected.
• Education: Educate parents about supportive care at home, medication administration, and red flag signs for seeking urgent medical attention.

Red Flags Requiring Immediate Attention

• Severe respiratory distress (nasal flaring, retractions, cyanosis).
• Persistent high fever or lethargy.
• Stridor or choking episodes.
• Worsening cough or signs of dehydration.
• Decreased oxygen saturation (<92%) on pulse oximetry.