EM Forum Case #107 "The Nagging Cough"
by Charlene Babcock Irvin, MD, FACEP
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A 68 y/o spry grandmother presents with a ‘nagging cough’. She states she has
had the cough for 3 weeks. She saw her primary doctor who prescribed
antibiotics, but it made no difference. She has coughing spells that are worse
at night, and she coughs so hard her chest is sore. When she has a coughing
spell, she does feel short of breath. No fevers, vomiting (although she
sometimes gags with her coughing spells). The chest pain is pleuritic, increased
with coughing, and not associated with diaphoresis. She also notes her abdomen
is a little sore from coughing. No change in bowels or urination. Her
great-granddaughter who is only 2 months old is coming for Thanksgiving, and she
doesn’t want to make her sick, so she came to the ED for a stronger antibiotic.
PMH: HTN
SH: No smoking.
PE: Thin elderly female, sitting upright and comfortably on the cot.
VS: BP=148/90, HR=98, RR=20, Sat=95%
HEENT: Unremarkable.
Heart: RRR, No Murmurs
Lungs: Expiratory Wheeze at both bases with some rhonchi.
Abd: Soft, scaphoid. No masses. Non-tender.
Ext: Trace edema to both pre tibial areas.
Neurologic: Unremarkable.
Questions:
1. Name at least 3 causes for this ‘Nagging Cough.’
2. Any ED medications to help with the cough?
3. What cause of cough might be life threatening to the great-granddaughter?
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