Cough Cough

Respiratory System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P18_F1.jpg"}},{"insert":"\n\n"},{"insert":"Surprised by how cold it is, you find yourself rushing inside the hospital from your car. You quickly close the door behind you to keep the chill outside.\n\nAre you arrive at the pediatric clinic, you notice the large number of patients outside. Not surprising, given that this is the flu season.\n\n\u0022Good morning doctor. Are you ready to begin?\u0022 your secretary asks, as you enter your office. \u0022Just give me two minutes, please.\u0022 you reply.\n\nYou settle down in your chair, start up the electronic health record system, and ask for the first patient to be sent in.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P18_F2.jpg"}},{"insert":"\n\n"},{"insert":"You immediately recognize ten-month-old Ana Alvarez and her mother.\n\nThe Alvarez family migrated to the U.S. from Guatemala about three years ago. They live in a very low-income area and have had troubling social issues from time to time over the years.\n\nYou greet them warmly and ask Mrs. Alvarez why she brought her daughter over today. \u0022Ana\u0027s had fever and cough since two days ago,\u0022 she responds.\n\nA few follow-up questions reveal that Ana has also been unwilling to eat anything. Mrs. Alvarez tried giving her acetaminophen but did not see a significant improvement.\n\nAna has no medical conditions. Her growth and development are age-appropriate. All vaccines are up to date. There is no family history of atopy.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/P18_F3.jpg"}},{"insert":"\n\n"},{"insert":"On examination, Ana is visibly irritable and coughing intermittently.\n\nHer temperature is 99.8 \u00b0F (37.7 \u00b0C), heart rate is 120 bpm, blood pressure is 85\/40 mmHg, and respiratory rate is 55\/min. Her oxygen saturation is 93% on room air.\n\nYou note nasal flaring and bilateral subcostal retractions. Auscultation reveals bilateral expiratory wheezes.\n"}]}


{"ops":[{"insert":"What will you do now?\n"}]}
1. Manage her as an outpatient
2. Admit her to your ward