Dismiss Notice
Last chance to give your feedback! Fill out the 2019 SDN Member Survey to let us know what's important to you (and win prizes!)

Question on chronic cough in kids

Discussion in 'Emergency Medicine' started by EctopicFetus, Mar 7, 2007.

  1. EctopicFetus

    EctopicFetus Keeping it funky enough
    10+ Year Member

    Joined:
    May 3, 2004
    Messages:
    10,562
    Likes Received:
    541
    Status:
    Attending Physician
    so this has come up a bit during my time in the peds ED.

    Whats your opinion / standard for a 16 yr old with cough for 2 weeks, cant sleep 2ndary to cough. How about for younger kids?

    I wanted to give some lortab (as I had in the past) but my attending stated that cough suppresion isnt recommended for kids.

    My opinion is that if these kids are coughing for that long the least I can do is help em sleep at night. Am I missing the "huge downside"?

    Your thoughts?
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  2. docB

    docB Chronically painful
    Physician Moderator Emeritus Lifetime Donor Verified Account 10+ Year Member

    Joined:
    Nov 27, 2002
    Messages:
    7,742
    Likes Received:
    213
    Status:
    Attending Physician
    First, of course, is to rule out badness. Is your 16 yo smoking or on BCPs? Could they have a PE, TB, pneumonia, etc.?

    That said, I don't see anything wrong in giving adolescents cough suppression. We all know that you can't treat kids like little adults but physiological adulthood isn't about voting ages either. I find that some pediatricians get uncomfortable about treating pain and other symptoms in kids who are basically physiologic adults.

    When I was a resident I was doing a peds rotation and had a 17 yo 240 lb, 6'1" male with a kidney stone. I started working like I work every other kidney stone. It fried the pediatrician's brain. He wouldn't let me give him morphine, no IVF, no motrin, no CT. He checked a UA, scheduled an out pt IVP (this was in 2002 so CT was by then firmly the study of choice), said you can't give NSAIDS because they are "hard on the kidneys" and sent the kid home with T#3s. Fortunately the kid came back to the ED the next day and I happened to be there and we got it straightened out. Thing was the pediatrician had never seen a kidney stone 'cause kids rarely get them. He was a lot more comfortable with a septic baby than with a run of the mill kidney stone.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  3. GiJoe

    GiJoe Senior Member
    7+ Year Member

    Joined:
    Mar 13, 2003
    Messages:
    299
    Likes Received:
    0
    albuterol helps
     
  4. OP
    OP
    EctopicFetus

    EctopicFetus Keeping it funky enough
    10+ Year Member

    Joined:
    May 3, 2004
    Messages:
    10,562
    Likes Received:
    541
    Status:
    Attending Physician
    So she already had Nebs and a MDI with spacer.

    Also docB, would you check a d-dimer? Even if she is sating 99-100? No risk factors etc? Just a question. I dont believe she was on OCPs.. but that would be a risk factor.

    Fetus
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  5. ERMudPhud

    ERMudPhud Back for a visit
    10+ Year Member

    Joined:
    Feb 24, 2003
    Messages:
    1,085
    Likes Received:
    23
    Here they get a pertussis swab, cxr, and hydrocodone with a follow up with their PCP. I'm seeing greater than 1 positive pertussis per month at this point
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  6. docB

    docB Chronically painful
    Physician Moderator Emeritus Lifetime Donor Verified Account 10+ Year Member

    Joined:
    Nov 27, 2002
    Messages:
    7,742
    Likes Received:
    213
    Status:
    Attending Physician
    I think if you can document no pleuritic pain, nl sat, no tachypnea and no tachycardia you can conclude no PE. The majority of teenage cough I see complain of pleuritic pain and if they're sick they often have some tachycardia. I'd say that if they are in that boat but have no other risk factors a neg Ddimer concludes the issue. If I think they're high risk I image them.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  7. DropkickMurphy

    DropkickMurphy Membership Revoked
    Removed

    Joined:
    Sep 13, 2005
    Messages:
    9,768
    Likes Received:
    21
    Status:
    Other Health Professions Student
    Perhaps adding a long acting bronchodilator would be a good suggestion, particularly in the setting of no relief from albuterol.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  8. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
    Moderator Physician Faculty Verified Expert 10+ Year Member

    Joined:
    Aug 2, 2006
    Messages:
    9,739
    Likes Received:
    6,059
    Status:
    Attending Physician
    Check for GERD.
     
  9. BADMD

    Physician 10+ Year Member

    Joined:
    Dec 28, 2006
    Messages:
    856
    Likes Received:
    34
    Status:
    Attending Physician
    Just to add to the list: mycoplasma

    Had that for 8 weeks in college and was coughing the whole time, until I got some erythro as a "just in case." Cleared up in 2 days.
     
  10. trkd

    10+ Year Member

    Joined:
    Dec 23, 2002
    Messages:
    719
    Likes Received:
    3
    Status:
    Attending Physician
    I was just about to say... what about the atypicals?? Maybe I am a newbie on the EM scene but my readings (and personal teenage years) say that the cough persists for up to 4 weeks (even after treatment). Sucks. And was always not recognized.
     
  11. OP
    OP
    EctopicFetus

    EctopicFetus Keeping it funky enough
    10+ Year Member

    Joined:
    May 3, 2004
    Messages:
    10,562
    Likes Received:
    541
    Status:
    Attending Physician
    Azithro should cover the atypicals.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  12. OP
    OP
    EctopicFetus

    EctopicFetus Keeping it funky enough
    10+ Year Member

    Joined:
    May 3, 2004
    Messages:
    10,562
    Likes Received:
    541
    Status:
    Attending Physician
    Question for DocB or others. same patient. lets say 16 yr old on OCPs cough for 2 weeks, rxed with azithro, albuterol, prednisone, still coughing. Normal sats, no tachypnea, no tachycardia, no resp distress.

    Send the D-Dimer? or no as vitals look good in this otherwise healthy 16 yr old?
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  13. docB

    docB Chronically painful
    Physician Moderator Emeritus Lifetime Donor Verified Account 10+ Year Member

    Joined:
    Nov 27, 2002
    Messages:
    7,742
    Likes Received:
    213
    Status:
    Attending Physician
    That's a good question. In that situation I would send the DDimer. The down side is that if it's positive I would feel obligated to get the CT. This is one of the reasons I continually say we (EPs) are expensive, poor quality primary care docs. The situation you describe could very appropriately be seen by a PMD and then referred to pulmo or given a different antibiotic or antiallergic med and followed up. In the ED we are appropriately trained to think of the worst possibility first and feel the need to ro PE.

    You also have to rely on your gut and your gestalt of the patient.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  14. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
    Moderator Physician Faculty Verified Expert 10+ Year Member

    Joined:
    Aug 2, 2006
    Messages:
    9,739
    Likes Received:
    6,059
    Status:
    Attending Physician
    Pertussis. Although Azithro should get it too. Maybe add some Biaxin, so that they know it is working.
     
  15. Apollyon

    Apollyon Screw the GST
    Physician Lifetime Donor Verified Expert Verified Account 15+ Year Member

    Joined:
    Nov 24, 2002
    Messages:
    19,791
    Likes Received:
    4,459
    Two macrolides? So, with the erythro, we complete the triple play.

    Don't add Biaxin.
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  16. Dr.McNinja

    Dr.McNinja Nobel War Prize Winner
    Moderator Physician Faculty Verified Expert 10+ Year Member

    Joined:
    Aug 2, 2006
    Messages:
    9,739
    Likes Received:
    6,059
    Status:
    Attending Physician
    Damn, forgot the italics.
    I was just mentioning the awful taste that a small percentage of people get.
     
  17. willlynilly

    willlynilly Senior Member
    10+ Year Member

    Joined:
    Sep 21, 2004
    Messages:
    213
    Likes Received:
    2
    screw it, get the cxray, tell em it's viral bronchitis, give them some t3's before bed.
     
  18. NinerNiner999

    NinerNiner999 Senior Member
    10+ Year Member

    Joined:
    Nov 5, 2003
    Messages:
    1,516
    Likes Received:
    226
    Status:
    Attending Physician
    Check out a monospot too - could be atypical presentation...
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  19. ispic

    ispic Get there!
    10+ Year Member

    Joined:
    Jan 12, 2003
    Messages:
    138
    Likes Received:
    0
    Status:
    Resident [Any Field]
    Being in AZ and all, how 'bout coccidiomycosis?
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...
  20. emedpa

    emedpa GlobalDoc
    10+ Year Member

    Joined:
    Aug 25, 2001
    Messages:
    6,014
    Likes Received:
    301
    Status:
    Post Doc
    assuming clear lungs how about considering a dx of sinusitis? post nasal drip worsens cough at night. z-pak is relatively poor coverage for sinusitis(per our I.D. folks) although biaxin would be ok....
     
    Stop hovering to collapse... Click to collapse... Hover to expand... Click to expand...

Share This Page