CoughAPPROACH

RESPIRATORY · 19 SECTIONS

⚲

569 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Wheezing, Undifferentiated Wheezing In Infants Stridor And Upper Airway Symptoms Dyspnea Aspiration Event Cough Hemoptysis Upper Respiratory Infection Symptoms Suspected Pulmonary Embolism Presentation Smoke Inhalation Concern Smoke Exposure And Inhalational Injury

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx81

Context and trajectory

›Symptom overview

›Time course

›Pattern

›Progression

›Baseline respiratory status

›Prior similar episodes

Onset

›Onset details

›Sudden

›Gradual

›Triggering event

›Temporal relation to illness

Provocation/Palliation

›Modifiers

›Worse with exertion

›Worse at night

›Worse supine

›Worse with cold air

›Worse with allergens

›Relief with bronchodilator

›Relief with antitussive

Quality

›Cough character

›Dry

›Productive

›Paroxysmal

›Barking

›Whoop

›Posttussive emesis

›Hemoptysis

Region/Radiation

›Associated location features

›Throat irritation

›Chest tightness

›Pleuritic pain

›Upper airway congestion

Severity

›Severity and impact

›Sleep disruption

›Dyspnea with speech

›Activity limitation

›Syncope or presyncope with cough

›Frequency per hour

Timing

›Timing pattern

›Daytime predominant

›Nocturnal predominant

›Postprandial

›Seasonal

›After viral illness

›Duration category

›Acute under 3 weeks

›Subacute 3 to 8 weeks

›Chronic over 8 weeks

Associated symptoms

›Associated symptoms cluster

›Fever

›Dyspnea

›Wheeze

›Sore throat

›Rhinorrhea

›Chest pain

›Heartburn

›Hoarseness

›Weight loss

›Night sweats

Exposure and context

›Exposures

›Sick contacts

›Travel

›TB exposure risk

›Occupational inhalants

›Smoke exposure

›Vaping exposure

›Animal exposures

Special populations history

›High risk context

›Immunocompromised state

›Pregnancy

›Anticoagulation use

›Chronic lung disease history

›Congestive heart failure history

Pediatric specific history

›Pediatric features

›Age under 3 months

›Feeding intolerance

›Wet diaper count

›Apnea episodes

›Color change episodes

›Vaccination status

›Foreign body aspiration concern

02Alarm Features/alarm45

Immediate escalation triggers

›Resuscitation triggers

›Airway compromise

›Stridor at rest

›Cyanosis

›Apnea

›Exhaustion

›Altered mental status

›Silent chest

›Inability to speak full sentences

Vital sign danger thresholds

›High risk vitals

›Oxygen saturation under 90 percent on room air

›Respiratory rate rising trend

›Hypotension

›Fever with toxicity

›Persistent tachycardia

Hemoptysis and bleeding risk

›Bleeding red flags

›Large volume hemoptysis

›Anticoagulation with hemoptysis

›Hemodynamic instability

›Airway contamination risk

Infection and sepsis red flags

›Severe infection indicators

›Rigors

›Confusion

›Lactate elevation if obtained

›New hypoxia

›Multifocal crackles with toxicity

Pulmonary embolism red flags

›PE concern features

›Pleuritic chest pain with dyspnea

›Syncope

›Unilateral leg swelling

›Hemoptysis with risk factors

Malignancy and TB red flags

›Serious chronic disease indicators

›Weight loss

›Night sweats

›Persistent focal abnormal chest exam

›Persistent hemoptysis

›Known cancer history

Pediatric red flags

›Pediatric danger features

›Age under 3 months with respiratory symptoms

›Poor feeding or dehydration

›Apnea

›Lethargy

›Grunting

›Nasal flaring

›Retractions severe

03Medications/meds18

Current and recent medications

›Medication reconciliation

›Prescribed medications

›OTC medications

›Recent antibiotics

›Recent steroids

›Inhalers

›Nebulized therapies

›Recent medication changes

Medication causes of cough

›Offending agents

›ACE inhibitor associated cough

›Beta blocker bronchospasm risk

›NSAID induced bronchospasm risk

›Inhaled irritants

High risk medication interactions

›Interaction considerations

›QT prolonging combinations if macrolide considered

›Warfarin interactions with antibiotics

›Sedating antitussives in older adults

›Opioid risk in pediatric patients

04Diet/diet10

Intake and reflux triggers

›Dietary context

›Poor oral intake

›Dehydration risk

›Postprandial cough

›Heartburn symptoms

›Late evening meals

Caffeine and stimulant exposure

›Stimulant intake

›Caffeine

›Energy drinks

›Symptom association with intake

05Review of Systems/ros28

Respiratory

›Respiratory symptoms

›Dyspnea

›Wheeze

›Pleuritic pain

›Sputum change

›Hemoptysis

›Orthopnea

›Paroxysmal nocturnal dyspnea

Infectious and constitutional

›Systemic symptoms

›Fever

›Chills

›Myalgias

›Fatigue

›Weight loss

›Night sweats

ENT and GI

›Upper airway and reflux

›Rhinorrhea

›Postnasal drip

›Sore throat

›Hoarseness

›Heartburn

›Dysphagia

Cardiac and vascular

›Cardiovascular symptoms

›Chest pressure

›Palpitations

›Syncope

›Leg swelling

›Calf pain

06Collateral History and Family History/chafh11

Collateral sources and reliability

›Collateral

›Source

›Reliability

›Symptom timeline confirmation

›Medication confirmation

Family history

›Familial conditions

›Asthma

›Atopy

›Cystic fibrosis (E84.9)

›Early cardiovascular disease

›Thrombophilia history

07Risk Factors/rf24

Infection and exposure risks

›Exposure risks

›Close contact with respiratory illness

›Recent travel

›Congregate living

›Health care exposure

›Aspiration risk

Pulmonary embolism risks

›Thrombosis risks

›Recent surgery or immobilization

›Prior VTE

›Active malignancy

›Estrogen therapy

›Pregnancy and postpartum

Chronic lung and airway risks

›Airway risks

›Asthma history (J45.909)

›COPD history (J44.9)

›Smoking history

›Vaping history

›Occupational exposures

Immunocompromised risks

›Host risks

›HIV or AIDS (B20)

›Chronic steroid use

›Transplant history

›Chemotherapy

›Neutropenia

08Differential Diagnosis/ddx84

Life threatening

›Life threatening causes

›Airway foreign body (T17.9)

›Sudden onset

›Unilateral wheeze

›Choking episode

›Severe asthma exacerbation (J45.901)

›Silent chest

›Accessory muscle use

›Hypercapnia risk

›Anaphylaxis (T78.2)

›Urticaria

›Hypotension

›Angioedema

›Pulmonary embolism (I26.99)

›Pleuritic pain

›Unexplained hypoxia

›Risk factors present

›Pneumonia with respiratory failure (J18.9)

›Hypoxia

›Toxic appearance

›Focal consolidation

›Heart failure with pulmonary edema (I50.9)

›Orthopnea

›Crackles

›Elevated JVP

›Tension pneumothorax (J93.0)

›Sudden pleuritic pain

›Unilateral absent breath sounds

›Hemodynamic compromise

›Massive hemoptysis

›Airway flooding risk

›Hemodynamic compromise

Common

›Common causes

›Viral upper respiratory infection

›Rhinorrhea

›Sore throat

›Self limited course

›Acute bronchitis (J20.9)

›Cough under 3 weeks

›No focal consolidation

›Asthma exacerbation (J45.901)

›Wheeze

›Response to bronchodilator

›COPD exacerbation (J44.1)

›Increased sputum volume

›Increased sputum purulence

›Postnasal drip syndrome

›Throat clearing

›Nasal congestion

›Gastroesophageal reflux disease (K21.9)

›Heartburn

›Postprandial cough

Less common and cannot miss

›Less common causes

›Pertussis (A37.9)

›Paroxysmal cough

›Posttussive emesis

›Prolonged course

›Tuberculosis (A15.0)

›Night sweats

›Weight loss

›Hemoptysis

›Medication induced cough

›ACE inhibitor exposure

›Temporal relationship to start

›Interstitial lung disease (J84.9)

›Dry cough

›Exertional dyspnea

›Lung malignancy (C34.90)

›Persistent cough

›Hemoptysis

›Weight loss

›Aspiration pneumonitis

›Vomiting event

›Altered mental status risk

›Croup in pediatrics (J05.0)

›Barking cough

›Stridor

›Bronchiolitis in pediatrics (J21.9)

›Age under 2 years

›Diffuse wheeze

›Epiglottitis (J05.1)

›Drooling

›Tripod posture

›Toxic appearance

09Past Medical History/pmh19

Relevant comorbidities

›Comorbid history

›Asthma

›COPD

›Heart failure

›Coronary artery disease

›Chronic kidney disease

›Diabetes mellitus type 2 (E11.9)

›GERD

Prior events and baseline

›Prior respiratory course

›Prior ICU admissions

›Prior intubations

›Home oxygen use

›Baseline exercise tolerance

›Prior VTE

Procedures and devices

›Procedures and devices

›Tracheostomy history

›Home ventilation

›Implanted cardiac devices

›Recent endoscopy or sedation

10Physical Exam/exam41

General and vitals interpretation

›General assessment

›Work of breathing

›Ability to speak

›Toxic appearance

›Hydration status

›Mental status

›Vital signs pattern

›Oxygen saturation trend

›Fever pattern

›Tachycardia correlation with distress

›Blood pressure adequacy

Respiratory exam

›Lung findings

›Wheeze

›Crackles

›Rhonchi

›Stridor

›Focal decreased breath sounds

›Prolonged expiratory phase

›Use of accessory muscles

›Retractions in pediatrics

ENT and upper airway

›Upper airway findings

›Nasal congestion

›Oropharyngeal erythema

›Tonsillar exudate

›Uvular deviation

›Drooling

›Voice change

Cardiac and volume status

›Cardiovascular findings

›JVP elevation

›Peripheral edema

›New murmur

›S3 gallop

›Capillary refill

Extremities and thrombosis signs

›DVT findings

›Unilateral calf swelling

›Calf tenderness

›Asymmetric edema

Focused neurologic and safety

›Neurologic and safety

›Agitation from hypoxia

›Somnolence from hypercapnia

›Ability to protect airway

11Lab Studies/labs19

Core labs by scenario

›Targeted labs

›CBC for suspected infection

›Electrolytes for dehydration or beta agonist effects

›Creatinine for contrast planning

›Venous blood gas for ventilatory failure concern

›Lactate for sepsis concern

Infectious testing

›Pathogen tests

›Viral PCR local protocol dependent

›Influenza testing when antiviral decision dependent

›SARS CoV 2 testing when isolation or therapy decision dependent

›Pertussis PCR when paroxysmal cough over 2 weeks

Biomarkers and limitations

›Biomarkers

›Procalcitonin local protocol dependent

›BNP for heart failure probability support

›D dimer for low risk PE pathways

›Pitfalls

›Normal WBC does not exclude pneumonia

›Early viral testing false negatives possible

›D dimer elevated in pregnancy and inflammation

12Imaging/img36

Scoring Systems

›Pneumonia severity tools

›CURB 65

›PSI

›Utility

›Admission risk support

›Discharge support with stability

›Limitations

›Not validated for severe immunocompromise

›Clinical judgment required

›PE risk tools

›Wells criteria

›PERC

›Age adjusted D dimer

›Use when low or intermediate pretest probability

›Avoid when high pretest probability

MRI

›MRI role

›Limited role in undifferentiated cough

›Consider when alternative diagnosis suspected

›Mediastinal mass characterization

›Cardiac MRI for myocarditis concern

›CT indications

›CT pulmonary angiography for PE evaluation

›CT chest for malignancy or ILD concern

›CT neck for deep space infection concern

›CT cautions

›Contrast nephropathy risk discussion

›Contrast allergy history

›Pregnancy radiation risk minimization

Ultrasound

›POCUS lung and heart

›B lines for pulmonary edema support

›Pleural effusion identification

›Consolidation patterns

›Right heart strain supportive findings for PE

›POCUS pitfalls

›Operator dependence

›Limited sensitivity for small pneumothorax in some windows

13Special Tests/spec14

Bedside respiratory assessment

›Bedside tests

›Peak expiratory flow for asthma severity trending

›End tidal CO2 for ventilatory status trending

›Ambulatory oximetry for exertional desaturation

Microbiology and airway evaluation

›Focused diagnostics

›Sputum culture in severe pneumonia or immunocompromised

›Blood cultures in septic physiology

›TB testing pathway local protocol dependent

›Bronchoscopy referral pathway for persistent hemoptysis

Pediatric focused tests

›Pediatric diagnostics

›Nasopharyngeal suction sample when bronchiolitis management depends on cohorting

›Foreign body evaluation pathway

›Sudden onset with asymmetric exam

›Consider rigid bronchoscopy consult

14ECG/ecg10

When ECG helps

›ECG indications

›Chest pain with cough

›Dyspnea disproportionate to exam

›PE concern

›Syncope with cough

High risk patterns

›ECG red flags

›New ischemic changes

›New right heart strain pattern

›New arrhythmia

›QT prolongation before QT active antibiotics

15Assessment/ax25

Problem representation

›Working problem list

›Cough with stability status

›Hypoxia presence

›Bronchospasm presence

›Focal lung findings presence

›Hemoptysis presence

Leading diagnoses with risk tier

›Likely diagnosis tiering

›Viral bronchitis

›Stable vitals

›No focal consolidation

›Asthma exacerbation (J45.901)

›Wheeze

›Bronchodilator response

›Pneumonia (J18.9)

›Fever

›Focal findings

›Heart failure (I50.9)

›Orthopnea

›B lines or edema signs

Uncertainty and cannot miss

›Must not miss list

›PE (I26.99)

›Pneumothorax (J93.9)

›Severe asthma (J45.901)

›Epiglottitis (J05.1)

›Foreign body (T17.9)

16Plan/plan55

First 5 minutes workflow

›Initial stabilization

›Monitor

›Cardiac monitor

›Pulse oximetry

›Noninvasive blood pressure

›Oxygen strategy

›Nasal cannula for mild hypoxia

›Nonrebreather for moderate hypoxia

›High flow nasal cannula when persistent hypoxia with increased work

›Airway readiness triggers

›Rising CO2 concern

›Exhaustion

›Altered mental status

›IV access criteria

›Hypoxia requiring high flow

›Sepsis concern

›Need for IV medications

Diagnostic sequencing

›Diagnostic pathway

›Chest radiograph when pneumonia or heart failure concern

›Viral testing when changes isolation or therapy

›PE pathway

›Risk stratification tool

›D dimer when appropriate

›CT pulmonary angiography when indicated

›Blood gas strategy

›Venous blood gas for ventilatory failure concern

›Arterial blood gas when severe hypoxia with unclear cause

Therapeutics by phenotype

›Bronchospasm treatment

›Salbutamol inhaled 4 to 8 puffs via spacer

›Repeat every 20 minutes for 1 hour if severe

›Ipratropium inhaled 4 to 8 puffs via spacer

›Prednisone PO 50 mg once daily

›Duration 5 days local protocol dependent

›Pneumonia treatment

›Antibiotic selection local protocol dependent

›Avoid antibiotics for uncomplicated acute bronchitis

›Sepsis bundle when shock physiology

›Croup treatment

›Dexamethasone PO or IM 0.6 mg per kg

›Maximum 10 mg

›Nebulized epinephrine for stridor at rest local protocol dependent

›GERD and upper airway cough syndrome pathway

›Trial therapy outpatient when stable

›Avoid empiric antibiotics

Reassessment loop

›Reassessment timing

›After each bronchodilator cycle

›Every 30 to 60 minutes in moderate respiratory distress

›Vital sign trend documentation

›Oxygen requirement trend

›Work of breathing trend

Consultation plan

›Consult triggers

›ENT for suspected epiglottitis or deep neck infection

›Pulmonology for persistent hemoptysis or suspected ILD

›ICU for escalating oxygen requirement or hypercapnia

›Pediatrics for infant respiratory distress

17Disposition/dispo22

ICU and monitored bed criteria

›Higher level of care criteria

›Persistent hypoxia despite high flow oxygen

›Rising CO2 with altered mental status

›Hemodynamic instability

›Severe work of breathing with fatigue

›Massive hemoptysis risk

Admission and observation criteria

›Inpatient or observation criteria

›Pneumonia with hypoxia

›Inability to maintain oral intake

›High risk comorbidities with instability

›Recurrent bronchodilator needs

›Social unreliability for follow up

Discharge criteria

›Discharge criteria

›Stable oxygen saturation on room air or baseline

›Improved work of breathing

›Tolerating oral intake

›Clear follow up plan

›Return precautions understood

Pediatric disposition criteria

›Pediatric disposition

›Age under 3 months with symptoms requires low threshold admission

›Persistent retractions or apnea observation

›Caregiver reliability for home monitoring

18Discharge Instructions/di17

Copy discharge instructions

›Discharge text

›Today you were seen for cough

›Your exam and tests did not show an emergency cause based on what was done today

›Take medications exactly as prescribed

›Use your inhaler as directed if you have wheezing or asthma

›Drink fluids and rest as needed

›Avoid smoking and vaping exposure

›Follow up with your primary care clinician within 2 to 3 days if not improving

›Return to the emergency department now for breathing trouble

›Return to the emergency department now for lips or face turning blue

›Return to the emergency department now for chest pain

›Return to the emergency department now for fainting

›Return to the emergency department now for coughing up blood

›Return to the emergency department now for worsening fever or severe weakness

›For infants and children return now for poor feeding

›For infants and children return now for fewer wet diapers

›For infants and children return now for pauses in breathing

19References/r10

Guidelines and decision tools

›Key sources

›American College of Chest Physicians cough guidelines 2006 with updates

›European Respiratory Society chronic cough guideline 2020

›British Thoracic Society clinical statement chronic cough 2023

›IDSA ATS community acquired pneumonia guideline 2019

›Global Initiative for Asthma strategy report 2024

›American Academy of Pediatrics bronchiolitis guideline 2014 reaffirmed updates local protocol dependent

›Project instructions source

›Formatting constraints applied

›Checkbox only structure applied

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.

CoughAPPROACH

RESPIRATORY · 19 SECTIONS

⚲

569 items

☷ Legend

⚲

Resuscitation and Universal Approaches9▾

Chest and Cardiovascular12▾

Respiratory11▾

Abdominal and Gastrointestinal24▾

Renal and Urinary7▾

Neurologic11▾

Back and Neck8▾

Women's Health, Pregnancy, and GU11▾

Infectious Disease and Fever Syndromes11▾

Allergy and Dermatology7▾

Musculoskeletal and Extremities14▾

Trauma and Wounds14▾

ENT, Eye, Dental10▾

Endocrine, Metabolic, and Abnormal Labs9▾

Toxicology and Behavioral14▾

Pediatrics16▾

Environmental and Exposure4▾

01History/hx81

Context and trajectory

›Symptom overview

›Time course

›Pattern

›Progression

›Baseline respiratory status

›Prior similar episodes

Onset

›Onset details

›Sudden

›Gradual

›Triggering event

›Temporal relation to illness

Provocation/Palliation

›Modifiers

›Worse with exertion

›Worse at night

›Worse supine

›Worse with cold air

›Worse with allergens

›Relief with bronchodilator

›Relief with antitussive

Quality

›Cough character

›Dry

›Productive

›Paroxysmal

›Barking

›Whoop

›Posttussive emesis

›Hemoptysis

Region/Radiation

›Associated location features

›Throat irritation

›Chest tightness

›Pleuritic pain

›Upper airway congestion

Severity

›Severity and impact

›Sleep disruption

›Dyspnea with speech

›Activity limitation

›Syncope or presyncope with cough

›Frequency per hour

Timing

›Timing pattern

›Daytime predominant

›Nocturnal predominant

›Postprandial

›Seasonal

›After viral illness

›Duration category

›Acute under 3 weeks

›Subacute 3 to 8 weeks

›Chronic over 8 weeks

Associated symptoms

›Associated symptoms cluster

›Fever

›Dyspnea

›Wheeze

›Sore throat

›Rhinorrhea

›Chest pain

›Heartburn

›Hoarseness

›Weight loss

›Night sweats

Exposure and context

›Exposures

›Sick contacts

›Travel

›TB exposure risk

›Occupational inhalants

›Smoke exposure

›Vaping exposure

›Animal exposures

Special populations history

›High risk context

›Immunocompromised state

›Pregnancy

›Anticoagulation use

›Chronic lung disease history

›Congestive heart failure history

Pediatric specific history

›Pediatric features

›Age under 3 months

›Feeding intolerance

›Wet diaper count

›Apnea episodes

›Color change episodes

›Vaccination status

›Foreign body aspiration concern

02Alarm Features/alarm45

Immediate escalation triggers

›Resuscitation triggers

›Airway compromise

›Stridor at rest

›Cyanosis

›Apnea

›Exhaustion

›Altered mental status

›Silent chest

›Inability to speak full sentences

Vital sign danger thresholds

›High risk vitals

›Oxygen saturation under 90 percent on room air

›Respiratory rate rising trend

›Hypotension

›Fever with toxicity

›Persistent tachycardia

Hemoptysis and bleeding risk

›Bleeding red flags

›Large volume hemoptysis

›Anticoagulation with hemoptysis

›Hemodynamic instability

›Airway contamination risk

Infection and sepsis red flags

›Severe infection indicators

›Rigors

›Confusion

›Lactate elevation if obtained

›New hypoxia

›Multifocal crackles with toxicity

Pulmonary embolism red flags

›PE concern features

›Pleuritic chest pain with dyspnea

›Syncope

›Unilateral leg swelling

›Hemoptysis with risk factors

Malignancy and TB red flags

›Serious chronic disease indicators

›Weight loss

›Night sweats

›Persistent focal abnormal chest exam

›Persistent hemoptysis

›Known cancer history

Pediatric red flags

›Pediatric danger features

›Age under 3 months with respiratory symptoms

›Poor feeding or dehydration

›Apnea

›Lethargy

›Grunting

›Nasal flaring

›Retractions severe

03Medications/meds18

Current and recent medications

›Medication reconciliation

›Prescribed medications

›OTC medications

›Recent antibiotics

›Recent steroids

›Inhalers

›Nebulized therapies

›Recent medication changes

Medication causes of cough

›Offending agents

›ACE inhibitor associated cough

›Beta blocker bronchospasm risk

›NSAID induced bronchospasm risk

›Inhaled irritants

High risk medication interactions

›Interaction considerations

›QT prolonging combinations if macrolide considered

›Warfarin interactions with antibiotics

›Sedating antitussives in older adults

›Opioid risk in pediatric patients

04Diet/diet10

Intake and reflux triggers

›Dietary context

›Poor oral intake

›Dehydration risk

›Postprandial cough

›Heartburn symptoms

›Late evening meals

Caffeine and stimulant exposure

›Stimulant intake

›Caffeine

›Energy drinks

›Symptom association with intake

05Review of Systems/ros28

Respiratory

›Respiratory symptoms

›Dyspnea

›Wheeze

›Pleuritic pain

›Sputum change

›Hemoptysis

›Orthopnea

›Paroxysmal nocturnal dyspnea

Infectious and constitutional

›Systemic symptoms

›Fever

›Chills

›Myalgias

›Fatigue

›Weight loss

›Night sweats

ENT and GI

›Upper airway and reflux

›Rhinorrhea

›Postnasal drip

›Sore throat

›Hoarseness

›Heartburn

›Dysphagia

Cardiac and vascular

›Cardiovascular symptoms

›Chest pressure

›Palpitations

›Syncope

›Leg swelling

›Calf pain

06Collateral History and Family History/chafh11

Collateral sources and reliability

›Collateral

›Source

›Reliability

›Symptom timeline confirmation

›Medication confirmation

Family history

›Familial conditions

›Asthma

›Atopy

›Cystic fibrosis (E84.9)

›Early cardiovascular disease

›Thrombophilia history

07Risk Factors/rf24

Infection and exposure risks

›Exposure risks

›Close contact with respiratory illness

›Recent travel

›Congregate living

›Health care exposure

›Aspiration risk

Pulmonary embolism risks

›Thrombosis risks

›Recent surgery or immobilization

›Prior VTE

›Active malignancy

›Estrogen therapy

›Pregnancy and postpartum

Chronic lung and airway risks

›Airway risks

›Asthma history (J45.909)

›COPD history (J44.9)

›Smoking history

›Vaping history

›Occupational exposures

Immunocompromised risks

›Host risks

›HIV or AIDS (B20)

›Chronic steroid use

›Transplant history

›Chemotherapy

›Neutropenia

08Differential Diagnosis/ddx84

Life threatening

›Life threatening causes

›Airway foreign body (T17.9)

›Sudden onset

›Unilateral wheeze

›Choking episode

›Severe asthma exacerbation (J45.901)

›Silent chest

›Accessory muscle use

›Hypercapnia risk

›Anaphylaxis (T78.2)

›Urticaria

›Hypotension

›Angioedema

›Pulmonary embolism (I26.99)

›Pleuritic pain

›Unexplained hypoxia

›Risk factors present

›Pneumonia with respiratory failure (J18.9)

›Hypoxia

›Toxic appearance

›Focal consolidation

›Heart failure with pulmonary edema (I50.9)

›Orthopnea

›Crackles

›Elevated JVP

›Tension pneumothorax (J93.0)

›Sudden pleuritic pain

›Unilateral absent breath sounds

›Hemodynamic compromise

›Massive hemoptysis

›Airway flooding risk

›Hemodynamic compromise

Common

›Common causes

›Viral upper respiratory infection

›Rhinorrhea

›Sore throat

›Self limited course

›Acute bronchitis (J20.9)

›Cough under 3 weeks

›No focal consolidation

›Asthma exacerbation (J45.901)

›Wheeze

›Response to bronchodilator

›COPD exacerbation (J44.1)

›Increased sputum volume

›Increased sputum purulence

›Postnasal drip syndrome

›Throat clearing

›Nasal congestion

›Gastroesophageal reflux disease (K21.9)

›Heartburn

›Postprandial cough

Less common and cannot miss

›Less common causes

›Pertussis (A37.9)

›Paroxysmal cough

›Posttussive emesis

›Prolonged course

›Tuberculosis (A15.0)

›Night sweats

›Weight loss

›Hemoptysis

›Medication induced cough

›ACE inhibitor exposure

›Temporal relationship to start

›Interstitial lung disease (J84.9)

›Dry cough

›Exertional dyspnea

›Lung malignancy (C34.90)

›Persistent cough

›Hemoptysis

›Weight loss

›Aspiration pneumonitis

›Vomiting event

›Altered mental status risk

›Croup in pediatrics (J05.0)

›Barking cough

›Stridor

›Bronchiolitis in pediatrics (J21.9)

›Age under 2 years

›Diffuse wheeze

›Epiglottitis (J05.1)

›Drooling

›Tripod posture

›Toxic appearance

09Past Medical History/pmh19

Relevant comorbidities

›Comorbid history

›Asthma

›COPD

›Heart failure

›Coronary artery disease

›Chronic kidney disease

›Diabetes mellitus type 2 (E11.9)

›GERD

Prior events and baseline

›Prior respiratory course

›Prior ICU admissions

›Prior intubations

›Home oxygen use

›Baseline exercise tolerance

›Prior VTE

Procedures and devices

›Procedures and devices

›Tracheostomy history

›Home ventilation

›Implanted cardiac devices

›Recent endoscopy or sedation

10Physical Exam/exam41

General and vitals interpretation

›General assessment

›Work of breathing

›Ability to speak

›Toxic appearance

›Hydration status

›Mental status

›Vital signs pattern

›Oxygen saturation trend

›Fever pattern

›Tachycardia correlation with distress

›Blood pressure adequacy

Respiratory exam

›Lung findings

›Wheeze

›Crackles

›Rhonchi

›Stridor

›Focal decreased breath sounds

›Prolonged expiratory phase

›Use of accessory muscles

›Retractions in pediatrics

ENT and upper airway

›Upper airway findings

›Nasal congestion

›Oropharyngeal erythema

›Tonsillar exudate

›Uvular deviation

›Drooling

›Voice change

Cardiac and volume status

›Cardiovascular findings

›JVP elevation

›Peripheral edema

›New murmur

›S3 gallop

›Capillary refill

Extremities and thrombosis signs

›DVT findings

›Unilateral calf swelling

›Calf tenderness

›Asymmetric edema

Focused neurologic and safety

›Neurologic and safety

›Agitation from hypoxia

›Somnolence from hypercapnia

›Ability to protect airway

11Lab Studies/labs19

Core labs by scenario

›Targeted labs

›CBC for suspected infection

›Electrolytes for dehydration or beta agonist effects

›Creatinine for contrast planning

›Venous blood gas for ventilatory failure concern

›Lactate for sepsis concern

Infectious testing

›Pathogen tests

›Viral PCR local protocol dependent

›Influenza testing when antiviral decision dependent

›SARS CoV 2 testing when isolation or therapy decision dependent

›Pertussis PCR when paroxysmal cough over 2 weeks

Biomarkers and limitations

›Biomarkers

›Procalcitonin local protocol dependent

›BNP for heart failure probability support

›D dimer for low risk PE pathways

›Pitfalls

›Normal WBC does not exclude pneumonia

›Early viral testing false negatives possible

›D dimer elevated in pregnancy and inflammation

12Imaging/img36

Scoring Systems

›Pneumonia severity tools

›CURB 65

›PSI

›Utility

›Admission risk support

›Discharge support with stability

›Limitations

›Not validated for severe immunocompromise

›Clinical judgment required

›PE risk tools

›Wells criteria

›PERC

›Age adjusted D dimer

›Use when low or intermediate pretest probability

›Avoid when high pretest probability

MRI

›MRI role

›Limited role in undifferentiated cough

›Consider when alternative diagnosis suspected

›Mediastinal mass characterization

›Cardiac MRI for myocarditis concern

›CT indications

›CT pulmonary angiography for PE evaluation

›CT chest for malignancy or ILD concern

›CT neck for deep space infection concern

›CT cautions

›Contrast nephropathy risk discussion

›Contrast allergy history

›Pregnancy radiation risk minimization

Ultrasound

›POCUS lung and heart

›B lines for pulmonary edema support

›Pleural effusion identification

›Consolidation patterns

›Right heart strain supportive findings for PE

›POCUS pitfalls

›Operator dependence

›Limited sensitivity for small pneumothorax in some windows

13Special Tests/spec14

Bedside respiratory assessment

›Bedside tests

›Peak expiratory flow for asthma severity trending

›End tidal CO2 for ventilatory status trending

›Ambulatory oximetry for exertional desaturation

Microbiology and airway evaluation

›Focused diagnostics

›Sputum culture in severe pneumonia or immunocompromised

›Blood cultures in septic physiology

›TB testing pathway local protocol dependent

›Bronchoscopy referral pathway for persistent hemoptysis

Pediatric focused tests

›Pediatric diagnostics

›Nasopharyngeal suction sample when bronchiolitis management depends on cohorting

›Foreign body evaluation pathway

›Sudden onset with asymmetric exam

›Consider rigid bronchoscopy consult

14ECG/ecg10

When ECG helps

›ECG indications

›Chest pain with cough

›Dyspnea disproportionate to exam

›PE concern

›Syncope with cough

High risk patterns

›ECG red flags

›New ischemic changes

›New right heart strain pattern

›New arrhythmia

›QT prolongation before QT active antibiotics

15Assessment/ax25

Problem representation

›Working problem list

›Cough with stability status

›Hypoxia presence

›Bronchospasm presence

›Focal lung findings presence

›Hemoptysis presence

Leading diagnoses with risk tier

›Likely diagnosis tiering

›Viral bronchitis

›Stable vitals

›No focal consolidation

›Asthma exacerbation (J45.901)

›Wheeze

›Bronchodilator response

›Pneumonia (J18.9)

›Fever

›Focal findings

›Heart failure (I50.9)

›Orthopnea

›B lines or edema signs

Uncertainty and cannot miss

›Must not miss list

›PE (I26.99)

›Pneumothorax (J93.9)

›Severe asthma (J45.901)

›Epiglottitis (J05.1)

›Foreign body (T17.9)

16Plan/plan55

First 5 minutes workflow

›Initial stabilization

›Monitor

›Cardiac monitor

›Pulse oximetry

›Noninvasive blood pressure

›Oxygen strategy

›Nasal cannula for mild hypoxia

›Nonrebreather for moderate hypoxia

›High flow nasal cannula when persistent hypoxia with increased work

›Airway readiness triggers

›Rising CO2 concern

›Exhaustion

›Altered mental status

›IV access criteria

›Hypoxia requiring high flow

›Sepsis concern

›Need for IV medications

Diagnostic sequencing

›Diagnostic pathway

›Chest radiograph when pneumonia or heart failure concern

›Viral testing when changes isolation or therapy

›PE pathway

›Risk stratification tool

›D dimer when appropriate

›CT pulmonary angiography when indicated

›Blood gas strategy

›Venous blood gas for ventilatory failure concern

›Arterial blood gas when severe hypoxia with unclear cause

Therapeutics by phenotype

›Bronchospasm treatment

›Salbutamol inhaled 4 to 8 puffs via spacer

›Repeat every 20 minutes for 1 hour if severe

›Ipratropium inhaled 4 to 8 puffs via spacer

›Prednisone PO 50 mg once daily

›Duration 5 days local protocol dependent

›Pneumonia treatment

›Antibiotic selection local protocol dependent

›Avoid antibiotics for uncomplicated acute bronchitis

›Sepsis bundle when shock physiology

›Croup treatment

›Dexamethasone PO or IM 0.6 mg per kg

›Maximum 10 mg

›Nebulized epinephrine for stridor at rest local protocol dependent

›GERD and upper airway cough syndrome pathway

›Trial therapy outpatient when stable

›Avoid empiric antibiotics

Reassessment loop

›Reassessment timing

›After each bronchodilator cycle

›Every 30 to 60 minutes in moderate respiratory distress

›Vital sign trend documentation

›Oxygen requirement trend

›Work of breathing trend

Consultation plan

›Consult triggers

›ENT for suspected epiglottitis or deep neck infection

›Pulmonology for persistent hemoptysis or suspected ILD

›ICU for escalating oxygen requirement or hypercapnia

›Pediatrics for infant respiratory distress

17Disposition/dispo22

ICU and monitored bed criteria

›Higher level of care criteria

›Persistent hypoxia despite high flow oxygen

›Rising CO2 with altered mental status

›Hemodynamic instability

›Severe work of breathing with fatigue

›Massive hemoptysis risk

Admission and observation criteria

›Inpatient or observation criteria

›Pneumonia with hypoxia

›Inability to maintain oral intake

›High risk comorbidities with instability

›Recurrent bronchodilator needs

›Social unreliability for follow up

Discharge criteria

›Discharge criteria

›Stable oxygen saturation on room air or baseline

›Improved work of breathing

›Tolerating oral intake

›Clear follow up plan

›Return precautions understood

Pediatric disposition criteria

›Pediatric disposition

›Age under 3 months with symptoms requires low threshold admission

›Persistent retractions or apnea observation

›Caregiver reliability for home monitoring

18Discharge Instructions/di17

Copy discharge instructions

›Discharge text

›Today you were seen for cough

›Your exam and tests did not show an emergency cause based on what was done today

›Take medications exactly as prescribed

›Use your inhaler as directed if you have wheezing or asthma

›Drink fluids and rest as needed

›Avoid smoking and vaping exposure

›Follow up with your primary care clinician within 2 to 3 days if not improving

›Return to the emergency department now for breathing trouble

›Return to the emergency department now for lips or face turning blue

›Return to the emergency department now for chest pain

›Return to the emergency department now for fainting

›Return to the emergency department now for coughing up blood

›Return to the emergency department now for worsening fever or severe weakness

›For infants and children return now for poor feeding

›For infants and children return now for fewer wet diapers

›For infants and children return now for pauses in breathing

19References/r10

Guidelines and decision tools

›Key sources

›American College of Chest Physicians cough guidelines 2006 with updates

›European Respiratory Society chronic cough guideline 2020

›British Thoracic Society clinical statement chronic cough 2023

›IDSA ATS community acquired pneumonia guideline 2019

›Global Initiative for Asthma strategy report 2024

›American Academy of Pediatrics bronchiolitis guideline 2014 reaffirmed updates local protocol dependent

›Project instructions source

›Formatting constraints applied

›Checkbox only structure applied

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed February 24, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.