Upper Respiratory Infection SymptomsAPPROACH

RESPIRATORY · 19 SECTIONS

⚲

522 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/hx119

Symptom characterization

›Upper respiratory symptom syndrome

›Time course

›Onset date

›Duration

›Pattern

›Sudden

›Gradual

›Waxing and waning

›Primary symptom cluster

›Nasal

›Congestion

›Rhinorrhea

›Sneezing

›Post nasal drip

›Throat

›Sore throat

›Hoarseness

›Odynophagia

›Cough

›Dry

›Productive

›Nocturnal

›Systemic

›Feverishness

›Myalgias

›Fatigue

OPQRST

›Symptom focus selection

›Dominant symptom

›Sore throat

›Cough

›Nasal congestion

›Ear pain

›OPQRST applicability

›Use for dominant symptom

›Omit for non symptom complaints

Onset

›Onset

›Time of first symptoms

›Hours

›Days

›Context at onset

›Sick contact exposure

›Travel

›New daycare

Provocation/Palliation

›Provocation and palliation

›Worse with

›Supine position

›Cold air

›Exertion

›Better with

›Fluids

›Humidified air

›Analgesics

Quality

›Quality

›Throat pain quality

›Burning

›Scratchy

›Sharp

›Nasal discharge quality

›Watery

›Mucoid

›Purulent appearing

Region/Radiation

›Region and radiation

›Throat location

›Anterior

›Unilateral

›Diffuse

›Radiation

›Ear

›Jaw

Severity

›Severity

›Functional impact

›Oral intake limitation

›Sleep disruption

›Peak severity timing

›Day 1 to 2

›Day 3 to 4

Timing

›Timing

›Daily pattern

›Morning worse

›Night worse

›Trajectory

›Improving

›Stable

›Worsening

Associated symptoms

›Associated symptoms

›Infection features

›Fever

›Chills

›Night sweats

›Respiratory features

›Dyspnea

›Wheeze

›Pleuritic chest pain

›ENT features

›Ear pain

›Sinus pressure

›Anosmia

›GI features

›Nausea

›Vomiting

›Diarrhea

Prior episodes and baseline

›Baseline and prior episodes

›Similar prior URI frequency

›Recurrent

›Rare

›Baseline respiratory status

›Asthma control

›COPD symptoms

Special populations

›Population modifiers

›Pregnancy status

›Gestational age

›Hyperemesis

›Immunocompromised status

›Solid organ transplant

›Chemotherapy

›Advanced HIV

›Pediatrics considerations

›Age under 3 months

›Feeding difficulty

02Alarm Features/alarm44

Immediate escalation triggers

›High risk triggers

›Airway risk

›Stridor

›Drooling

›Muffled voice

›Respiratory compromise

›Severe dyspnea

›Hypoxemia

›Exhaustion

›Systemic toxicity

›Altered mental status

›Rigors

›Poor perfusion

Vital sign danger thresholds

›Vital sign danger thresholds

›Oxygen saturation

›Persistent under 92 percent on room air

›Increasing oxygen requirement

›Respiratory rate

›Adult over 30

›Pediatric age adjusted tachypnea

›Hemodynamics

›SBP under 90 mmHg

›HR over 130 with toxicity

High risk historical patterns

›High risk symptom patterns

›Neck and throat

›Inability to swallow secretions

›Trismus

›Rapidly progressive unilateral throat pain

›Sinus and face

›Periorbital swelling

›Vision change

›Chest

›Pleuritic pain with dyspnea

›Hemoptysis

High risk exam findings

›High risk exam findings

›Oropharynx

›Uvular deviation

›Tonsillar abscess appearance

›Neck

›Tender swelling

›Crepitus

›Lungs

›Focal crackles

›Increased work of breathing

03Medications/meds21

Current medications and interactions

›Medication inventory

›Prescribed

›Antibiotics in last 30 days

›Inhaled corticosteroids

›OTC

›Acetaminophen

›Ibuprofen

›Decongestants

›Supplements

›Herbal cold remedies

›Zinc

Contraindications to common symptomatic therapy

›Contraindications

›NSAIDs

›CKD

›Peptic ulcer disease

›Decongestants

›Uncontrolled hypertension (I10)

›Tachyarrhythmia history

›First generation antihistamines

›Urinary retention risk

›Glaucoma risk

04Diet/diet14

Hydration and intake

›Intake pattern

›Oral intake

›Normal

›Reduced

›Hydration indicators

›Dry mouth

›Decreased urine output

Exposure triggers

›Dietary exposures

›Caffeine

›Increased

›Energy drinks

›Alcohol

›Recent use

›Heavy use

05Review of Systems/ros21

System based symptom screen

›ROS

›Constitutional

›Fever

›Weight loss

›HEENT

›Sore throat

›Ear pain

›Sinus pain

›Respiratory

›Cough

›Dyspnea

›Wheeze

›Cardiovascular

›Chest pain

›Palpitations

›GI

›Nausea

›Diarrhea

›Neuro

›Headache

›Neck stiffness

06Collateral History and Family History/chafh14

Exposures and contacts

›Collateral and exposures

›Sick contacts

›Household

›School

›Outbreak settings

›Long term care

›Shelter

Family history

›Family history

›Atopy

›Asthma

›Allergic rhinitis

›Immunodeficiency

›Primary immunodeficiency history

›Recurrent severe infections

07Risk Factors/rf21

Host risk factors

›Host risk

›Immunocompromised

›Chronic steroids

›Biologic agents

›Chronic lung disease

›Asthma (J45)

›COPD (J44.9)

Exposure risks

›Exposure risk

›Seasonal viral circulation

›Winter peaks

›School exposure

›Travel

›Recent international travel

›Cruise

Complication risks

›Complication risk

›Severe bacterial infection risk

›Asplenia (Z90.81)

›Sickle cell disease (D57)

›Rheumatic fever risk context

›Untreated GAS pharyngitis

›Prior rheumatic fever history

08Differential Diagnosis/ddx49

Life threatening

›Life threatening

›Epiglottitis (J05.1)

›Drooling

›Stridor

›Peritonsillar abscess (J36)

›Trismus

›Uvular deviation

›Deep neck space infection

›Neck swelling

›Toxic appearance

›Pneumonia (J18.9)

›Focal lung findings

›Hypoxemia

Common

›Common

›Viral URI (J06.9)

›Rhinorrhea

›Mild sore throat

›Acute pharyngitis

›Viral (J02.9)

›Streptococcal (J02.0)

›Acute rhinosinusitis

›Viral

›Bacterial suspected

›Influenza (J10)

›Abrupt myalgias

›Fever

›COVID 19 (U07.1)

›Anosmia

›Exposure

Less common

›Less common

›Infectious mononucleosis (B27.90)

›Posterior cervical lymphadenopathy

›Splenomegaly

›Pertussis (A37.90)

›Paroxysmal cough

›Post tussive emesis

›Allergic rhinitis (J30.9)

›Itchy eyes

›Sneezing

›GERD related cough (K21.9)

›Heartburn

›Worse supine

Mimics and pitfalls

›Mimics and pitfalls

›Viral symptoms with bacterial co infection

›Secondary fever after improvement

›New focal pain

›Purulent nasal discharge

›Not specific for bacterial sinusitis

›Can occur in viral URI

09Past Medical History/pmh14

Relevant comorbidities

›Relevant history

›Chronic respiratory disease

›Asthma (J45)

›COPD (J44.9)

›Diabetes mellitus (E11.9)

›Infection severity risk

›Dehydration risk

Procedures and devices

›Procedures and devices

›Tonsillectomy history

›Impact on exam

›Recurrent abscess history

›Tracheostomy

›Airway colonization risk

›Equipment dependence

10Physical Exam/exam40

General and vitals

›General and vitals

›Appearance

›Toxic

›Non toxic

›Vitals pattern

›Fever

›Tachycardia

›Tachypnea

HEENT

›HEENT

›Nose

›Congestion

›Discharge

›Oropharynx

›Tonsillar exudate

›Erythema

›Uvular deviation

›Ears

›TM bulging

›Otalgia with normal TM

Neck

›Neck

›Lymph nodes

›Anterior cervical

›Posterior cervical

›Range of motion

›Pain with extension

›Stiffness

Respiratory

›Respiratory

›Work of breathing

›Accessory muscle use

›Speaking full sentences

›Auscultation

›Focal crackles

›Wheeze

Skin and hydration

›Skin and hydration

›Hydration status

›Dry mucous membranes

›Capillary refill delay

›Rash

›Scarlatiniform

›Urticarial

11Lab Studies/labs14

Targeted infectious testing

›Infectious labs

›Rapid antigen detection test for GAS

›Adults with Centor or McIsaac intermediate risk

›Children with backup throat culture if negative

›NAAT for SARS CoV 2

›High community prevalence

›High risk patients

General labs when complicated

›Complication screening labs

›CBC

›Severe systemic symptoms

›Immunocompromised

›BMP

›Dehydration concern

›Significant vomiting or diarrhea

12Imaging/img30

Scoring Systems

›Clinical decision tools

›Centor criteria

›Tonsillar exudate

›Tender anterior cervical lymphadenopathy

›Fever history

›Absence of cough

›McIsaac modification

›Age adjustment

›Same core criteria

MRI

›MRI indications

›Deep neck infection complication evaluation

›Contrast requirement

›Airway risk monitoring

›Contraindications

›Non MRI compatible implants

›Hemodynamic instability

›CT indications

›CT neck with IV contrast

›Suspected peritonsillar abscess with unclear exam

›Suspected deep neck space infection

›CT sinus

›Concern for orbital complication

›Concern for intracranial extension

Ultrasound

›Ultrasound

›Bedside I and D guidance

›Peritonsillar abscess localization

›Differentiation cellulitis vs abscess

›Neck ultrasound

›Lymphadenitis assessment

›Thyroid mimic evaluation

13Special Tests/spec14

Bedside tests

›Bedside tests

›Peak flow

›Asthma exacerbation overlap

›Response to bronchodilator

›Ambulatory oximetry

›Exertional desaturation

›Disposition support

Microbiology confirmation

›Microbiology

›Throat culture

›Children with negative RADT

›High suspicion outbreaks

›Heterophile antibody testing

›Infectious mononucleosis suspicion

›False negative early illness

14ECG/ecg14

When to obtain

›ECG indications

›Chest pain

›Pleuritic vs non pleuritic differentiation

›Cardiac risk factors

›Palpitations

›Decongestant exposure

›Tachycardia out of proportion

High risk patterns

›High risk patterns

›Myocarditis concern

›Diffuse ST T changes

›Arrhythmias

›Dehydration physiology

›Sinus tachycardia

›QT prolongation with electrolyte disturbance

15Assessment/ax17

Working diagnosis framing

›Working diagnosis

›Uncomplicated viral URI (J06.9)

›Predominant nasal symptoms

›No focal lung findings

›Pharyngitis severity tier

›Low risk GAS

›Intermediate risk GAS

›Acute bacterial sinusitis suspected

›Persistent symptoms over 10 days

›Severe onset pattern

Complications to exclude

›Complications to exclude

›Lower respiratory tract infection

›Hypoxemia

›Focal crackles

›Deep space infection

›Trismus

›Uvular deviation

16Plan/plan32

First 5 minutes

›First 5 minutes

›Monitoring and access

›Pulse oximetry if dyspnea

›IV access if dehydration or toxicity

›Oxygen

›If SpO2 under 92 percent on room air

›Target SpO2 92 to 96 percent

Symptomatic therapy

›Symptomatic therapy

›Analgesia and antipyretics

›Acetaminophen PO 1000 mg every 6 hours

›Maximum 3000 mg per 24 hours

›NSAID option

›Ibuprofen PO 400 mg every 6 to 8 hours

›Avoid in CKD

›Nasal therapy

›Saline irrigation

›Intranasal corticosteroid

›Fluticasone 1 to 2 sprays each nostril daily

Targeted antimicrobial therapy

›Antimicrobials

›GAS pharyngitis confirmed

›Penicillin V PO 500 mg twice daily for 10 days

›Amoxicillin PO 500 mg twice daily for 10 days

›Penicillin allergy

›Cephalexin PO 500 mg twice daily for 10 days

›Avoid if anaphylaxis history

Reassessment loop

›Reassessment loop

›Timing

›30 to 60 minutes if respiratory symptoms

›Before discharge if analgesia given

›Triggers

›Rising RR

›New hypoxemia

17Disposition/dispo21

Discharge criteria

›Discharge criteria

›Stable vitals

›SpO2 92 percent or higher on room air

›No persistent tachypnea

›Oral intake adequate

›Tolerating fluids

›Pain controlled

Observation or admission criteria

›Observation or admission

›Respiratory compromise

›Ongoing oxygen requirement

›Increased work of breathing

›Deep neck infection concern

›Airway symptoms

›Imaging required with monitoring

Follow up timing

›Follow up timing

›Primary care

›2 to 3 days if not improving

›7 days if persistent cough

›ENT

›Suspected peritonsillar abscess

›Recurrent severe tonsillitis

18Discharge Instructions/di14

Copy discharge instructions

›Today you were seen for upper respiratory infection symptoms.

›Most causes are viral and improve within 7 to 10 days.

›Use acetaminophen or ibuprofen as directed for pain or fever.

›Drink fluids and rest as needed.

›Avoid decongestants if you have uncontrolled high blood pressure or heart rhythm problems.

›Return to the ER now for

›Trouble breathing

›Blue lips

›Oxygen level under 92 percent if you have a home pulse oximeter

›Severe throat pain with drooling

›Inability to swallow fluids

›New confusion

›Persistent fever over 3 days

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

19References/r9

Guidelines and evidence

›Respiratory tract infection guidance

›NICE guideline acute respiratory tract infections antibiotic prescribing, 2021 to 2023 updates

›CDC outpatient antibiotic stewardship for respiratory infections, updated guidance

›GAS pharyngitis

›IDSA guideline for group A streptococcal pharyngitis, 2012 with updates and stewardship summaries

›AAP guidance on streptococcal pharyngitis testing in children

›Acute bacterial rhinosinusitis

›IDSA guideline acute bacterial rhinosinusitis, 2012 with stewardship updates

›AAO HNS adult sinusitis guideline update, 2015 with later updates

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.

Upper Respiratory Infection SymptomsAPPROACH

RESPIRATORY · 19 SECTIONS

⚲

522 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/hx119

Symptom characterization

›Upper respiratory symptom syndrome

›Time course

›Onset date

›Duration

›Pattern

›Sudden

›Gradual

›Waxing and waning

›Primary symptom cluster

›Nasal

›Congestion

›Rhinorrhea

›Sneezing

›Post nasal drip

›Throat

›Sore throat

›Hoarseness

›Odynophagia

›Cough

›Dry

›Productive

›Nocturnal

›Systemic

›Feverishness

›Myalgias

›Fatigue

OPQRST

›Symptom focus selection

›Dominant symptom

›Sore throat

›Cough

›Nasal congestion

›Ear pain

›OPQRST applicability

›Use for dominant symptom

›Omit for non symptom complaints

Onset

›Onset

›Time of first symptoms

›Hours

›Days

›Context at onset

›Sick contact exposure

›Travel

›New daycare

Provocation/Palliation

›Provocation and palliation

›Worse with

›Supine position

›Cold air

›Exertion

›Better with

›Fluids

›Humidified air

›Analgesics

Quality

›Quality

›Throat pain quality

›Burning

›Scratchy

›Sharp

›Nasal discharge quality

›Watery

›Mucoid

›Purulent appearing

Region/Radiation

›Region and radiation

›Throat location

›Anterior

›Unilateral

›Diffuse

›Radiation

›Ear

›Jaw

Severity

›Severity

›Functional impact

›Oral intake limitation

›Sleep disruption

›Peak severity timing

›Day 1 to 2

›Day 3 to 4

Timing

›Timing

›Daily pattern

›Morning worse

›Night worse

›Trajectory

›Improving

›Stable

›Worsening

Associated symptoms

›Associated symptoms

›Infection features

›Fever

›Chills

›Night sweats

›Respiratory features

›Dyspnea

›Wheeze

›Pleuritic chest pain

›ENT features

›Ear pain

›Sinus pressure

›Anosmia

›GI features

›Nausea

›Vomiting

›Diarrhea

Prior episodes and baseline

›Baseline and prior episodes

›Similar prior URI frequency

›Recurrent

›Rare

›Baseline respiratory status

›Asthma control

›COPD symptoms

Special populations

›Population modifiers

›Pregnancy status

›Gestational age

›Hyperemesis

›Immunocompromised status

›Solid organ transplant

›Chemotherapy

›Advanced HIV

›Pediatrics considerations

›Age under 3 months

›Feeding difficulty

02Alarm Features/alarm44

Immediate escalation triggers

›High risk triggers

›Airway risk

›Stridor

›Drooling

›Muffled voice

›Respiratory compromise

›Severe dyspnea

›Hypoxemia

›Exhaustion

›Systemic toxicity

›Altered mental status

›Rigors

›Poor perfusion

Vital sign danger thresholds

›Vital sign danger thresholds

›Oxygen saturation

›Persistent under 92 percent on room air

›Increasing oxygen requirement

›Respiratory rate

›Adult over 30

›Pediatric age adjusted tachypnea

›Hemodynamics

›SBP under 90 mmHg

›HR over 130 with toxicity

High risk historical patterns

›High risk symptom patterns

›Neck and throat

›Inability to swallow secretions

›Trismus

›Rapidly progressive unilateral throat pain

›Sinus and face

›Periorbital swelling

›Vision change

›Chest

›Pleuritic pain with dyspnea

›Hemoptysis

High risk exam findings

›High risk exam findings

›Oropharynx

›Uvular deviation

›Tonsillar abscess appearance

›Neck

›Tender swelling

›Crepitus

›Lungs

›Focal crackles

›Increased work of breathing

03Medications/meds21

Current medications and interactions

›Medication inventory

›Prescribed

›Antibiotics in last 30 days

›Inhaled corticosteroids

›OTC

›Acetaminophen

›Ibuprofen

›Decongestants

›Supplements

›Herbal cold remedies

›Zinc

Contraindications to common symptomatic therapy

›Contraindications

›NSAIDs

›CKD

›Peptic ulcer disease

›Decongestants

›Uncontrolled hypertension (I10)

›Tachyarrhythmia history

›First generation antihistamines

›Urinary retention risk

›Glaucoma risk

04Diet/diet14

Hydration and intake

›Intake pattern

›Oral intake

›Normal

›Reduced

›Hydration indicators

›Dry mouth

›Decreased urine output

Exposure triggers

›Dietary exposures

›Caffeine

›Increased

›Energy drinks

›Alcohol

›Recent use

›Heavy use

05Review of Systems/ros21

System based symptom screen

›ROS

›Constitutional

›Fever

›Weight loss

›HEENT

›Sore throat

›Ear pain

›Sinus pain

›Respiratory

›Cough

›Dyspnea

›Wheeze

›Cardiovascular

›Chest pain

›Palpitations

›GI

›Nausea

›Diarrhea

›Neuro

›Headache

›Neck stiffness

06Collateral History and Family History/chafh14

Exposures and contacts

›Collateral and exposures

›Sick contacts

›Household

›School

›Outbreak settings

›Long term care

›Shelter

Family history

›Family history

›Atopy

›Asthma

›Allergic rhinitis

›Immunodeficiency

›Primary immunodeficiency history

›Recurrent severe infections

07Risk Factors/rf21

Host risk factors

›Host risk

›Immunocompromised

›Chronic steroids

›Biologic agents

›Chronic lung disease

›Asthma (J45)

›COPD (J44.9)

Exposure risks

›Exposure risk

›Seasonal viral circulation

›Winter peaks

›School exposure

›Travel

›Recent international travel

›Cruise

Complication risks

›Complication risk

›Severe bacterial infection risk

›Asplenia (Z90.81)

›Sickle cell disease (D57)

›Rheumatic fever risk context

›Untreated GAS pharyngitis

›Prior rheumatic fever history

08Differential Diagnosis/ddx49

Life threatening

›Life threatening

›Epiglottitis (J05.1)

›Drooling

›Stridor

›Peritonsillar abscess (J36)

›Trismus

›Uvular deviation

›Deep neck space infection

›Neck swelling

›Toxic appearance

›Pneumonia (J18.9)

›Focal lung findings

›Hypoxemia

Common

›Common

›Viral URI (J06.9)

›Rhinorrhea

›Mild sore throat

›Acute pharyngitis

›Viral (J02.9)

›Streptococcal (J02.0)

›Acute rhinosinusitis

›Viral

›Bacterial suspected

›Influenza (J10)

›Abrupt myalgias

›Fever

›COVID 19 (U07.1)

›Anosmia

›Exposure

Less common

›Less common

›Infectious mononucleosis (B27.90)

›Posterior cervical lymphadenopathy

›Splenomegaly

›Pertussis (A37.90)

›Paroxysmal cough

›Post tussive emesis

›Allergic rhinitis (J30.9)

›Itchy eyes

›Sneezing

›GERD related cough (K21.9)

›Heartburn

›Worse supine

Mimics and pitfalls

›Mimics and pitfalls

›Viral symptoms with bacterial co infection

›Secondary fever after improvement

›New focal pain

›Purulent nasal discharge

›Not specific for bacterial sinusitis

›Can occur in viral URI

09Past Medical History/pmh14

Relevant comorbidities

›Relevant history

›Chronic respiratory disease

›Asthma (J45)

›COPD (J44.9)

›Diabetes mellitus (E11.9)

›Infection severity risk

›Dehydration risk

Procedures and devices

›Procedures and devices

›Tonsillectomy history

›Impact on exam

›Recurrent abscess history

›Tracheostomy

›Airway colonization risk

›Equipment dependence

10Physical Exam/exam40

General and vitals

›General and vitals

›Appearance

›Toxic

›Non toxic

›Vitals pattern

›Fever

›Tachycardia

›Tachypnea

HEENT

›HEENT

›Nose

›Congestion

›Discharge

›Oropharynx

›Tonsillar exudate

›Erythema

›Uvular deviation

›Ears

›TM bulging

›Otalgia with normal TM

Neck

›Neck

›Lymph nodes

›Anterior cervical

›Posterior cervical

›Range of motion

›Pain with extension

›Stiffness

Respiratory

›Respiratory

›Work of breathing

›Accessory muscle use

›Speaking full sentences

›Auscultation

›Focal crackles

›Wheeze

Skin and hydration

›Skin and hydration

›Hydration status

›Dry mucous membranes

›Capillary refill delay

›Rash

›Scarlatiniform

›Urticarial

11Lab Studies/labs14

Targeted infectious testing

›Infectious labs

›Rapid antigen detection test for GAS

›Adults with Centor or McIsaac intermediate risk

›Children with backup throat culture if negative

›NAAT for SARS CoV 2

›High community prevalence

›High risk patients

General labs when complicated

›Complication screening labs

›CBC

›Severe systemic symptoms

›Immunocompromised

›BMP

›Dehydration concern

›Significant vomiting or diarrhea

12Imaging/img30

Scoring Systems

›Clinical decision tools

›Centor criteria

›Tonsillar exudate

›Tender anterior cervical lymphadenopathy

›Fever history

›Absence of cough

›McIsaac modification

›Age adjustment

›Same core criteria

MRI

›MRI indications

›Deep neck infection complication evaluation

›Contrast requirement

›Airway risk monitoring

›Contraindications

›Non MRI compatible implants

›Hemodynamic instability

›CT indications

›CT neck with IV contrast

›Suspected peritonsillar abscess with unclear exam

›Suspected deep neck space infection

›CT sinus

›Concern for orbital complication

›Concern for intracranial extension

Ultrasound

›Ultrasound

›Bedside I and D guidance

›Peritonsillar abscess localization

›Differentiation cellulitis vs abscess

›Neck ultrasound

›Lymphadenitis assessment

›Thyroid mimic evaluation

13Special Tests/spec14

Bedside tests

›Bedside tests

›Peak flow

›Asthma exacerbation overlap

›Response to bronchodilator

›Ambulatory oximetry

›Exertional desaturation

›Disposition support

Microbiology confirmation

›Microbiology

›Throat culture

›Children with negative RADT

›High suspicion outbreaks

›Heterophile antibody testing

›Infectious mononucleosis suspicion

›False negative early illness

14ECG/ecg14

When to obtain

›ECG indications

›Chest pain

›Pleuritic vs non pleuritic differentiation

›Cardiac risk factors

›Palpitations

›Decongestant exposure

›Tachycardia out of proportion

High risk patterns

›High risk patterns

›Myocarditis concern

›Diffuse ST T changes

›Arrhythmias

›Dehydration physiology

›Sinus tachycardia

›QT prolongation with electrolyte disturbance

15Assessment/ax17

Working diagnosis framing

›Working diagnosis

›Uncomplicated viral URI (J06.9)

›Predominant nasal symptoms

›No focal lung findings

›Pharyngitis severity tier

›Low risk GAS

›Intermediate risk GAS

›Acute bacterial sinusitis suspected

›Persistent symptoms over 10 days

›Severe onset pattern

Complications to exclude

›Complications to exclude

›Lower respiratory tract infection

›Hypoxemia

›Focal crackles

›Deep space infection

›Trismus

›Uvular deviation

16Plan/plan32

First 5 minutes

›First 5 minutes

›Monitoring and access

›Pulse oximetry if dyspnea

›IV access if dehydration or toxicity

›Oxygen

›If SpO2 under 92 percent on room air

›Target SpO2 92 to 96 percent

Symptomatic therapy

›Symptomatic therapy

›Analgesia and antipyretics

›Acetaminophen PO 1000 mg every 6 hours

›Maximum 3000 mg per 24 hours

›NSAID option

›Ibuprofen PO 400 mg every 6 to 8 hours

›Avoid in CKD

›Nasal therapy

›Saline irrigation

›Intranasal corticosteroid

›Fluticasone 1 to 2 sprays each nostril daily

Targeted antimicrobial therapy

›Antimicrobials

›GAS pharyngitis confirmed

›Penicillin V PO 500 mg twice daily for 10 days

›Amoxicillin PO 500 mg twice daily for 10 days

›Penicillin allergy

›Cephalexin PO 500 mg twice daily for 10 days

›Avoid if anaphylaxis history

Reassessment loop

›Reassessment loop

›Timing

›30 to 60 minutes if respiratory symptoms

›Before discharge if analgesia given

›Triggers

›Rising RR

›New hypoxemia

17Disposition/dispo21

Discharge criteria

›Discharge criteria

›Stable vitals

›SpO2 92 percent or higher on room air

›No persistent tachypnea

›Oral intake adequate

›Tolerating fluids

›Pain controlled

Observation or admission criteria

›Observation or admission

›Respiratory compromise

›Ongoing oxygen requirement

›Increased work of breathing

›Deep neck infection concern

›Airway symptoms

›Imaging required with monitoring

Follow up timing

›Follow up timing

›Primary care

›2 to 3 days if not improving

›7 days if persistent cough

›ENT

›Suspected peritonsillar abscess

›Recurrent severe tonsillitis

18Discharge Instructions/di14

Copy discharge instructions

›Today you were seen for upper respiratory infection symptoms.

›Most causes are viral and improve within 7 to 10 days.

›Use acetaminophen or ibuprofen as directed for pain or fever.

›Drink fluids and rest as needed.

›Avoid decongestants if you have uncontrolled high blood pressure or heart rhythm problems.

›Return to the ER now for

›Trouble breathing

›Blue lips

›Oxygen level under 92 percent if you have a home pulse oximeter

›Severe throat pain with drooling

›Inability to swallow fluids

›New confusion

›Persistent fever over 3 days

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

19References/r9

Guidelines and evidence

›Respiratory tract infection guidance

›NICE guideline acute respiratory tract infections antibiotic prescribing, 2021 to 2023 updates

›CDC outpatient antibiotic stewardship for respiratory infections, updated guidance

›GAS pharyngitis

›IDSA guideline for group A streptococcal pharyngitis, 2012 with updates and stewardship summaries

›AAP guidance on streptococcal pharyngitis testing in children

›Acute bacterial rhinosinusitis

›IDSA guideline acute bacterial rhinosinusitis, 2012 with stewardship updates

›AAO HNS adult sinusitis guideline update, 2015 with later updates

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.