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Chapter 3: Respiratory
Respiratory: Common Cold and Flu
COL Warren Whitlock, MC, USAIntroduction: Over 200 kinds of viruses and bacteria infect the mucous membranes, leading to such
symptoms as nasal congestion, sore throat, and coughing (see also ID sections on Adenovirus, Infectious
Mononucleosis) Several typical pediatric diseases, such as diptheria, that can infect unprotected adults). This
section focuses on the relatively mild, viral, acute respiratory tract infections (contrast with Acute Respiratory
Distress Syndrome Section later in this chapter), typically called colds. The frequency of these infections
generally decreases with age. Acute local infections generally occur at the site of viral infection - the nose
and throat. The “flu” is a viral infection of the nose, throat, bronchial tubes and lungs caused by inuenza
viruses A or B, typically presenting with sudden fever, chills, headache and fatigue. The fever often runs higher
than 101°F, and usually subsides within three days. Muscle aches of the back, arms and legs are especially
prominent symptoms. Patients generally continue functioning with a cold virus, but with u their activity is
more seriously curtailed. Elderly patients, infants, expectant mothers (3rd trimester) the immunosuppressed
and patients with chronic heart and lung diseases will have more frequent life-threatening complications, such
as pneumonia. Approximately 10,000 people die annually in the US due to inuenza.
Subjective: Symptoms
General: Malaise, fever, nasal congestion, clear secretions, sneezing, scratchy or sore throat, cough,
hoarseness, and headache
Focused History: Quality: Is your cough productive? (Viral coughs are generally non-productive or produce
only clear mucus.) How high has your fever been? (characteristically normal or low-grade temp; patients com-
monly “just feel hot”) How bad is your headache? (Mild headache that worsens upon standing is typical; severe
headache signals other potential illness.) Where is the headache? (If located over sinuses and worsens when
head is lowered, may have sinusitis with or without cold.) Is the cough worse at night? (typical for post-nasal drip
from cold, sinusitis, allergic or irritant rhinitis) Duration: How long have you had the symptoms? (Colds usually
do not last longer than a few days, and not over 2 weeks.) How often do you get colds? (frequent colds may
suggest allergies, increased susceptibility to infection due to immunocompromise, anatomical defect, etc.) Have
you had the inuenza vaccination? (Flu symptoms should be less severe and shorter in duration if vaccinated
for the infecting strain.) Alleviating or Aggravating Factors: What makes the symptoms better, or worse?
(Medications including decongestants and acetaminophen may improve symptoms.)
Objective: Signs
Using Basic Tools: Inspection: Secretions in nose; red, irritated throat which may have exudate; normal
to low-grade fever
Palpation: Non-tender sinuses (tender sinuses with sinusitis)
Auscultation: Clear chest (wheezes occur in patients with known asthma or in 10% of cases of viral influenza)
Using Advanced Tools: Otoscope: Eardrums appear normal with no fluid behind them; Lab: Monospot
negative; WBC with differential is normal or may demonstrate an increase in atypical lymphocytes
Assessment:
Differential Diagnosis: See appropriate sections in this book for more information on many of these
conditions.
significant risk of both immediate and delayed life threatening consequences.
Follow-up Actions
Evacuation/Consultation Criteria: Evacuate patients with acute anemia and acute sickle crisis after initial
stabilization. There is usually no need to evacuate patients with other anemias. Consult hematologist as
needed.