Special Operations Forces Medical Handbook

3-15

CXR: clear: asthma or upper airway cause, infiltrate: pneumonia, cavity: lung cancer or tuberculosis

Assessment:
Differential Diagnosis
Infections - bronchitis (acute or chronic), pneumonia (viral, bacterial, fungal, mycoplasma including TB),
sinusitis, pharyngitis, laryngitis
Aspiration - foreign body, gastric contents.
Allergic or sensitization response - asthma, pneumonitis (chemical, biological), allergic rhinitis
Chronic lung disease - emphysema, COPD, chronic bronchitis, smoking, cancer.
Other lung disease - pulmonary embolism, pneumothorax, pleurisy
Other non-pulmonary disease - congestive heart failure, irritant rhinitis, gastroesophageal (GE) reux, medica-
tion effect

Plan:
Treatment

1. See separate Respiratory sections for treatment for asthma, pneumonia, pleurisy, pneumothorax, allergic
   pneumonitis, emphysema, COPD, pulmonary embolism.


2. Antibiotics are only indicated in patients with evidence of a mycoplasma or bacterial infection, or at high
   risk due to a chronic underlying pulmonary disease (empirically treat for both Gram positive and negative).
   Antibiotics are not generally needed for acute bronchitis.


3. Treat symptomatically when the findings on history and physical examination do not warrant antibiotics.
   Do not suppress a productive cough unless it interferes with obtaining adequate rest/sleep or jeopardizes
   concealment. Dextromethorphan in tablet or liquid form (children over age 2: 2.5 mg, to age 12: 10
   mg, Adults: 30-60 mg, q hs or q 4 hrs) or combined with expectorants like guaifenesin are often used.
   Expectorants have not been proven to be effective. Codeine (children over age 6: 5 mg; age 12, 10 mg;
   adults: 30-60 mg, po q hs or q 4 hrs for severe cough. QHS is preferred for severe cough that interferes
   with the ability to rest (use no more than 3 nights) and will not impair the ability to clear secretions
   during the daytime.


4. If you cannot determine a clear etiology for the cough, treat empirically for allergy, since this is one of the
   most common causes in otherwise healthy individuals and treatment is well tolerated.

Patient Education
Follow-Up: Return if cough persists for more than 2 weeks or worsens.

NOTES: Cough can be associated with psychological symptoms. However, “psychogenic cough” is a
diagnosis of exclusion, but can be associated with severe anxiety or becomes part of a conversion reaction.

Symptom: Depression and Mania

MAJ Michael Doyle, MC, USA

Introduction: Everyone experiences happiness and sadness. However, command and medical personnel
should be concerned when service members’ variations in mood begin to impair duty performance. 20% of
the general population will at some point experience depression outside of the level of sadness expected
in daily life. Another 2-5% will experience sustained mood elevation, called mania or hypomania. Both
depression and mania appear in all cultures. SOF medics may be called upon to evaluate host nation civilian
and military personnel.