Pertussis

Age: ‍ ‍monthsyears old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of cough

Cough described as ‍paroxysmal

Severity is ‍mildmoderatesevere

Pattern ‍persistentintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective

Known exposure to pertussis: ‍yesno

Vaccination status: ‍up-to-datedelayednever vaccinated



Associated symptoms: *Try using right-click for negatives*

‍paroxysms of coughing

‍inspiratory "whoop" sound after coughing fits

‍post-tussive vomiting

‍apnea

‍fatigue

‍fever, up to ‍°, over ‍ ‍hoursdays

‍rhinorrhea, ‍clearcolored

‍nasal congestion

‍shortness of breath



Contributing factors:

‍close contact with individuals with suspected pertussis

‍immunocompromised status

‍chronic lung disease

‍recent upper respiratory infection

‍school or community outbreak





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Pertussis ‍likelysuspectedpossible

DDx: pertussis, viral URI, croup, bronchiolitis, bronchitis, asthma exacerbation, COPD exacerbation, pneumonia, influenza, COVID-19, foreign body aspiration, laryngomalacia, allergic rhinitis, tuberculosis, sinusitis, post-nasal drip, GERD





PLAN:

Investigations:

- Chest X-ray

- Nasopharyngeal swab for pertussis PCR

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍CRP, ‍LFTs, ‍blood culture

Treatments:

- ‍Antibiotics

- ‍Cough suppressants

- ‍Analgesics

- Encourage hydration

- Isolation until 5 days of antibiotics completed

- Vaccination review and update

Further care:

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or persist after 3 days

- Referral to ER if severe shortness of breath, signs of dehydration, or high fever