RESPIRATORY DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 234

Cough
Is the cough dry or productive (sputum is coughed up)?
What kind of material is coughed up?
Does it contain blood, pus, or foreign material?
Pain
Where is the pain?
Did it begin suddenly or gradually?
Is the pain mild or severe?
What makes it worse?
Is the pain stabbing, sharp, dull, or crushing?
Is the pain constant or intermittent?
How is the pain related to breathing?
How is the pain related to other symptoms?
Fever
How high is the temperature?
Did it rise suddenly or gradually?
Have chills or sweating occurred?
Many illnesses or injuries cause shortness of breath. At altitudes above 8000 feet (2400
m), shortness of breath with cough may indicate early high-altitude pulmonary edema
(HAPE). Since HAPE may progress rapidly to a life-threatening problem, early detection
is important.
Altitude bronchitis—a persistent, dry, hacking cough—is common at high altitude due
to drying and irritation of the throat. This inflammation of the breathing tubes is not due
to infection but rather to breathing dry air. Cough at altitude, however, may also indicate
lung disease or the presence of fluid in the lungs. Usually such fluid is reabsorbed, but
it may develop into HAPE. The sputum is usually thin, watery, and pink or bloody with
HAPE( Chapter24:DisordersCausedbyAltitude ) .Thecoughduetoinfectionsofthelung
is deeper and usually produces sputum that is green, yellow, or rust colored and thick and
stringy. With pulmonary embolism, the sputum is usually bloody.
Pleuriticchestpainiscausedbydiseasesofthelungassociatedwithinflammationofthe
pleura, or injuries of the chest wall, and characteristically changes with respiratory move-
ments. Deep inspiration typically causes sharp, stabbing pain. Pain that is dull or crush-
ing and constant is more typical of heart disease ( Chapter 17: Heart and Blood Vessel
Disorders ) .
PHYSICAL EXAMINATION
Even though the problem appears to be in the lungs, a full physical exam should be per-
formed. A rapid, hard pulse associated with fever is indicative of significant disease. Fever