John Bielinski, MS PA-C How many patients out of 100 that present with pulmonary symptoms are really sick? How many with cough, SOB or DOE are really ill? 
Pulmonary symptoms are as soft as the dry cough from bronchitis (a self-limiting problem) to life-threatening pulmonary embolism or congestive heart failure.
I was employed full time for four years as a night-time house officer in a hospital in Rochester, N.Y. It was my job to care for patients who were sick enough to be in the hospital, yet not quite in the ICU – so I covered a respiratory wing of the hospital. This assignment presented meant I was in for an interesting learning curve when I first started. I felt inadequate in my assessment skills, and I mismanaged a number of patients, such as treating an asthma patient with Lasix, thinking it was CHF.
My respiratory medicine turning point
Then one day I hit a tipping point. I finally made it my quest to master this part of my job. I immediately started doing blood gasses (ABGs) and chest radiographs on all acute pulmonary complaints. I did a very detailed history and physical exam. I learned to apply laboratory data to take optimal care of these pulmonary patients. I took an amazing CME course called Fundamentals of Critical Care Support (FCCS.) It was from this quest for learning, and caring for scores of patients, that I developed the “HORID” approach to pulmonary patients. I still practice this way today, and I have taught it to literally thousands of providers.
When it comes to pulmonary complaints, you don’t want to make a “HORID” mistake. “HORID” is a mnemonic to the approach of the pulmonary patient. If you apply this mnemonic to any patient whose primary complaint is respiratory, you will follow a reasonable and logical evaluation.
H=Heart
O=Obstruction
R=Reactive
I=Infection
D=Death! (From a PE or pneumothorax)
We’ll break down more details of HORID in upcoming posts here at CME4LIFE!
Image courtesy of FreeDigitalPhotos.net/olovedog
