A man presents with a cough productive of saliva and black particles after sleeping while smoking. What is the priority in his evaluation?

In evaluating a patient who presents with a cough that is productive of saliva and black particles, assessing for respiratory distress is critical. This symptom, particularly occurring after sleeping while smoking, raises immediate concerns about the patient’s airway and respiratory function. Respiratory distress can indicate a severe obstruction or irritation of the airway that may warrant urgent intervention.

By prioritizing the assessment for respiratory distress, a healthcare provider ensures that they are addressing any life-threatening issues first. This evaluation would involve looking for signs such as increased work of breathing, use of accessory muscles, tachypnea, cyanosis, and wheezing, which could indicate an acute pulmonary concern related to smoking or aspiration.

Performing a medical history is certainly necessary and helpful for providing context and determining underlying health issues but does not take precedence when a patient's respiratory status could be compromised. Evaluating for asthma is also important but would generally follow an assessment of any immediate threats to respiration. The Rule of Nines is related to burn assessments and is not relevant in this scenario, thus it is not a priority in the evaluation.