EM Forum Case #101 "Could this be the Swine Flu?"
by Charlene Babcock Irvin, MD, FACEP
A 24 y/o homeless man presents with fever, cough, and muscle aches. He has been sick for 2 days, and is not getting better.
ROS: No vomiting, no diarrhea. No shortness of breath. No rashes. He has muscle aches all over, and has been coughing so hard he also has chest pain when he coughs. He also complains of a headache and a sore throat.
PMH: No Hospitalizations
SH: Past drug and alcohol abuse. Patient states he has not had any alcohol or used drugs in the past 2 days (and does not appear high or intoxicated). He denies IVDA. He’s never been tested for HIV.
PE: Temp 102.8, RR=20, BP=130/85, HR=130 Sat 96% on RA
PE: WDWN male, disheveled, lying still on his side sweating (he was given Tylenol at triage).
HEENT: PERRL, TM normal, PMM dry pharynx, erythema, no exudates. Minimal cervical lymphadenopathy. Poor dentition, neck supple.
HEART: Regular tachycardic rhythm, no murmurs, rubs, or gallops.
LUNGS: Clear, no rales, rhonchi, or wheezing.
ABD: Soft, nontender, scaphoid. No masses. Unremarkable.
EXT: No rashes, unremarkable. Pulses present. Muscles mildly tender on palpation throughout.
NEUROLOGIC: Unremarkable.
Questions:
1. Could this patient have novel H1N1 (Swine flu)?
2. Should you send a flu swab?
3. Should you give him Oseltamivir (Tamiflu)?
4. What do you need to know about anti-virals? Which one is contraindicated in asthmatics? Which can you give to infants?
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