EM Forum Case #106
"FAST Plus"
by Charlene Babcock Irvin, MD, FACEP
A 17 y/o male presents to a small Emergency Department with a persistent cough.
He also notes shortness of breath. His mom made him come because she has noted
the cough started yesterday, which initially just started as an occasional
cough, but today has progressed till the point her son can’t go more than a
minute or so without coughing. The cough is not forceful, but irritating and
persistent. The son does note a little shortness of breath today while at
basketball practice. He also started coughing more after practice. The cough is
dry, and there is no history of fevers, vomiting, abdominal pain, chest pain,
rash, sore throat, nasal drainage, or exposure to anyone else who is sick.
PMH: Unremarkable, no hospitalizations, no surgeries
SH: Negative
FH: Negative
PE: WDWN muscular tall male, in no acute distress. He does have a persistent
cough, almost with every third exhalation.
VS: T=98F, RR=22, BP=115/65, HR=98, Sat=98%
HEENT: Normal
Heart: RRR no murmurs
LUNGS: No rales, rhonchi or wheezing. Breath sounds are decreased slightly on
the left.
Abd: Unremarkable, non-tender
EXT: Normal
Questions:
1. What are your concerns? And what are the treatment options?
2. What are the contraindications to chest tube insertion?
3. What is the ‘lung point’ sign by ultrasound?
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