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THE MORNING REPORT

The Best in FOAM Education

  • Amanda Baroutjian, MD

Sickle Cell Disease in the ED



Vaso-occlusive Phenomena

Stroke

  • Ischemic

  • Hemorrhagic

Acute Chest Syndrome

  • Diagnostic Criteria

    • New pulmonary density on chest imaging involving at least one complete lung segment and ≥1 of the following:

      • Temperature ≥38.5°C

      • >3 percent decrease in SpO2 (oxygen saturation) from a documented steady-state value on room air

      • Tachypnea (per age-adjusted normal)

      • Intercostal retractions, nasal flaring, or use of accessory muscles of respiration

      • Chest pain

      • Cough

      • Wheezing

      • Rales

  • Symptoms

    • Fever

    • Cough

    • Chest pain

    • Shortness of breath

    • Hemoptysis

  • Triggers

    • Infection

    • Vaso-occlusive Crisis

    • Pulmonary Embolism

    • Asthma

    • Pulmonary Edema

    • Atelectasis

    • Opioid induced hypoventilation

  • Treatment

    • Antibiotics

    • Maintaining oxygenation >95%

    • fluid hydration

    • pain control

    • inhaled incentive spirometry

Acute Pain Crisis

  • Affected Systems

    • Pulmonary: CP, SOB

    • CNS: HA

    • Musculoskeletal: Tender + warm joints, bone pains

    • GI: Abdominal pain

  • Other findings: Fever, Leukocytosis

  • Consider other differentials:

    • CP/SOB: ACS, ARDS, cor pulmonale, high output heart failure, pneumonia, pulmonary embolism

    • headache: Stroke, memingitis, CV thrombosis, ocular pathologies

    • Arthralgias: septic arthritis, acute trauma, avascular necrosis

    • Abdominal Pains: Splenic sequestration, acute intrahepatic sequela, mesenteric vascular occlusions, renal infarcts.

Sequelae of hemoglobinopathies:

  • Priapism

  • Sickle Cell Nephropathy

  • UTI/Pyelonephritis

  • Renal meduallary carcinomas

  • Splenic Sequestration

  • RUQ/Abdominal pain

    • Symptomatic cholelithiasis

    • cholecystitis

    • acute sickle hepatic crisis

      • acute intrahepatic cholestasis

    • Acute hepatic Sequestration

Microbiology reminders to watch out for in asplenic sickle cell patients

  • Streptococcus Pneumoniae

  • Haemophilus Infleunza

  • Non-typhoidal salmonella species

  • mycoplasma

  • C. Pneumoniae

  • Yersinia enterocolitica

Amanda Baroutjian, MD

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