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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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