Sickle Cell IMC (classic presentations, etc)

Question 1

Sickle Cell IMC

ASAP:

Answer 1

ASAP: ABCs, IV, O2, monitor, VS, EKG

Question 2

Hx/exam:

Answer 2

Hx/exam: similar to prev pain crises?, fever, infxn?, CP, SOB, bone pain; TTP, tachypnea,

Question 3

Labs/Rads:

Answer 3

Labs/Rads: ABG, CBC, reticulocyte count, BUN/Cr, lytes, gluc, UA; CXR, ± ext XR for bone pain (osteo), ± CTA chest for PE, ± CT brain for CVA.

Question 4

Pain crisis -

Answer 4

Pain crisis - search for cause (infx, cold, stress, trauma, dehyd, etc). Rule out other causes (ARDS ect)
Pulmonary (CP/SOB), CNS (HA), skeletal (arthralgias/dactylitis), GI (abdominal pain)
Tx: IVF, analgesia (opioids, may need large doses), NSAIDS, ±O2, treat cause. Avoid meperidine (renal dysfunction → seizure

Question 5

Stroke - common age 9-15. Risk factors: high flow velocity on transcranial doppler low Hb, high WBC, HTN, hx of silent infarcts, hx of acute chest
CT will miss early signs and is insufficient for ruling out in child. MRI with diffusion-weighted imaging and MRA of head and neck
Tx:
Adults: evaluate for tPA and intra-arterial thrombolysis
Pediatric: IVF and exchange transfusion to achieve Hb S level < 30%. If unable to exchange transfuse a simple transfusion should be
done. Target a max Hb of 13
Children with HTN within first 72 hours after ischemic stroke associated with increased risk of death. Goal 50th-95th percentile
Try labetalol or ACEI to lower BP 25% over 24 hours

Answer 5

Stroke - common age 9-15. Risk factors: high flow velocity on transcranial doppler low Hb, high WBC, HTN, hx of silent infarcts, hx of acute chest
CT will miss early signs and is insufficient for ruling out in child. MRI with diffusion-weighted imaging and MRA of head and neck
Tx:
Adults: evaluate for tPA and intra-arterial thrombolysis
Pediatric: IVF and exchange transfusion to achieve Hb S level < 30%. If unable to exchange transfuse a simple transfusion should be
done. Target a max Hb of 13
Children with HTN within first 72 hours after ischemic stroke associated with increased risk of death. Goal 50th-95th percentile
Try labetalol or ACEI to lower BP 25% over 24 hours