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21 Cards in this Set
- Front
- Back
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Triggers of sickling?
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- IV contrast
- stasis - dehydration - hypoxemia - acidosis |
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SCA
-CBC findings? -CMP findings? -LDH and haptoglobin? |
normocytic anemia
reticulocytosis leukocytosis (mild) thrombocytosis (mild, 2/2 autosplenectomy) ALK PHOS elevation (mild) T. Bili elevation LDH elevaion haptoglobin decreased |
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Vaso-occlusive (pain) crisis - mgmt?
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IVF, narcotics --> admit if pain refractory to tx
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SCA patient presents with ACUTE DROP in Hgb - DDx?
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- Splenic sequestration crisis
- Hemolytic crisis - Aplastic crisis |
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<24 m.o. SCA baby presents with abdominal pain, dyspnea, pallor - Dx? Tx?
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Splenic sequestration crisis
Supportive care SPLENECTOMY AFTER FIRST EPISODE |
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14 y.o. SCA kid presents with fatigue, dyspnea. Recent URI. - Dx? Tx?
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Aplastic crisis (#1 = 2/2 parvovius B19)
acute transfusion therapy |
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20 y.o. SCA patient presens with JAUNDICE, dyspnea. - Dx?
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Hemolytic crisis (#1 = 2/2 Rx)
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SCA - Indications for ADMISSION
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- refractory pain
- unable to take PO - NEURO findings - PULM findings (hypoxia, infiltrate) - SEQUESTRATION crisis - APLASTIC crisis - FEVER >40C and TOXIC |
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SCA - Indications for TRANSFUSIONS?
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- APLASTIC crisis
- SEQUESTRATION crisis - ACS - CVA - PRIAPISM - Pregnancy - Pre-op |
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Transfusions in SCA - Hgb GOAL?
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< 10 g/dL
(b/c polycythemia INCR risk of sickling!) |
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SCA - Indictions for PARTIAL EXCHANGE transfusions?
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- CRISES
- in the setting of chronic t'fusions |
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SCA - Acute Chest Syndrome (ACS) - Definition
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1) NEW INFILTRATE on CXR
...AND EITHER... 2) T > 38.5C, tachypnea, chest pain, cough, wheezing |
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SCA patient presets with pain crisis - R/O what else?
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ACS!
(Often triggered by vaso-occlusive crisis) |
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ACS - Triggers?
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- Infection
- Emboli - rib infarctions - RAR/asthma - fluid OVERLOAD - atelectasis (2/2 splinting) |
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ACS - common pathophysiology?
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vaso-occlusion --> infarction and necrosis of ALVEOLI
--> regional hypoxemia and acidosis --> VICIOUS CYCLE of sickling! |
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ACS - work-up?
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CBC, retic #
Blood Cx CMP CXR UA / Cx +/- sputum Cx |
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ACS - Tx?
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ADMISSION
IVF, O2 narcotics 3rd GEN CSPN (ceftriaxone) to cover encapsulated Macrolide (Azithromycin) to cover atypicals +/- partial EXCHAGE transfusion (esp. if multilobar PNA or severe anemia, helps DECR respiratory failure) |
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SCA patient with FEVER
- Who is High-risk? Mgmt? |
High-risk: ADMIT for IV ceftriaxone
TOXIC T > 40C (-) ppx PCN |
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SCA patient with FEVER
- Who is Low-risk? Mgmt? |
Low-risk: OUTPATIENT f/u in 24 hours
NON-toxic T < 40c (+) ppx PCN Obtain CBC, CMP, B Cx, UA/Cx, CXR... 1 dose ceftriaxone --> Obs unit --> f/u in 24 hrs |
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SCA patient with FEVER + BONE PAIN - DDx? Tx?
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Bone infarcts vs. osteomyelitis
HARD to differentiate! Mgmt: EMPIRIC ABX for all |
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SCA - how to DDx bone infarct vs. osteomyelitis?
Infarcts: OM: |
bone infarcts vs OM:
___: MULTI-focal, lower ESR, (-) leukocytosis ___: UNI-focal, higherESR, (+) leukocytosis |
