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18 Cards in this Set
- Front
- Back
what is the incidence of sickle cell |
4,000-5,000 births/year are at risk for sickle
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what is the physiology of sickle cell
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1. sickling of RBC
2. increased viscocity of blood 3. Deoxygenation indiced polymerization of Hb S (deoxygenation occurs very often) |
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whats the clinical course of sickle cell
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1 typically ID early in life
2. anemia in btwn painful episodes 3. all organ systems are affected by vasoocclusions and so can have acute organ damage 4. intravascular and extravascular hemolysis 5. increased infections bc of poor splenic fx 5. live to 42 (M) 48 (F) 6. tx to help sx, no therapy to get cells normal |
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what things predispose someone to vaso-occlusive crisis
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*this is the REALLY really painful episode. can be NO PE findings (others will have fever, tenderness, swelling, tachypenia, HTN, nausea, vomit)
**pain is all over but LE/back, abdomen is common. more severe later in life (3/4 decade) Many things: 1. dehydration 2. Cold 3. infection 4. stress 5. menses 6. EtOH 7. UNKNOWN |
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what organism is most likely to cause ______ in sickle cell
1. Osteomylitis 2. Meningitis 3. Sepsis 4. Pneumonia |
1. osteomylitis- salmonella. eats away at the bone so you make new bone
2. Meningitis: strep pneumonia 3. Sepsis: strep pneumonia (leukocytosis, L shift) 4. Pneumonia: mycoplasm, or viral |
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what is the standard of care for a febrile pt with sickle cell
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WORK THEM UP! infection is common
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in our sickle kid with the swollen knee what do we need to RO
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1. septic arthritis- joint locked, ppl wont move them and its hard for you to. need to wash out in OR, can cause perm damage
2. Osteomylitis: caused by salmonella, eats away at the bone and new bone is made. Xray! |
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what happens to the spleen in sickle cell
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first gets big then autosplenectomy
**no longer can fight off infection |
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Define factors, both psychological and physiological, which may place sickle patients in the category of “drug seekers”
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they get hooked! the incomplete therapy for acute attacks. prolonged duration of pain promotes drug seeking
They metablize drugs FAST, they need mre drug **treatment by PCP is good bc they know the pt and condition/course of disease ** **give pain meds aggressively, O2, hydration |
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strep pneumonia commonly causes what in sickle cell pts
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sepsis
meningitis **can also be HIB, E coli, Salmonella |
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salmonella causes what in sickle cell pts
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osteomylitis
**infarcted bone. strep pneumonia, E coli, proteus, and s aureus also can cause it |
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what does Mycoplasm and virus lead to in sickle cell pts
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pneumonia
**it is NOT strep pneunomia and H influenze are NOT the most common **important to know bc AB choice will differ |
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why do we care so much about the infectinos sickle cell sdisease ppl get
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we can treat them, we cant do a whole lot else for sickle cell
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what are the neuro complicaiotsions assicuated with sickle cell
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25% get some neuro
Most Common: TIA, transient ischemic attack 2. Cerebral infarct 3. cerebral hemmorage 4. seizuire 5. unexplained coma |
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what are hte cardiac complicaitons associated with sickle cell
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well pts are anemic and have highly viscous blood. CO increased --> chamber enlargement
**cardiomegaly |
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what is the pain mgmt for sickle cell
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aggressive! also give hydration, O2
**not drug seekers!!!! **family doc is GREAT bc they know the pt and the course of disease **they metabolize faster so need more drug! |
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how many ppl get sicke in the us
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5000 a year
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what will a reticulocyte count tell us about a person with sickle cell
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if their body is trying to make new blood cells, high is good :)
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