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27 Cards in this Set
- Front
- Back
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How early in life are sickle cell patients vulnerable to sepsis?
Why? |
4 mo old - splenic dysfunction begins this early
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What is a reason for false neg sickledex?
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Hb <6 g/dl
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What are 2 pieces of historical data that are red flags when admitting a SCD patient?
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-History of acute chest syndrome
-History of chronic lung disease |
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What admission order is most important to write when admitting a SCD patient?
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Pulse ox
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How does morphine help SCD patients breathe?
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Decreased pain allows deeper inspiration
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What is acute chest syndrome defined by?
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-New pulmonary infiltrate
-2/more others - fever, tachypnea, chest pain, etc.. |
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What may precede ACS by several days?
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Back/extremity/abdominal pain
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How do patients often present with ACS?
-peds under 2 yrs old -adults |
<2 yrs - fever
adults - pain |
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What is the final common pathway of ACS?
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Infarction and death
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3 lab/xray findings in ACS:
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-Hypoxia
-Elevated WBC -Fall in Hb -Nonspcf CXR |
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Which lobe is more affected in
-peds -adults |
Peds - both upper/lower lobe
Adults - lower lobe |
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Top 3 causes of ACS:
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-fat embolism
-Infection -Infarct |
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How to treat ACS:
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oxygen
3rd gen ceph + macrolide trial of bronchodilaters |
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2 additional options for treating acs:
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Transfusion if indicated
Corticosteroids if bad asthma |
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When should you transfuse RBCs in ACS?
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EARLY
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What are the goals of pain management in SCD patients?
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-Relieve pain
-Avoid euphoria |
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What are 5 risks of narcotic infusion?
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-Respiratory suppression
-Seizures -Constipation -Tolerance -Abuse |
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What are 4 key points to remember about pain crisis patients?
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-every one is different
-SC pts clear opioids rapidly -Risk of abuse is SMALL -Avoid Meperidine |
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What causes pain cris patients >20 yr old to die earlier?
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More frequent pain crises
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What are 2 factors associated with high rates of pain crises?
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-High hct
-Low HbF levels |
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On phys exam in a black SCD patient where should you look for pallor?
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-Conjunctiva
-Mucous membranes -Palms -Soles |
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What labs should you order first on a patient with possible splenic infarct?
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-Type/crossmatch
-Then CBC, retic count |
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What lab study can help you differentiate aplastic crisis from splenic sequestration?
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Retic count
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What is the most likely etiology of aplastic crisis in a SCD patient?
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Parvo B19
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What is the therapy for aplastic crisis?
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Blood
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What is the treatment aim for stroke, severe ACS, severe priapism, or other life/limb threatening complications?
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Reduce HbS conc to <30%
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How much blood should you transfuse?
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4cc/kg of PRBCs will raise the Hb 1g/dl - usual max is 15-20 cc per kg
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