CLIPP 30 - Sickle Cell Flashcards
Common Procedures for young people with SCD (2)
- tonsillectomy (lymphoidal-tissue hypertrophy)
- cholecystectomy (bilirubin gallstones)
Why are SCD kids at higher risk for sepsis and what do we do about it?
- decreased splenic function
- prophylactic penicillin until age 5 or 6 (unless documented sepsis and bacteremia or splenectomy)
SCD immunization recommendations
-Hib (2, 4, 6mos)
-Pneumococcal 13 (<1 yo)
-Pneumococcal 23 (2, 5yo)
Meningococcal (2, booster 3-5 years later)
-influenza
Areas affected by chronic illness
- academic progress
- socialization and self-esteem
- family financial hardship
- sibling mental health
Causes of impaired growth in SCD (5)
chronic anemia, poor nutrition, painful crises, endocrine dysfunction, poor pulmonary function
Important physical exam findings in SCD (3)
- splenic enlargement (splenic sequestration crisis) -scleral icterus (RBC hemolysis)
- neurologic exam (Stroke)
Baseline Hg in SCD
6-9 g/dL
Acute chest vs pericarditis vs CHF, vs rib fracture vs sepsis on CXR
- ACS: +infiltrates, effusions, atelectasis
- Pericarditis: +effusion, infiltrates
- CHF: +cardiomegaly, lower lobe infiltrates
- Rib fracture: +effusion, -infiltrate, cardiomegaly, hypoxia
- Sepsis: -cardiomegaly, infiltrates
Indications for RBC transfusion in SCD (5)
- fall in Hgb from baseline
- increasing respiratory rate
- worsening chest symptoms
- declining O2 sats
- progressive infiltrates on CXR
When to seek emergency care in SCD (8)
fever, splenic enlargement, slurred speech, chest pain, rapid breathing, increased pallor, increased jaundice, priapism
Antibiotic treatment of ACS
third generation cephalosporin + macrolide
Differential diagnosis of fever, respiratory distress, and chest pain in SCD (5)
- ACS: fever, cough, chest pain, SOB, decreased oxygenation
- Pericarditis: tachypnea, fever, -chest pain, splenomegaly
- CHF: tachypnea, -chest pain
- Rib infarction: tachypnea, -rhonchi
- Sepsis: -chest pain
