Sickle cell acute complications: Viva

This is acute chest syndrome complicating a vaso-occlusive pain crisis in a child with sickle cell disease. The structured oral runs from the diagnosis through the immediate resuscitation, the transfusion strategy, the avoidance of harm, and the prevention, and it ends with the parallel emergencies of the stroke and the sequestration. ^[4]

Opening: make the diagnosis

Examiner. The boy was admitted for a pain crisis and now has a fever, a cough, and a saturation of 89 percent on room air. What is the diagnosis, and why did it appear now? ^[4]

Candidate. The diagnosis is acute chest syndrome, defined by the new pulmonary infiltrate on the chest radiograph together with the fever, the breathlessness, the cough, and the hypoxia, and the saturation of 89 percent marks a moderate-to-severe episode. It appeared after admission because the rib and chest pain of the crisis caused splinting and atelectasis, which seeded the lung, and this is the typical pattern in which the acute chest follows the pain crisis by a day or two. The acute chest syndrome is the leading cause of death in sickle cell disease, so I act now. ^[4]