Acute chest syndrome: Difference between revisions
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**Overly aggressive IV hydration | **Overly aggressive IV hydration | ||
==Work-Up== | ==Clinical Features== | ||
*[[Fever]] >38.5 | |||
*[[Cough]] | |||
*[[Wheezing]] | |||
*[[Tachypnea]] | |||
*[[Chest pain]] | |||
==Differential Diagnosis== | |||
==Diagnosis== | |||
===Work-Up=== | |||
*CBC | *CBC | ||
*Retic count | *Retic count | ||
*VBG | *VBG | ||
*Bcx /sputum cx | *Bcx /sputum cx | ||
*CXR | |||
== | ===Evaluation=== | ||
*New infiltrate on CXR with at least one of the following: | *New infiltrate on CXR with at least one of the following: | ||
**Fever >38.5 | **Fever >38.5 | ||
Revision as of 16:34, 30 May 2015
Background
- Occurs most commonly in the 2-4yr old age group and then declines with age
- Due to pulmonary ischemia and infarction; complication of PNA
- Causes
- Pulmonary infection
- C. pneumoniae and mycoplasma are most common organisms
- May also be caused by viruses, H. flu, klebsiella, staph
- Fat emboli
- Lodge in pulmonary vasculature -> additional ischemia
- Rib infarction
- Overly aggressive IV hydration
- Pulmonary infection
Clinical Features
- Fever >38.5
- Cough
- Wheezing
- Tachypnea
- Chest pain
Differential Diagnosis
Diagnosis
Work-Up
- CBC
- Retic count
- VBG
- Bcx /sputum cx
- CXR
Evaluation
- New infiltrate on CXR with at least one of the following:
- Fever >38.5
- Cough
- Wheezing
- Tachypnea
- Chest pain
- Note: CXR findings may lag behind the clinical features
Treatment
- O2
- Titrate to pulse oximetry
- Hydration
- Oral hydration preferred
- IV hydration with hypotonic fluid if pt unable to tolerate PO
- Analgesia
- Bronchodilators
- Abx
- Treat as if pt has community-acquired PNA
- Tranfusion (leukocycte depleted)
- Consider transfusion to goal of Hb 11 / Hct 30 for:
- O2 Sat <92% on room air
- Hct 10-20% below pt's usual Hct or dropping Hct
- Exchange transfusion
- Consider for:
- Progression of ACS despite simple transfusion
- Severe hypoxemia
- Multi-lobar disease
- Previous history of severe ACS or cardiopulmonary disease
- Consider for:
Complications
- Pulmonary Embolism (bone marrow, fat or thrombotic)
- Pneumonia
- CVA
- Sepsis