Acute chest syndrome

Background

Causes

1. most common pathogen- C.pneumonia then M.pneumonia and RSV
2. cause of acute chest were fat emb, infc and infarction
3. xray findings of acute chest occur ~2.5d after admission
4. multilobar involvement, esp of lower lobes common

Work-Up

1. CBC
2. retic
3. ABG
4. BC/sputum cx

Diagnosis

Any chest symptoms with a new finding on CXR (however, CXR finding may be delayed)

1. low grade fever
2. chest pain
3. cough

DISCUSSION

1. sx at presentation are age dependent
   1. age less than 10 were wheeze, cough and fever.
   2. Age older than 20 is arm/ leg pain and dyspnea
2. pain is prodrome

Treatment

1. Bonchodilators (even if no wheezing)
2. Incentive spirometry
3. Empiric ABX (for PNA)
4. Pain management (to avoid splinting, hypoventilation, and narcosis)
5. O2 only if nec (maintian PaO2 <100)
6. IVF for hypovolemia only
7. Consider transfusion (Leukocyte depleted blood products!) for
   1. for heart dz
   2. severe/worsening anemia
   3. multilobar PNA
   4. unresponsive hypoxemia
8. Consider exchange transfusion for PaO2 <70 on high O2 + not improving

Exchange Transfusion

1. Phlebotomize 500mL
2. NS 300mL bolus
3. Phlebotimize 500m:
4. Infuse 4-5 units PRBC

Prognosis

1. Worsens with age
2. Resp failure predictors:
   1. bad xray, thrombocytopenia (<200), h/o cardiac dz

Concerning Workup

1. Dec Hb
2. inc WBC x 2
3. platelet <200

Complications

1. PE (bone marrow, fat or thrombotic)
2. Pneumonia
3. pulm hem
4. cor pulm
5. hypovolemic shock from splenic seq
6. Sepsis
7. Intracranial hem
8. Seizure
9. Neuro events = AMS, neuromusc events, seizure, anoxia
   1. strong relation between acute chest and neuro complications
   2. RF = low platelets

See Also

Heme: Sickle Cell Crisis

Source

8/07 DONALDSON (adapted from Mistry)