Acute chest syndrome: Difference between revisions
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==Background== | ==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 | |||
==Work-Up== | ==Work-Up== | ||
*CBC | |||
*Retic count | |||
*VBG | |||
*Bcx /sputum cx | |||
==Diagnosis== | ==Diagnosis== | ||
*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== | ==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 | |||
===Complications=== | ===Complications=== | ||
*[[Pulmonary Embolism]] (bone marrow, fat or thrombotic) | |||
*[[Pneumonia]] | |||
*[[CVA]] | |||
*[[Sepsis]] | |||
==See Also== | ==See Also== | ||
[[Sickle Cell Crisis]] | *[[Sickle Cell Crisis]] | ||
== | ==References== | ||
[[Category:Heme/Onc]] | [[Category:Heme/Onc]] | ||
Revision as of 16:32, 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
Work-Up
- CBC
- Retic count
- VBG
- Bcx /sputum cx
Diagnosis
- 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