A fictional 28-year-old with sickle cell disease admitted for a painful crisis develops fever, chest pain, hypoxaemia and a new pulmonary infiltrate.
Frame the danger first.
- Consider acute chest syndrome with fever and/or respiratory symptoms plus a new pulmonary infiltrate.
- Monitor throughout admission because it may develop after presentation for another sickle complication.
- Assess oxygenation, work of breathing, pain, haemoglobin trend and neurological state repeatedly.
Act, escalate, reassess.
- Call haematology and senior acute-care help early while beginning ABCDE assessment and continuous monitoring.
- Follow the current local sickle-cell pathway for oxygenation, analgesia, hydration, respiratory support and antimicrobial treatment.
- Investigate infective and alternative causes without delaying treatment.
- Discuss transfusion strategy early when hypoxia, anaemia, progression or other severe features are present.
Red flags that change pace.
- Increasing oxygen requirement, severe hypoxia, exhaustion or multilobar disease
- Falling haemoglobin, neurological features or rapid radiographic progression
- Failure to respond or possible need for exchange transfusion and critical care
What makes care less safe.
- Assuming chest pain is only part of the painful crisis
- Using excessive opioid or fluid treatment without close respiratory reassessment
- Waiting for severe hypoxia before discussing transfusion and critical care
Say the concern plainly.
Possible acute chest syndrome with oxygenation [trend], imaging [finding], haemoglobin [trend] and infection assessment [summary]. Current respiratory support and treatment are [list]. I need urgent haematology advice about transfusion and escalation.