Acute chest syndrome- what to do?

[Sucheta]

A 20-year-old black male patient, with sickle cell disease, was admitted following a vasoocclusive episode. Therapy with intravenous fluids, analgesics, supplemental oxygen and antibiotics was done. In the 7th day of admission, the patient developed fever, dyspnea and hypoxemia. Investigation showed worsening anemia (decrease in hemoglobin from 7.9 to 5.3 g/dL) and hemolysis, with increased inflammatory markers. Chest computed tomography revealed bilateral, homogeneous, lung condensation and pleural effusion. How to treat this?

[Souptik]

@sucheta Acute management of ACS includes pain control, intravenous (IV) fluids, antibiotics, supplemental oxygen, and blood transfusions. Pain control for children normally starts with ketorolac, since it is nonsedating and less likely to cause hypoventilation than opioid pain medication. Adult pain management can also begin with ketorolac. Both pediatric and adult patients whose pain is not adequately controlled with ketorolac and acetaminophen will require opioid pain medication best delivered by a PCA (patient controlled anesthesia) device. Pain control in ACS is a balance between analgesia to prevent atelectasis and over-sedation which can lead to hypoventilation and hypoxia. Fluid management is necessary in cases of dehydration since hypovolemia can cause additional sickling. Recommendations no longer advise large volume IV hydration, since overhydration can lead to pulmonary edema, which again leads to more respiratory complications. Fluid management should be directed by the patient’s hydration status.