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201705121

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Sickle Cell Disease and Fever - Pediatric ED Algorithm

Sickle Cell Disease and Fever - Pediatric ED Algorithm - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Clinical Practice Guidelines, Hematology and Coagulation, Related


Patient Presentation
ξ Perform cardiorespiratory monitoring, pulse oximetry, and pain screen/assessment
ξ Administer oxygen if O
2
saturation < 95%
ξ Initial labs: CBC with differential, reticulocyte count, blood culture
ξ Consider immediate chest x-ray if tachypneic, chest pain, shortness of breath and/or rales
ξ Consider additional labs such as: total bilirubin, creatinine, urinalysis and urine culture.
If in pain, consider Type and Screen, potassium, sodium, bicarbonate, and chloride and
refer to Evaluation and Initial Management of Children with Sickle Cell Disease and Pain Suspected
to be a Vaso-Occlusive Event – Pediatric – Emergency Dept. Algorithm
ξ Check immunization status
ξ Start maintenance fluids (bolus if clinically dehydrated)
Evaluation and Initial Management of Children with Sickle Cell Disease and Fever – Pediatric –
Emergency Dept. Algorithm
Patient Population:
Age > 2 months and < 18 years
HbSS, SC, Sβ
0
-thalassemia
Fever > 38.5°C in the past 48 hours
Is the pt
ill appearing or
any historical red
flags*?
Administer IV ceftriaxone
**Acute Chest Syndrome:
New infiltrate on chest x-ray AND one or more
of the following NEW symptoms:
ξ Fever
ξ Cough
ξ Sputum production
ξ Dyspnea
ξ Hypoxia
Fluids in Acute Chest Syndrome:
Avoid excessive fluid administration,
resuscitate as necessary
Contact CCKM for revisions.
Reference the UW Health Acute Evaluation and Management of
Children with Sickle Cell Disease – Pediatric – ED Guideline
Acute chest
syndrome?**
Yes
ADMIT TO PICU or
PEDS HEM/ONC
Administer IV ceftriaxone
+ oral azithromycin
ADMIT TO PICU or PEDS HEM/ONC
(based on supplemental O
2
need)
***Low Risk Features:
ξ Normal vital signs
ξ Tolerating PO
ξ Hgb > 6 mg/dL
ξ Reticulocyte count > 5% (unless Hgb > 10 mg/dL)
ξ No significant drop in Hgb from baseline
ξ WBC 5,000-30,000/mm
3
ξ No history of bacteremia or sepsis
ξ No splenic sequestration within the past 3 months
ξ Not multiple visits for same febrile illness
ξ Compliant with penicillin
ξ Fully immunized
ξ Able to follow-up next day with Peds Hem/Onc via appointment or telephone contact
Age > 18
months?
ADMIT TO PEDS HEM/ONC
No
Low risk?***
Yes
Observe for 1 hour
post antibiotics
Yes
Contact PEDS HEM/ONC
to discuss discharge, follow-up, and
additional antibiotic therapy
No
*Historical Red Flags
ξ History of Acute Chest
Syndrome
ξ History of stroke
ξ History of splenic
sequestration
ξ History of sepsis or
bacteremia
ξ Reactive airway disease
ξ Requires chronic transfusions
ξ History of PICU admission for
SCD related complications
Administer IV
ceftriaxone
Consult with
PEDS HEM/ONC or PICU
for admission
Perform further
evaluation and
management as clinically
appropriate
(e.g., fluid resuscitation,
vancomycin, etc.)
Yes
INTERVENE IMMEDIATELY-
PATIENT MAY BE CRITICALLY ILL
No
No
Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority
Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org