pediatric in pain

And I wouldn't just say that infection causes it as it has several causes with some complex pathogenesis.

Fat emboli from bone/marrow infarction, multiple viral/bacterial causes, and in a good number of cases the cause is frankly not known.
 
FLdoc2011 said:
And I wouldn't just say that infection causes it as it has several causes with some complex pathogenesis.

Fat emboli from bone/marrow infarction, multiple viral/bacterial causes, and in a good number of cases the cause is frankly not known.
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Darned syndromes, can't get them to commit to one etiology over another!

I hated treating inmates with sickle cell, jail is not where you treat something like that, yet these people really needed to have their "time out".
 
FLdoc2011 said:
Did the initial admitting hospital not recognize acute chest syndrome in a kid with sickle cell?
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Community hospital that doesn't see a lot of sickle cell. Not sure we missed it, because it was in our differential. We transferred him because we didn't know if we were treating ACS or a pain crisis.

Correction: there is indeed more than 1 etiology of Acute Chest Syndrome.
 
Even if a community hospital setting it's one of the more known sickle cell emergencies, especially in pediatrics which an ER doc would/should be familiar with.
 
FLdoc2011 said:
Even if a community hospital setting it's one of the more known sickle cell emergencies, especially in pediatrics which an ER doc would/should be familiar with.
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Familiar with and manage/treat in house?
 
I'm assuming they were admitted to a pediatrics service?

Yes, assuming they were physicians that went to med school and completed a residency in some pediatrics related field they should be familiar with one of the more common and more serious complications of sickle cell disease in children.

Now if just a small pediatric service with no ICU level care and just not equipped then yea transfer out, but I would think they would recognize that from admission and not a day or so into it think, "oh crap, he has acute chest syndrome"
 
Even if it looks like a "simple pain crisis" at first, both children and adults with sickle cell disease can develop acute chest over the next few days.

No one suggested it here, but it bears some emphasis - just don't let the parents of a febrile kid with sickle cell (± chest pain) decline transport to the ED, if you can help it. Most of those kids are getting admitted, and they are all getting antibiotics (preferably with 1 hour of arrival).

These are very high-risk patients, probably worse than most traumas or MIs you transport.
 
Interesting call tonight that immediately made me think of this thread. I had never heard of acute chest syndrome prior to reading this thread and then doing some additional research a few days ago. Had a call at about 0100 tonight for a 6 YOF with "very bad" pinpoint chest pain and a mild fever. Pain located mid sternally and is reproducible to palpation and inspiration, along with waking her from sleep this evening. Patient stayed home from school yesterday with stomach pain, and has no history of recent trauma or illness. Patient has a history of sickle cell anemia and presented very stably with no abnormalities in vital signs or remainder of physical exams.

Honestly, I have no idea whether this patient will end up having acute chest syndrome at all or of it will be completely unrelated, but I'm actually glad they transported her and I will call for some follow-up out of curiosity later.
 
chaz90 said:
Interesting call tonight that immediately made me think of this thread. I had never heard of acute chest syndrome prior to reading this thread and then doing some additional research a few days ago. Had a call at about 0100 tonight for a 6 YOF with "very bad" pinpoint chest pain and a mild fever. Pain located mid sternally and is reproducible to palpation and inspiration, along with waking her from sleep this evening. Patient stayed home from school yesterday with stomach pain, and has no history of recent trauma or illness. Patient has a history of sickle cell anemia and presented very stably with no abnormalities in vital signs or remainder of physical exams.

Honestly, I have no idea whether this patient will end up having acute chest syndrome at all or of it will be completely unrelated, but I'm actually glad they transported her and I will call for some follow-up out of curiosity later.
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What was the pre hospital treatment?
 
I'm dense. Exactly why is this syndrome tender to palpp?
 
teedubbyaw said:
What was the pre hospital treatment?
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Based on the current stability, BLS monitor and transport. Like I said, I don't even know if this was acute chest syndrome or not. In all honesty, it was a very routine call on first glance and one I wouldn't have thought anything of if I hadn't recently learned about acute chest syndrome. This might be a classic case of thinking zebras when I heard hoofbeats, but I'm glad to at least have this in my list of differentials.
 
Hi, I really appreciate the topic about recommendations about this matter. It really helps a lot during emergency cases.
 
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