Patient Presentation · Perform cardiorespiratory monitoring, pulse oximetry, and pain screen/assessment · Administer oxygen if O2 saturation < 95% · Initial labs: CBC with differential, reticulocyte count, blood culture · Consider immediate chest x-ray if tachypneic, chest pain, shortness of breath and/or rales · 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 · Check immunization status · Start maintenance fluids (bolus if clinically dehydrated) Sickle Cell Disease Acute Evaluation and Management - Pediatric - Emergency Department Algorithm Patient Population: Age > 2 months and < 18 years HbSS, SC, Sβ0-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: · Fever · Cough · Sputum production · Dyspnea · 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 O2 need) ***Low Risk Features: · Normal vital signs · Tolerating PO · Hgb > 6 mg/dL · Reticulocyte count > 5% (unless Hgb > 10 mg/dL) · No significant drop in Hgb from baseline · WBC 5,000-30,000/mm3 · No history of bacteremia or sepsis · No splenic sequestration within the past 3 months · Not multiple visits for same febrile illness · Compliant with penicillin · Fully immunized · 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 · History of Acute Chest Syndrome · History of stroke · History of splenic sequestration · History of sepsis or bacteremia · Reactive airway disease · Requires chronic transfusions · 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 ED - SCD and Fever 4-20-17 Final.vsd Page-1