Approach to the Critical Patient

Immediate priorities

Airway and oxygenation threats

Circulation and anemia threats

Escalation and alarm features

Alarm features triggering ICU escalation

Monitoring and targets

Monitoring bundle

Immediate consults

Consultation triggers

History

Presenting symptoms

Respiratory complaints

Constitutional symptoms

Temporal context

Symptom onset and evolution

Risk factors and SCD history

Disease-specific history

Transfusion and alloimmunization history

Prior transfusion details

Vaccination and prophylaxis history

Infection prevention history

Physical Exam

Vital signs

Hemodynamic and respiratory assessment

Pulmonary exam

Respiratory findings

Cardiac exam

Cardiac findings

Abdominal and general exam

Abdominal findings

General appearance

Differential Diagnosis

Life-threatening diagnoses

Pulmonary emergencies requiring urgent action

Pulmonary mimics

Conditions mimicking ACS

Abdominal and other mimics

Non-pulmonary diagnoses to consider

Laboratory Tests

Hematologic studies

Complete blood count with differential

Reticulocyte count

Peripheral blood smear

Chemistry and inflammatory markers

Metabolic panel

C-reactive protein

Procalcitonin

Microbiological studies

Cultures and respiratory testing

Coagulation and type and screen

Coagulation profile

Blood gases

Arterial or venous blood gas

Diagnostic Tests

Scoring Systems

ACS diagnostic criteria (NHLBI 2014 definition)

Severity stratification

MRI

MRI chest and bone marrow

CT

CT chest

CT brain

Ultrasound

Point-of-care ultrasound

Disposition

Admission indications

Admission criteria

ICU indications

ICU admission criteria

Transfer criteria

Transfer indications

Discharge criteria

Criteria for safe discharge

Treatment

Supplemental oxygen

Oxygen therapy

Incentive spirometry

Respiratory therapy

Transfusion therapy

Simple transfusion

Exchange transfusion

Empiric antibiotic therapy

Antibiotic regimen

Analgesia

Pain management

Bronchodilators

Inhaled bronchodilator therapy

Fluid management

IV fluid therapy

Corticosteroids

Steroid use — caution required

Disease-modifying therapy

Hydroxyurea

Special Populations

Pregnancy

Pregnancy-specific considerations

Geriatric

Geriatric-specific considerations

Pediatrics

Pediatric-specific considerations

Background

Epidemiology

Disease burden

Pathophysiology

Mechanisms of ACS

Therapeutic Considerations

Evidence base for key interventions

Patient Discharge Instructions

copy discharge instructions

Discharge instructions for Sickle Cell Acute Chest Syndrome

References

Guidelines and key sources

Primary guidelines

Supporting studies

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.