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Sickle cell acute chest syndrome — SCE Acute Medicine MCQ

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ModerateHaematological EmergenciesSickle cell acute chest syndromeSCE Acute Medicine

A 29-year-old man is assessed on the acute medical unit. He has sickle cell disease with chest pain, fever and new infiltrate on chest radiograph. Oxygen saturation has fallen to 91%. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: E — Give oxygen, antibiotics and urgent haematology review

Give oxygen, antibiotics and urgent haematology review is the best answer because acute chest syndrome needs oxygen, antibiotics, analgesia and early haematology input for transfusion decisions. Give isotonic crystalloid boluses with frequent reassessment is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: It can evolve from vaso-occlusive crisis and deteriorate quickly.

Reference: NICE sickle cell acute painful episode guidance