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Sickle Cell Scenario

Sickle Cell Scenario

You are called to a 21-year-old female in severe pain. She states to the 999-call handler she has sickle cell disease and it has suddenly got worse again. As you arrive the patient looks in immense pain, but she still apologises for calling as she is normally pretty good at managing her symptoms. She recently has been struggling with a chest infection which hasn’t been getting better and seems to have exacerbated her sickle cell symptoms. Her usual pain medication doesn’t seem to be helping on this episode.

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Question 1 of 15

1. Question

You look to gain observations quickly so you can look at what pain relief to administer. You record: 115 HR, 24 RR, 92% Sp02, 142/92 BP, 4.2 BM and 38.5 Temp. What is this patients NEWS score?

7
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9
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6
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10
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Question 2 of 15

2. Question

You look to treat the patient’s hypoxia primarily. What is the target 02 saturation for sickle cell patients?

94-98%
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92-96%
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88-92%
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>85%
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Question 3 of 15

3. Question

You note the relatively high NEWS score but think some of it may be elevated due to her pain. The patient has taken co-codamol 3 hours ago and ibuprofen 5 hours ago. What pain relief would be more appropriate for this patient?

IM morphine
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IV morphine
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IV paracetamol
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Oral paracetamol
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Question 4 of 15

4. Question

What tool can you use to help in the assessment of pain in sickle cell patients?

SOCRATES
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Abbey pain scale
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Wong baker score
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Pained scale
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Question 5 of 15

5. Question

Severe pain in sickle cell disease usually is caused by….

Vascular occlusion caused by sickle shaped red blood cells causing tissue infarction
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Chronic inflammation causing pain on movement
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Small but numerous sites of infection within tissues
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Harsh skeletal and smooth muscle spasms
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Question 6 of 15

6. Question

You start to see the effects of the morphine and the patient starts to settle slightly. She has been coughing green phlegm for a couple of days with alongside a reduced exercise tolerance. This seems to be getting worse, but she has been away and has been unable to get to her GP.

What tool could be used for an assessment aid in patients suffering with chest infections?

CURB-65
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WELLs score
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Brugada criteria
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MEND test
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Question 7 of 15

7. Question

You consult the CURB-65 tool and score the patient as low risk. The patient tells you they really want to stay home and don’t want to go to hospital and cause a fuss. However, before deciding on your management plan for the patient, what should you refer to, if available, in sickle cell patients?

The patients individualised treatment plan
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The patients GP
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The sickle cell society website
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Senior clinician service available within trust
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Question 8 of 15

8. Question

You look at the patients individualised treatment plan which states several reasons why the patient should be taken to hospital including showing signs of acute chest syndrome. What is acute chest syndrome?

The evidence of pulmonary vaso-occlusion in sickle cell patients which leads to further hypoxia
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The evidence of ST segment ischemia on 12-lead ECG
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Evidence of sickle cell anaemia including pale complexion and chronic shortness of breath
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The evidence of secretions obstructing the alveoli within the lungs causing respiratory plugs within the airways
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Question 9 of 15

9. Question

What symptoms are associated with acute chest syndrome?

Tachypnoea
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Tachycardia
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Fever
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Hypoxia
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Chest pain
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Headache
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Joint pain
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Question 10 of 15

10. Question

What sounds would you expect to hear when auscultating patients with acute chest syndrome?

Bilateral crackles
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Normal breath sounds
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Pleural rub
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Inspiratory wheeze
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Question 11 of 15

11. Question

You consider that this patient is displaying symptoms of acute chest syndrome and therefore look to convey to hospital. All sickle cell patients should not be walked to the ambulance as this can exacerbate hypoxia in the tissues?

True
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False
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Question 12 of 15

12. Question

What other differentials should we consider when presented with this patient?

PE
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Pneumonia
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MI
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Asthma
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COPD
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Question 13 of 15

13. Question

Sickle cell disease is a genetic disorder that causes abnormal Haemoglobin structures causing sickle shaped red blood cells?

True
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False
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Question 14 of 15

14. Question

Sickle cell disease can also be developed through chronic inflammation caused by chronic exposure to pollutants or pathogens?

False
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True
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Question 15 of 15

15. Question

In general, any patient presenting with a Sickle Cell exacerbation must be taken to hospital for further care and examination?

False
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True
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