Pediatric Fever with Sickle Cell Disease

Case Description

Patient is a 3-year-old African American male brought in by EMS with a chief complaint of poor feeding and sleepiness. Mother reports that her child has had a low-grade fever for 2 days, vomiting, diarrhea and today refused to eat and has been sleeping all day. Patient has a history of sickle cell disease and has not been on any medications because they ran out. Patient is admitted to the PICU after he received 3 IV fluid boluses for his tachycardia and borderline blood pressure.

Learning Objectives

1. Learners will recognize shock in a pediatric patient.
a. Learners will assess perfusion- learners will assess pulses, capillary refill (delayed), and will ask about urine output (decreased) and mental status (sleepy)
b. Learners will ask for lab data to assess for end organ perfusion (increased creatinine, increased liver function markers, metabolic acidosis, increased lactate)
2. Learners will recognize and treat septic shock in an immunocompromised patient.
a. Learner will recognize that the patient is likely asplenic and that he is at higher risk for infection with encapsulated organisms
3. Learners will develop and implement an initial management plan for septic shock.
a. Learners will apply oxygen
b. Learners can consider giving additional fluid boluses
c. Learners will order appropriate medical management: antibiotics, antipyresis
4. Learners will recognize decompensation in patient with septic shock.
a. Learners will recognize decreasing blood pressure in patient, worsening tachycardia, worsening mental status
b. Learners will initiate vasoactive medications
5. Learners will recognize when to intubate a patient in septic shock.
a. As mental status continues to deteriorate and the patient has less respiratory drive, learners will initiate bag mask ventilation and prepare for intubation
b. As vasoactive doses increase, learners will prepare for intubation
Learners will communicate effectively with team members.
6. Learners will communicate effectively with team members.