Severe Pain in Sickle Cell Disease: Acute Chest Syndrome

A branching clinical case simulation for a patient presenting with severe limb and back pain. Take a history, examine, investigate, diagnose and treat while the patient responds to every decision, then see the score by clinical domain with the reasoning for each mark.

Year 4medium20 min6 stages

Patient: 26 years, male
Presenting complaint: Severe limb and back pain
Decision stages: History, Examination, Investigations, Diagnosis, Treatment, Monitoring

The presentation

You are the junior doctor in the emergency department of a district general hospital. A 26-year-old man with sickle cell disease is brought in by his mother with a 2-day history of severe pain in his arms, legs, and back. He has also developed a cough and chest pain today. The triage nurse has already obtained a chest radiograph, which shows a new right lower zone infiltrate. His oxygen saturation is 91% on air. He is in obvious distress and has trouble speaking in full sentences.

What this case teaches

Prompt, adequate analgesia; recognise acute chest syndrome; oxygen, antibiotics, fluids and haematology referral; avoid the mistakes of under-treating pain.

How the case unfolds

1Focused HistoryHistory
2Physical ExaminationExamination
3InvestigationsInvestigations
4DiagnosisDiagnosis
5Immediate ManagementTreatment
6Monitoring and Ongoing CareMonitoring

The decisions available at each stage, and what each one costs or earns, appear when you run the case.

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A free account opens the simulator: the patient's observations move with your decisions, and every choice is scored and explained.

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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.