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학습 자료 둘러보기 →In a child with sickle cell anemia presenting with severe pain, fever, lethargy, and decreased urine output, the priority is circulation. Signs indicate hypovolemic shock and evolving vaso-occlusive crisis. Dehydration, acidosis, and stasis are primary drivers of sickling and must be reversed immediately.
The first intervention is to establish IV access and begin fluid resuscitation with isotonic crystalloids, typically a 10-20 mL/kg bolus of normal saline or lactated Ringer's, repeated as clinically indicated. This restores intravascular volume, improves microvascular perfusion, and interrupts the sickling cycle.
Do not delay fluid resuscitation for pain medication or laboratory studies. While pain control is critical, it is secondary to stabilizing the airway, breathing, and circulation. Routine oxygen administration without documented hypoxia is not recommended and can suppress erythropoiesis.
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