24th May 2023

A 20-year-old with sickle cell disease presents to the emergency department

A 20-year-old with sickle cell disease presents to the emergency department with chest pain, shortness of breath and pain on breathing. On examination, she is drowsy and tachypnoeic. She is tachycardic, hypotensive and has oxygen saturations of 93% on 15L oxygen via a non-rebreather mask, with type 1 respiratory failure on arterial blood gas. Chest x-ray shows pulmonary infiltrates. She is started on intravenous fluids, analgesia, and antibiotics. Her blood pressure following IV fluids increases to 100/54mmHg.

In addition to blood transfusion, what next step should be considered, given the likely diagnosis?