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A 24-Year-Old Man with Sickle Cell Disease (Hemoglobin SS) Comes

question 160

Multiple Choice

A 24-year-old man with sickle cell disease (hemoglobin SS) comes to the emergency department with chest pain and shortness of breath. He has felt unwell for the last several days with increasing extremity, abdominal, and chest pain. The patient took extra doses of oral morphine with little relief. He stopped taking hydroxyurea 4 months ago due to stomach upset.
His blood pressure is 122/72 mm Hg, pulse is 108/min, respirations are 22/min, and oxygen saturation is 84% on room air. Bilateral crackles are heard on chest auscultation. A 2/6 midsystolic murmur is heard at the left upper sternal border. The abdomen is diffusely tender without rebound. There is no swelling of the extremities.
Laboratory results are as follows:

Chest x-ray reveals bilateral dense infiltrates involving both upper and lower right lung fields and the lower left lung field. Intravenous fluids, supplemental oxygen, and antibiotics are initiated.
Which of the following is the best next step in management of this patient?

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Definitions:

Hierarchy of Needs

A theory in psychology proposed by Abraham Maslow, categorized in a five-level model of human needs, from basic physiological needs to self-actualization.

Abraham Maslow

An American psychologist best known for proposing Maslow's hierarchy of needs, emphasizing a theory of human motivation based on a hierarchy of needs.

Total Person

A holistic concept referring to the multi-dimensional nature of individuals, encompassing physical, psychological, social, and spiritual aspects.

Stress Management

The process of using techniques and strategies to reduce or handle stress in personal or professional life.