Emergent assessment

Starting pain management within 30-60 minutes of arrival,² and reassessments every 30-60 minutes.2,3 Febrile patients should be assessed and have antibiotics started within 30-60 minutes of arrival.¹

New neurologic deficits should be urgently assessed for possible stroke.
Abdominal pain should be urgently assessed for possible splenic sequestration.
Priapism is a surgical emergency.

Investigations: For fever or respiratory symptoms: CBC, reticulocyte count, bilirubin (total and direct), and type and screen.3 All febrile patients also require blood cultures.

Consider blood gas, urine culture, lumbar puncture, stool culture based on clinical presentation.³ For infants < 2 months, refer to the AAP Clinical Practice Guidelines for Well Appearing Febrile infants 8-60 Days Old.⁴
Consider nasopharyngeal swab for respiratory viruses and mycoplasma pneumonia serology for respiratory symptoms.¹
Perform chest X-ray for all patients with respiratory symptoms or SpO₂ <95%, and consider in those with isolated fever.

Blood transfusions: The decision to transfuse should be based on both clinical status and context and should be guided in many instances by the baseline hemoglobin. Indications for transfusion may include:¹

Acute chest syndrome
Acute splenic sequestration with severe anemia
Aplastic anemia with profound drop in reticulocytes
Isolated severe anemia (Hgb ≥20 g/L below baseline OR <60 g/L if baseline unknown)