Sickle Cell Pain Crisis

Assessment

Pediatric Pearls: Signs & Symptoms: Differential: 
□ Pediatric hypotension is defined as SBP < 70 + (age in years x 2) mmHg □ Pain
□ Shortness of breath
□ Tachycardia 
□ Diaphoresis 
□ Hypoxia 
□ Fever
□ New stroke-like symptoms
□ Priapism
□ LUQ abdominal pain
□ Shock		□ Infection/Sepsis 
□ Dehydration 
□ Acute chest
□ Splenic sequestration
□ Osteomyelitis
□ Meningitis

Clinical Management Options

EMT-B
• Oxygen, target SpO2 92 – 96% 
• Pain scale assessment 0-10, Wong-Baker faces for pediatrics, FLACC for infants 
• Ice pack as needed 
Paramedic
• Consider vascular access 
• Isotonic Crystalloid as needed 
• Consider medications for pain control
• Acetaminophen/Ibuprofen for mild to moderate pain
• Fentanyl for severe pain, MAP>65 and no respiratory depression
• Monitor ECG and ETCO2 if fentanyl was provided
Consult Online Medical Control as Needed

Pearls

  • Patients with chest pain, fever, tachycardia, and/or shortness of breath may be suffering from acute chest syndrome. Pediatric patients need to go to a children’s hospital as these patients may need antibiotics and admission.
  • Patients with LUQ abdominal pain, hypotension may be suffering from splenic sequestration. Follow the shock protocols. 
  • Patients with sickle cell often have severe pain. It is reasonable to treat this pain en route .