Notes – Sickle Cell Pain Crisis

Sickle Cell Pain Crisis

Patient Safety Considerations

  1. None recommended

Notes/Educational Pearls

Key Considerations

  1. Assess for life-threatening complications of sickle cell disease – these patients have significantly higher risk of numerous complications in addition to pain crises
  2. Provide appropriate treatment for pain, respiratory distress, and shock
  3. These patients may have a higher tolerance to narcotic pain medications if they are taking them on a regular basis
  4. These patients will tolerate acute blood loss poorly due to baseline anemia
  5. Patients with sickle cell trait can have acute pain crises in extreme conditions (e.g. heat exhaustion, dehydration) and a number of college athlete deaths have been linked to sickle cell trait

Pertinent Assessment Findings

  1. Lung exam and assessment of respiratory distress
  2. Altered mental status
  3. Focal neurologic deficits
  4. Inability to move a joint

Quality Improvement

Associated NEMSIS Protocol(s) (eProtocol.01)

  • 9914165 – Other (as of 3/1/2017, no specific NEMSIS protocol exists)

Key Documentation Elements

  • Documentation of normal respiratory and neuro status
  • Documentation of how this pain crisis compares with others in terms of location, severity, and triggers
  • Documentation of home pain medications used

Performance Measures

  • Assessment for life-threatening etiology
  • Mitigation of pain per the Pain Management guideline

Reference

  1. Mitchell BL. Sickle cell trait and sudden death – bringing it home. J Natl Med Assoc. 2007;99(3):300-5.