Sickle Cell Pain Crisis

Table of Contents

Aliases

None

Patient Care Goals

  1. Identify potentially life-threatening complications of a sickle cell disease
  2. Improve patient comfort

Patient Presentation

Inclusion Criteria

  1. Patient with known sickle cell disease experiencing a pain crisis

Exclusion Criteria

  1. Pain due to acute traumatic injury [see Trauma section guidelines]
  2. Abdominal pain due to or related to pregnancy [see OB/GYN section guidelines]
  3. Patients with sickle cell trait

Patient Management

Assessment

  1. Perform airway assessment and management per the Airway Management guideline
  2. Obtain vital signs including pulse, respiratory rate, pulse oximetry, and blood pressure
  3. Provide evaluation and management of altered mental status per the Altered Mental Status guideline
  4. Provide evaluation and management of pain per the Pain Management guideline
  5. Obtain vascular access as necessary to provide analgesia and/or fluid resuscitation
  6. Assess for potentially serious complications other than pain crisis which may include:
    1. Acute chest syndrome
      1. Hypoxia
      2. Chest pain
      3.  Fever
    2. Stroke [see Suspected Stroke/Transient Ischemic Attack guideline]
      1. Focal neurologic deficits
    3. Meningitis
      1. Headache
      2. Altered mental status
      3. Fever
    4. Septic arthritis
      1. Severe pain in a single joint
      2. Fever
    5. Splenic sequestration crisis (usually young pediatric patients)
      1. Abdominal pain, LUQ
      2. Splenic enlargement (examine with care)
      3. Hypotension, tachycardia
  7. Assess for signs of shock – If shock is present, treat per Shock guideline

Treatment and Interventions

  1. Medication Administration:
  2. Provide analgesia per the Pain Management guideline
  3. Start oxygen by nasal cannula
  4. Start an IV and provide saline 10 ml/kg normal saline bolus (up to 1L)
  5. Provide transport to an appropriate receiving facility.
  6. Reassess vital signs and response to therapeutic interventions throughout transport
  7. Comfort measures:
    1. Keep patient warm and dry
    2. Transport in a position of comfort unless clinical condition requires otherwise

Notes – Sickle Cell Pain Crisis