The Sickle Cell Patient in the ED – Management of Acute Complications

Evidence-based guidelines and expert panels recommend the following in the management and treatment of pain crisis:

  • Initiate analgesia within 30 minutes of triage. (Consensus – Panel Expertise)
  • Employ individualized prescribing and pain monitoring protocols. (Consensus – Panel Expertise)
  • If no contraindications, give NSAIDs as adjuvant pain therapy. (Moderate Recommendation, Low-Quality Evidence)
  • Avoid meperidine (pethidine) (normeperidine, the active metabolite of meperidine, is excreted by the kidneys, and is associated with an increased incidence of seizures in the setting of renal dysfunction – common in occlusive crisis)

Defibrillate then Give Adrenaline for IHCA

Guidelines recommend prompt defibrillation for treatment of in-hospital cardiac arrest due to an initial rhythm of ventricular fibrillation (or pulseless ventricular tachycardia) Epinephrine (adrenaline) is recommended only when patients remain in refractory ventricular fibrillation or pulseless ventricular tachycardia after many defibrillation attempts. Use of epinephrine before defibrillation is associated with lower odds of survival to discharge and of favourable neurological survival, probably due to lower odds of achieving return of spontaneous circulation

Approach to Chest Pain

Clinical factors that INCREASE likelihood of ACS/AMI:

  • CP radiating bilaterally > right > left
  • Diaphoresis associated with CP
  • N/V associated with CP
  • Pain with exertion

Clinical factors that DECREASE likelihood of ACS/AMI:
Chest pain that is:

  • Pleuritic
  • Positional
  • Sharp, stabbing
  • Reproducible with palpation

Pleural Effusions

Pleural effusions have traditionally been classified as transudative versus exudative and thoracentesis with application of Light’s Criteria used to differentiate the two with 98% sensitivity and 83% specificity for exudative process.