Sickle Cell Crises

One of the reasons that managing Sickle Cell pain crises can be challenging is that we often under-dose analgesics in these patients. Use IV opiods for rapid effect. The subcutaneous route is more reliable than the IM route if no IV available. Use NSAIDS sparingly in Sickle Cell Disease! While NSAIDs for acute pain crises have been shown to be effective in reducing pain and decreasing hospital length of stay, many patients with sickle cell disease have progressive chronic renal failure as a result of renal infarcts and their serum creatinine level may appear normal despite this.
Boluses of IV fluid should NOT be given unless patients are overtly hypovolemic (sepsis, diarrheal illness, vomiting). In these situations, resuscitate only to euvolemia and for maintenance fluids use a hypotonic solution such as ½ NS or D5-½ NS.
In patients presenting with simple pain without other symptoms who are not being admitted, lab tests are generally NOT necessary. The reticulocyte count is the most useful blood test in those patients who present with complicated pain crises.

Managing Sickle Cell Disease in the ED