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Monday, April 15, 2019

Sickle Cell Vaso-occlusive Crises

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emDocs - april 15, 2019 - Author: Cisewski D - Edited by: Singh M; Koyfman A and Long B
..."The Upshot
Vaso-occlusive crisis pain is a common, debilitating pathology among sickle cell patients and should not be misinterpreted as drug-seeking behavior. Early recognition and initiation of an analgesic regimen is essential to limiting further sequelae and hospital admission rates/length of stay. Do not rely on abnormal vital signs (or absence of) to guide your management. Oral, intranasal, subcutaneous, nebulized, and intravenous routes of administration should all be considered. Remember that typical pain management regimens are not usually effective in treating a vaso-occlusive crisis. Limit NSAIDS and avoid fluid boluses during acute pain management. Limit oxygen to patients with O2 saturation < 95%. If admission is required, ensure a smooth transition of care that involves a continued analgesic regimen and involvement of the pain management or hematologic consultation service."