This guideline is about the management of acute sickle cell crises in hospital. However there are a couple of points useful for us:
Initial Assessment of a Patient:
The patient will know what their normal crisis is like. If they say it is different, consider other potential causes for their pain.
Assess obs (including temperature and sats).
- Expert Patient. Depending on the severity / past experience of pain and analgesia, the patient will know what works for them. Listen to the patient!
- Repeat medications. Many crises will be managed at home, so the patient may need medication on repeat, or a standby dose at home.
- It is common for weak and strong opioids to be needed. All patients should also use paracetamol and NSAIDs if not contra-indicated, during a crisis.
- Adjunctive Medications. They may need an antiemetic and laxatives too.
Beware more significant sequelae:
- Acute Chest syndrome – beware respiratory symptoms, low sats (< 95%), chest pain or fever.
- Strokes, osteomyelitis, infections, aplastic crisis and splenic sequestration can all occur.