3.14. PAIN IN SICKLE CELL CRISIS

Related Names

None.

Purpose of assistance

1. Determine the presence of life-critical complications associated with sickle cell crisis.
2. Improve overall patient comfort.

Patient description

Inclusion criteria

Patients with an existing sickle cell crisis in a state of pain crisis.

Exclusion criteria

1. Pain due to severe trauma (see instructions of the “Injury” section).
2. Abdominal pain is associated with pregnancy (see instructions of the section “Obstetrics/Gynecology”).
3. Patients with signs of sickle cell disease.

Patient care

Condition assessment

1. Inspect the airway according to the Airway Control manual.

2. Collect data on vital signs – pulse, respiratory rate, pulse oximetry, blood pressure.

3. Evaluate and control the altered state of consciousness according to the instruction “Mental disorder.”

4. Perform a pain assessment and assist according to the Pain Management guideline.

5. Provide IV access (if necessary) for administration of analgesics and/or infusion resuscitation.

6. Assess the presence of life-threatening complications in addition to the pain crisis, including:

a) acute chest pain syndrome:

hypoxia;
chest pain;
fever;

b) stroke (see instruction “Suspected stroke/Transient ischemic attack”):
focal neurological deficiency;

c) meningitis:
headache;
altered state of consciousness;
fever;

d) septic arthritis:
acute pain in one joint;
fever;

d) spleen sequestration crisis (usually in younger children):
abdominal pain (upper left quadrant);
enlargement of the spleen (requires careful examination);
hypotension, tachycardia.

7. Assess the presence of signs of shock – if any, proceed according to the “Shock” instruction.

Treatment and intervention

1. Drug administration:

a) perform anesthesia according to the guidelines “Pain Control”;
b) start oxygen therapy with a nasal cannula;
c) provide IV access, start infusion with sodium chloride solution 0.9% at a dose of 10 mg/kg bolus (up to 1 liter);
d) deliver to the receiving department;
d) re-evaluate vital signs and response to therapy during transportation.

2. Ensuring patient comfort:

a) keep the patient dry and warm;
b) transport in a comfort position while the clinical picture allows it.

Patient safety

There are no recommendations.

Useful information for training

Key points

1. Assess the presence of life-critical complications associated with sickle cell disease – these patients have a high risk of various complications.
2. Give the right help for pain, respiratory distress or shock.
3. These patients have a high tolerance to narcotic painkillers, if they use them on a daily basis.
4. These patients poorly tolerate massive blood loss due to initial anemia.
5. Patients with this disease can have a pain crisis in extreme conditions (dehydration, overheating), in this regard, mortality among young athletes in higher educational institutions is associated

Relevant evaluation results

1. Examination of the lungs and evaluation of respiratory distress.
2. Disturbance of consciousness.
3. Focal neurological deficits.
4. Inability to move the joint.

Key elements of documentation

1. Normal respiratory and neurological condition.
2. Data on how this pain crisis is compared in sensations with other crises in the context of place, severity and pathogens.
3. Drugs that the patient takes at home

Criteria for the effectiveness of care

1. Assessment of the presence of life-critical causes.
2. Pain reduction according to the instruction “Pain control.”