Newsletters

POSTED: October 30th, 2020
POSTED IN: EM Pulse - The Official Newsletter of MOCEP, September/October 2020,

Did you know?

• Pain associated with vaso-occlusion indicates underlying tissue hypoxia. Triggers include hypoxia, dehydration and infection, although many are unpredictable with no underlying cause.
• 40% of patients have no vaso-occlusive episdoes in a year; less than 1% have greater than 6.
• Guidelines recommend treating vaso-occlusive episodes with parenteral opioids within 60 minutes of ED arrival. Subcutaneous administration, or intranasal fentanyl for children with sickle cell disease, should be utilized if intravenous access will be delayed. Opioids should be re-dosed every 20-30 minutes.
• Labs and imaging are useful screening tools to identify complications such as aplastic crisis or acute chest syndrome. However, they labs are often normal in a vaso-occlusive episode.
• Average age of death for men with Hb SS disease is 42 years and 48 years for women; those with Hb SC disease often live into their 60s. Those with frequent vaso-occlusive episodes have a higher mortality rate.

What can you do?

• Trust the patient’s report of pain and treat accordingly.
• Partner with your local hematologist to ensure adequate multidisciplinary care and outpatient management.
• Work with your emergency department to develop standardized care protocols, which can significantly improve throughput times and patient care.
• Educate yourself about this disease.

Resources

• Annals of Emergency Medicine online supplement dedicated to sickle cell disease
• Emergency Department Sickle Cell Care Coalition (EDSC³) website
  • EDSC³ Resource Webpage – Find podcasts, fact sheets, training videos, and MORE!
• Coming Soon! ACEP POC tool

National Academies of Science, Engineering and Medicine (NASEM) report on addressing SCD