Sickle Cell pain treatment

Pain triggers

• inflammation
• hemolysis
• organ damage
• deoxygenation status
• dehydration
• infection
• stress

Diagnositc criteria

• pain onset within 10ndays of presentation lasting >2 hrs
• At least one: focal tenderness, focal pain w movement or regional pain causing decreased ROM,
• lab evidence of hemolysis
• pain not explained by another diagnosis

Management points:

• treat pain first: IN fentanyl if available, intranasal fentanyl instead of oral d/t bioavailability
• Individualized pain plan
• Explore social determinants
• If self-dc likely, plan oral step-down and follow-up within 48-72 hrs

Pharmacy lecture

• Renal colic
  • first line: ketorolac 15mgIV once, tyelnol 1000mg PO once
  • Second line: mag sulfate 2g IV, lidocaine 1.5mg/kg over 15 mins, ketamine
  • DC: ibuprofen 400mg PO Q4-6H, naproxen 500mg BID, ketorolac 10mg PO Q6H