Pain in the Emergency Room or Hospital Setting
Acute pain syndromes associated with sickle cell disease include:
If the symptoms of acute pain cannot be managed at home, hospital admission for pain relief may be needed. The goal of emergency room care is to assess the clinical problem, initiate a trial of oral or IV pain medications, assess the response, and decide with the patient whether or not hospitalization is necessary.
It is not possible to diagnose a painful vaso-occlusive episode with a specific clinical finding or laboratory test. Due to multiple complications of sickle cell disease that present with pain, multiple tests may be done to “rule out” or make sure a patient does not have another complication.
Certain lab tests can help discern precipitating or complicating factors:
- CBC: evaluation of baseline hemoglobin; helps to determine if an infection is likely if there is an issue with the spleen or bone marrow cell production
- blood chemistry studies: evaluation of kidney function and red blood cell turnover
- chest X-ray and oxygen saturation (O2Sat): evaluation of lung functioning
- abdominal X-ray or ultrasound: evaluation of abdominal pain to check for constipation or gallstones
- blood/fluid culture: evaluation if blood or bone infection is present