ED Pathway for Evaluation/Treatment of Children with Sickle Cell Disease and Pain

History and Physical

Consider Stroke Protocol:

History
Pain

Pain Assessment

  • Pain typical of previous VOE?
  • Location, quality, duration, intensity

Analgesics

  • Medications used
  • Frequency, dose, time of last dose
  • Usual pain regimen

Complications of Sickle Cell Disease

  • Acute chest syndrome
  • Aplastic crisis (Parvovirus Infection)
  • Documented bacteremia
  • Stroke, TIA
  • Splenic sequestration
  • Gall bladder disease
  • Osteomyelitis, septic arthritis

Past Medical History

  • Baseline pulse oximetry reading
  • Previous admissions, ICU admissions
  • Transfusion history
  • Vaccination history including Prevnar

Medications

  • Penicillin prophylaxis
  • Hydroxyurea
  • Folic acid
  • Chronic pain medications

Allergies

Physical Exam
  • VS, pulse oximetry reading
  • General appearance, jaundice
  • Pain assessment
  • Respiratory status
  • Circulatory status
  • Neurologic status
  • Evidence of focal infection
  • Spleen size
  • Presence of rash or petechiae