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Current Guidelines For Sickle Cell Disease: Management Of Acute Complications

December 2009

Abstract

 
In this issue of EM Practice Guidelines Update, 2 guidelines addressing the management of sickle cell disease (SCD) are reviewed. As a result of numerous SCD-related complications, patients with SCD have significantly diminished life expectancy. Although most patients will be followed by subspecialty hematologists, SCD is fundamentally a “disease of emergencies.” Emergency clinicians should be familiar with the recommendations around management of acute SCD complications because failure to appreciate the nuances of care in these brittle patients may place them at risk for short-term morbidity and mortality. The methodology of these practice guidelines varies greatly—from evidence- based to expert opinion—and must be applied to emergency practice with caution and pragmatism. 
 
Practice Guideline Impact
  • In the management of acute SCD pain crises, bolus normal saline is not recommended unless the patient is hypovolemic. In euvolemic patients, intravenous hydration should not exceed 1.5 times maintenance with 5% dextrose in half normal saline. 
  • In the management of acute SCD pain crises, specific recommendations exist with regard to opiate choice and adjuvant medications. 
  • In patients with SCD and suspected infection, criteria exist to identify candidates for outpatient treatment.
  • Separate algorithms exist for the diagnosis and treatment of stroke in adults and children with SCD.
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