Code 3 Workshop

Paramedic Education
Home/All lessons/Medical/Sickle Cell Crisis in the Field
Lesson

Sickle Cell Crisis in the Field

10 min Medical Skip to quiz

Objective: Treat sickle cell pain as real. Screen for stroke, acute chest syndrome, and infection. Do not delay care because you suspect drug seeking, and do not put a non-rebreather on a talking patient with a normal saturation.

Why this matters

The patient wants pain medicine, and a crew member may treat that request as the whole call. The pain is still real. Sickled cells block small vessels. First, treat the pain as real and screen for stroke, acute chest syndrome, and infection. Do not delay care because you suspect drug seeking. Acute chest syndrome, stroke, and splenic sequestration need a short scene.

Key points
  • Ask how this crisis compares with their usual one. New one-sided weakness is a stroke until proven otherwise.
  • Give oxygen if they are hypoxic. Do not put a non-rebreather on a talking patient with a normal saturation.
  • Treat fever plus sickle cell disease as infection until the hospital says it is not.

Clinical sequence

  1. Compare this episode with their usual crisis. A new focal deficit is a stroke pathway.
  2. Give oxygen for hypoxia or distress. Do not put a non-rebreather on a talking patient whose saturation is normal.
  3. Treat fever plus sickle cell disease as infection until proven otherwise, and transport.
  4. Treat pain per protocol. This page has no opioid dose. Screen for acute chest syndrome: chest pain and hypoxia can be acute chest syndrome, and fever may be present. Do not withhold pain medicine because of stigma.

Teaching points

  • Vaso-occlusive pain. The pain comes from blocked small vessels. Give analgesia per protocol. Do not withhold it because of a drug-seeking label. Do not invent an opioid dose.
  • Acute chest syndrome. Chest pain, fever, hypoxia, and later a new infiltrate. In the field, chest pain and hypoxia in sickle cell disease are the clue. Treat hypoxia and transport.
  • Stroke. Children with sickle cell disease have strokes. Use your stroke pathway.
  • Other emergencies. Priapism, and splenic sequestration in a child who is pale, has a large spleen, and is in shock, are destination problems.

Common errors

  • Do not let a drug-seeking label delay care.
  • Do not skip the neurologic exam.
  • Do not withhold oxygen from a hypoxic patient in chest crisis.

Practice

One-minute check

A 16-year-old with sickle cell disease has new right-arm weakness. Say whether this is a pain-only call or a stroke pathway, and say why.

Related: Stroke, Fentanyl.

Sources & Further Study

Named guidelines for further study. They are not clinical orders and do not replace your protocol or medical direction.

Education only. Apply learning within your protocols and medical direction. This is not clinical care guidance.

Check Your Understanding

Questions drawn only from this lesson. After you check, the key is highlighted. Education practice — not a certification exam.

1. Vaso-occlusive pain in sickle cell is:
2. New focal weakness in a child with sickle cell:
3. Fever plus sickle cell:
4. Oxygen in sickle cell:
← Meningitis & Fever With Stiff Neck Hypoglycemia Refusal & Capacity →