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Dark Angel · 10-04-2009, 12:47 PM

I recently had a patient who was having a sickle cell crisis. He was having alot of pain in his legs, but refuse meds for it, stating he would wait until he got to the hospital for them. Even though he refused the analgesics, I figured I would get a line in him and start giving him some fluids.

Unfortunately, I couldn't get an IV. From all the IV's and blood transfusions over the years, everywhere I looked was really scarred up. I was able to find a vein in his foot, but it blew as soon as I touched it with the angio. The poor kid told me that that happens quite often to him, that he has had to have IVs in his foot before, and if all else fails they will put in an EJ. Granted, I could have went to his neck, but at that point we were getting ready to pull into the ER so I opted to just let them find something.

My question for all of you is, besides O2, is there anything else that you would have done for this patient? I just felt horrible that I couldn't do anything for this guy.

screaming pizza · 10-04-2009, 02:57 PM

The only pre-hospital treatment that I am familiar with for SCC patients, besides pain meds, is D5W, provided that you can get a line of course. It was (is? Not there anymore anyways...) in the protocols and explained by MC that D5W is thought to have properties that have shown a propensity to slow, stop, or even reverse sickling. But since it wasn't a clinically proven fact (at least at the time) it was put forth as a recommendation. But, I haven't worked there since 7/04, so if there is anybody that's current at da Gradies they can maybe clarify.

FF/EMTP1317 · 10-05-2009, 01:54 AM

In MD it's Lactated Ringers (provided you can get access) and Morphine. If he was refusing pain meds though there really isn't much else you can do for him. My understanding is that fluids are key for these patients and you want to make them comfortable. Some of them are already on decent pain meds so our little bit of Morphine or whatever you carry may not do much for them.

**anthonyt** · 10-11-2009, 09:39 PM

I have read a couple of studies that suggest High Flow O2 may be minimally helpful, as over-saturating the blood may help to prevent further sickling, and possible re-inflate a small quantity of newly sickled RBC's. I have tried it with many of my SSC pts and had marginal results, couldn't even be sure that it wasn't just placebo effect. But, it can't hurt, maybe might help...

Other than that... fluids, and analgesics.

FF/EMTP1317 · 10-11-2009, 11:00 PM

Quote:

Originally Posted by anthonyt

I have read a couple of studies that suggest High Flow O2 may be minimally helpful, as over-saturating the blood may help to prevent further sickling, and possible re-inflate a small quantity of newly sickled RBC's. I have tried it with many of my SSC pts and had marginal results, couldn't even be sure that it wasn't just placebo effect. But, it can't hurt, maybe might help...

Other than that... fluids, and analgesics.

Interesting.

**medic pathetic** · 10-12-2009, 01:42 AM

My protocol is in line with what anthonyt said. IV, highflow O2, monitor, fluids, and morphine or fentanyl. The main focus is overall comfort. Another med that is included for us is Ketorolac(tordol) less for the pain and more for the inflammation. Also it can help potentiate the effects of morphine (not sure about fentanyl and other narcotics) if it is given once he gets to the hospital. If you carry it and it were allowed you could see if he would accept that, especially if his concern was the idea of being given a narcotic. Many people it seems automatically relate any pain pill with developing an instant dependancy. Maybe a non narcotic would be more easily accepted. It can be given IM and there is no real concern with them becoming hemodynamically unstable from that medication alone. But sometimes your hands are tied, like in this instance. You did all you could with what you had. :-)

Philly Medic · 10-12-2009, 12:50 PM

No offense to all the treatment suggestions for sickle cell but most of our sickle cell calls are repeat calls(multiple times per week) who are only seeking meds. It is so bad that we don't even have a sickle cell protocol. BLS transport.

CornholioMedic · 10-12-2009, 08:28 PM

Quote:

Originally Posted by Philly Medic

No offense to all the treatment suggestions for sickle cell but most of our sickle cell calls are repeat calls(multiple times per week) who are only seeking meds. It is so bad that we don't even have a sickle cell protocol. BLS transport.

Unfortunately, that happens more times than not.

**anthonyt** · 10-15-2009, 10:44 AM

Quote:

Originally Posted by Philly Medic

No offense to all the treatment suggestions for sickle cell but most of our sickle cell calls are repeat calls(multiple times per week) who are only seeking meds. It is so bad that we don't even have a sickle cell protocol. BLS transport.

While that may be the case more oft than not, we have to keep in mind that there are times when a Sickle Cell Crisis, truly is a crisis. You should be able to tell the difference, and treat accordingly. Period.

To allow your treatment to be truncated simply because of those people who use the dx as a justification for drug seeking, is irresponsible, and quite frankly immoral.

Philly Medic · 10-15-2009, 12:49 PM

I'm not and I agree with you if you read the other thread on this subject this is in line with my feelings. Keep in mind in Philly we are less than 5 minutes from any hospital. For me to push pain meds for a crisis I need to get medical command when I can be at the hospital in the same amount of time to get my mother may I.

10-04-2009, 12:47 PM	#1
Dark Angel Survived medic year #1! Join Date: Sep 2009 Location: Indiana Posts: 65 My Mood: Rep Power: 6	Sickle Cell anemia I recently had a patient who was having a sickle cell crisis. He was having alot of pain in his legs, but refuse meds for it, stating he would wait until he got to the hospital for them. Even though he refused the analgesics, I figured I would get a line in him and start giving him some fluids. Unfortunately, I couldn't get an IV. From all the IV's and blood transfusions over the years, everywhere I looked was really scarred up. I was able to find a vein in his foot, but it blew as soon as I touched it with the angio. The poor kid told me that that happens quite often to him, that he has had to have IVs in his foot before, and if all else fails they will put in an EJ. Granted, I could have went to his neck, but at that point we were getting ready to pull into the ER so I opted to just let them find something. My question for all of you is, besides O2, is there anything else that you would have done for this patient? I just felt horrible that I couldn't do anything for this guy. __________________ Compassion is not a page in your protocol book; it comes from within you. As paramedics, we must have and never lose our sense of compassion for the sick, the injured and the ones who call for no apparent reason.

10-04-2009, 02:57 PM	#2
screaming pizza Darwin Was A Optomist Join Date: Feb 2007 Location: Land O' Pain Control Rx Posts: 1,858 Blog Entries: 1 My Mood: Rep Power: 83	Re: Sickle Cell anemia The only pre-hospital treatment that I am familiar with for SCC patients, besides pain meds, is D5W, provided that you can get a line of course. It was (is? Not there anymore anyways...) in the protocols and explained by MC that D5W is thought to have properties that have shown a propensity to slow, stop, or even reverse sickling. But since it wasn't a clinically proven fact (at least at the time) it was put forth as a recommendation. But, I haven't worked there since 7/04, so if there is anybody that's current at da Gradies they can maybe clarify. __________________ TERRIBILIS EST LOCU ISTE The problem with socialism is that you eventually run out of other people's money

10-05-2009, 01:54 AM	#3
FF/EMTP1317 Senior Member Join Date: Aug 2006 Location: state of confusion Posts: 4,032 My Mood: Rep Power: 125	Re: Sickle Cell anemia In MD it's Lactated Ringers (provided you can get access) and Morphine. If he was refusing pain meds though there really isn't much else you can do for him. My understanding is that fluids are key for these patients and you want to make them comfortable. Some of them are already on decent pain meds so our little bit of Morphine or whatever you carry may not do much for them. __________________ God is great, beer is good, and people are crazy - Billy Currington

10-11-2009, 09:39 PM	#4
anthonyt Super Moderator Join Date: Nov 2005 Posts: 1,132 My Mood: Rep Power: 82	Re: Sickle Cell anemia I have read a couple of studies that suggest High Flow O2 may be minimally helpful, as over-saturating the blood may help to prevent further sickling, and possible re-inflate a small quantity of newly sickled RBC's. I have tried it with many of my SSC pts and had marginal results, couldn't even be sure that it wasn't just placebo effect. But, it can't hurt, maybe might help... Other than that... fluids, and analgesics. __________________ Anthonyt Those who would give up essential liberty, to purchase temporary safety, deserve neither liberty, nor safety. -Benjamin Franklin It is a grand mistake to think of being great without goodness and I pronounce it as certain that there was never a truly great man that was not at the same time truly virtuous. -Benjamin Franklin

10-12-2009, 01:42 AM	#6
medic pathetic It's just me. Join Date: Apr 2006 Location: In the cabinet behind the normal saline. Posts: 2,973 Blog Entries: 3 My Mood: Rep Power: 113	Re: Sickle Cell anemia My protocol is in line with what anthonyt said. IV, highflow O2, monitor, fluids, and morphine or fentanyl. The main focus is overall comfort. Another med that is included for us is Ketorolac(tordol) less for the pain and more for the inflammation. Also it can help potentiate the effects of morphine (not sure about fentanyl and other narcotics) if it is given once he gets to the hospital. If you carry it and it were allowed you could see if he would accept that, especially if his concern was the idea of being given a narcotic. Many people it seems automatically relate any pain pill with developing an instant dependancy. Maybe a non narcotic would be more easily accepted. It can be given IM and there is no real concern with them becoming hemodynamically unstable from that medication alone. But sometimes your hands are tied, like in this instance. You did all you could with what you had. :-) __________________ "I'm shattered, but it really doesn't matter. My rescue is gonna be here soon."- Coldplay "I love the body. Flesh is so honest, and organs do not lie." ~Candea Core- Starke “It is sometimes an appropriate response to reality to go insane.” -Philip K. Dick FNG: Required dress code Click Here (safe for work.)

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10-12-2009, 12:50 PM	#7
Philly Medic Philly Medic Join Date: Nov 2005 Location: Philadelphia,PA Posts: 508 Rep Power: 62	Re: Sickle Cell anemia No offense to all the treatment suggestions for sickle cell but most of our sickle cell calls are repeat calls(multiple times per week) who are only seeking meds. It is so bad that we don't even have a sickle cell protocol. BLS transport.

10-15-2009, 12:49 PM	#10
Philly Medic Philly Medic Join Date: Nov 2005 Location: Philadelphia,PA Posts: 508 Rep Power: 62	Re: Sickle Cell anemia I'm not and I agree with you if you read the other thread on this subject this is in line with my feelings. Keep in mind in Philly we are less than 5 minutes from any hospital. For me to push pain meds for a crisis I need to get medical command when I can be at the hospital in the same amount of time to get my mother may I.