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Always use the "A, B, C, D, E, F" principles when caring for patients with sickle cell pain, urges Allan Platt, PA-C, program coordinator for the Atlanta-based Georgia Comprehensive Sickle Cell Center at Grady Health System.
• A = Assess the pain.
Remember that all pain may not be attributed to sickle cell, says Platt. "Patients can have appendicitis, myocardial infarction, and everything those without sickle cell disease have," he adds.
• B = Believe the patient’s stated level of pain.
"This is so important to optimal pain management," says Platt.
• C = Complications.
Infection, dehydration, acute chest, acidosis, and hypoxia can set off a pain crisis, says Platt. "Always look behind the pain to see what triggered it," he says. "Patients with complications should be admitted to the hospital."
• D = Drugs and distraction.
Use appropriate analgesics such as nonsteroidal anti-inflammatory drugs and central acting agents such as morphine in fixed doses or a pump, says Platt. In addition, distract patients with video, music, and relaxation, he advises. "Stay away from using meperidine in those with frequent pain," he says. "It builds up toxic metabolites that can cause seizures." Inhaled nitric oxide is now in clinical trials as a pain crisis treatment, Platt reports. "Preliminary reports look promising that it may shorten pain crisis," he says. "This may the ED treatment of the near future."
• E = Environment.
Provide a quiet place to calm pain and anxiety of patients, says Platt. "We treat patients for eight hours in our sickle cell ED and get 80% of the patients better to go home," he says. "Patients who are no better in eight hours or have complications should be admitted."
• F = Fluids and fixed dosing.
Give hypotonic D5W intravenously to reverse sickling, advises Platt. Use fixed drug dosing, with no "as-needed" pain medications, he advises.