Sickle cell vaso-occlusive pain crisis in adults: alternative strategies for management in the emergency department.
The gene for sickle cell disease is carried by 8% of the African-American population in the United States. The primary care physician is often called upon to recognize and treat one of the major sequelae of sickle cell disease--vaso-occlusive pain crisis. An injectable nonsteroidal anti-inflammatory drug has recently become available and may offer some improvement in outcome of vaso-occlusive pain crises. We present five case reports reviewing various current therapeutic options, including newer pharmacologic agents, and comment on alternatives to impatient management of pain crises. The use of the emergency department short-term observation unit as an alternative to hospitalization is discussed.
Sanders
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Department of Medicine, University of Mississippi School of Medicine, Jackson.
Severance
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Pollack
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D000082:Acetaminophen / Q000008:administration & dosage / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000639:Amitriptyline / Q000008:administration & dosage / Q000627:therapeutic use; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use; D000755:Anemia, Sickle Cell / Q000150:complications*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D020910:Ketorolac; D008297:Male; D008614:Meperidine / Q000008:administration & dosage / Q000627:therapeutic use; D010098:Oxycodone / Q000008:administration & dosage / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000209:etiology*; D011398:Promethazine / Q000008:administration & dosage / Q000627:therapeutic use; D014046:Tolmetin / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000627:therapeutic use; D014652:Vascular Diseases / Q000188:drug therapy* / Q000209:etiology*
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000639:Amitriptyline; D000082:Acetaminophen; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D008614:Meperidine; D010098:Oxycodone; D014046:Tolmetin; D011398:Promethazine; D020910:Ketorolac