title: Treatment of the acute sickle cell vaso-occlusive crisis in the Emergency Department: a Brazilian method of switching from intravenous to oral morphine.
abstract: OBJECTIVE
  Describe the treatment of patients with vaso-occlusive crises (VOC) in a Brazilian emergency department (ED) and the successful switch from intravenous to oral morphine.
  
  
  METHODS
  We analyzed records of 315 patients with sickle cell disease using two different protocols for pain: one in March 2010 prescribing intravenous morphine every 4 h throughout their stay, and another in March 2011 and 2012 prescribing one initial dose of intravenous morphine followed by equianalgesic doses of oral morphine every 4 h. Patients were triaged into three groups: mild, moderate, and severe VOC. The mild group was treated within 1 h after triage, the moderate within 30 min and the severe was treated immediately. Patients whose pain was not relieved within 6 h after the first dose of morphine were transferred into a different holding area of the ED where they continued to receive the same treatment for 48 h after which they were hospitalized if still in pain.
  
  
  RESULTS
  The number of patients who stayed <24 h in the ED increased significantly from 63 in 2010 to 87 in 2012, and the number of admissions decreased from 26 in 2010 to 10 in 2012. The incidence of acute chest syndrome decreased from 8.5% in 2010 to 1.9% in 2012.
  
  
  CONCLUSIONS
  Patients treated with oral morphine stayed a shorter time in the ED, had more pain relief, were admitted less frequently, and had less acute chest syndrome. These differences may be due to environmental, cultural, psychological, and pharmacogenetic factors.
authors.affiliation: Clinical Hematology Division, Instituto de Hematologia Arthur de Siqueira Cavalcanti - HEMORIO, Rio de Janeiro, Brazil.
authors.forename: Jessica
authors.initials: J
authors.lastname: Campos
authors.forename: Clarisse
authors.initials: C
authors.lastname: Lobo
authors.forename: Ana Maria Mach
authors.initials: AM
authors.lastname: Queiroz
authors.forename: Emilia Matos
authors.initials: EM
authors.lastname: do Nascimento
authors.forename: Carlos Bernardo
authors.initials: CB
authors.lastname: Lima
authors.forename: Gilberto
authors.initials: G
authors.lastname: Cardoso
authors.forename: Samir K
authors.initials: SK
authors.lastname: Ballas
mesh_terms: D000284:Administration, Oral; D000755:Anemia, Sickle Cell / Q000188:drug therapy*; D001938:Brazil; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D012189:Retrospective Studies
chemical_list: D009020:Morphine
keywords: intravenous morphine; oral morphine; sickle cell disease; sickle cell pain; vaso-occlusive crisis