The Curbsiders Internal Medicine Podcast #422 LIVE! Inpatient Management of Sickle Cell Crisis, Acute Pain, RBC Transfusions & Acute Chest Syndrome
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Jan 15, 2024 Dr. Yoo Mee Shin shares practical tips for managing patients with sickle cell disease in the hospital. Topics discussed include acute pain management, adjuvant therapies, IV fluids, oxygen therapy, acute chest syndrome, and simple vs exchange transfusions. Key takeaways include early triage and analgesia, addressing misconceptions about opioid use disorder, and recognizing complications of vaso-occlusive crises.
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Replace With Demand-Only IV PCA
- Use IV PCA (demand-only) for inpatient vaso-occlusive pain and increase doses by 25–50% if prior outpatient opioids were insufficient.
- Set a 10–20 minute analgesic expectation and a 15-minute PCA lockout to allow effect and reduce overdose risk.
Keep Long-Acting Opioids, Avoid Routine Basal PCA
- Continue a patient's long-acting oral opioid while treating acute pain with IV PCA rather than replacing long-acting therapy.
- Avoid routine continuous basal PCA in opioid-naive patients because evidence of benefit is mixed.
Multimodal Pain Adjuncts And Ambulation
- Use multimodal adjuvants: scheduled IV ketorolac (short course), acetaminophen, topical lidocaine patches, heat, and nonpharmacologic measures.
- Limit IV NSAIDs to ~3 days and prioritize ambulation and incentive spirometry.