Patient Presentation · Perform cardiorespiratory monitoring, pulse oximetry, and pain screen/assessment · Administer O2 if O2 saturation < 95% · Administer IN fentanyl 1.5 mcg/kg (max 100 mcg/dose) ASAP (until IV access established) · Obtain initial labs: CBC with differential, reticulocyte count, Type and Screen Sickle Cell Disease Acute Evaluation and Management - Pediatric - Emergency Department - Pain Suspected to be a Vaso-Occlusive Event Algorithm Patient Population: HbSS, SC, Sβ0-thalassemia · Give normal saline bolus 20 mL/kg (max 1 L) as indicated · Consider 2 view chest x-ray if tachypneic, chest pain, shortness of breath and/or rales · If fever, obtain blood culture and refer to Evaluation and Initial Management of Children with Sickle Cell Disease and Fever – Pediatric – Emergency Dept. Algorithm Is pain well controlled? Administer PO oxycodone + PO ibuprofen (if no NSAID in last 6 hours) *REASSESS IN 60 MINUTES* Yes Is pain well controlled? Contact Peds Hem/Onc to discuss possible discharge and follow-up Yes Meet discharge criteria? DISCHARGE Provide prescription for 3 days of scheduled oxycodone, ibuprofen, and miralax. Yes No Administer IV opioid + IV ketorolac (if no NSAID in the last 6 hours) *REASSESS IN 20 MINUTES* No No Is pain well controlled? Yes Discharge Considerations · Pain well-controlled · Tolerating PO liquids · Absence of other acute SCD complications IV opioid: 50% loading dose *REASSESS IN 20 MINUTES* No Is pain well controlled? IV opioid: 50% loading dose No ADMIT TO PEDS/HEM ONC · Contact Peds Hem/Onc with lab results and patient status · Consider initiation of PCA or scheduled long-acting oral opioid. Yes References: 1. National Heart L, and Blood Institute. Evidence-based Management of Sickle Cell Disease. Expert Panel Report: U.S. Department of Health and Human Services National Institutes of Health; 2014:32-38. 2. Rees DC, Olujohungbe AD, Parker NE, et al. Guidelines for the management of the acute painful crisis in sickle cell disease. Br J Haematol. 2003;120(5):744-752. 3. Fein DM, Avner JR, Scharbach K, Manwani D, Khine H. Intranasal fentanyl for initial treatment of vaso-occlusive crisis in sickle cell disease. Pediatr Blood Cancer. 2016. ADMIT TO PEDS HEM/ONC Reference historical therapy received and/or pain plan documented in the patient’s medical record (Problem List) Copyright © 2017 University of Wisconsin Hospitals and Clinics Authority Contact: Lee Vermeulen, CCKM@uwhealth.org Last Revised: 04/2017CCKM@uwhealth.org ED - SCD and Pain Suspected to be VOC Event 4-20-17 Final.vsd Page-1