Sickle Cell Disease with Pain Clinical Pathway – Emergency Department and Inpatient

History and Physical

Carefully assess for other causes of pain as well as complications that can be associated with vaso-occlusive event (VOE).

Consider Stroke Protocol:

Severe or typical HA
Altered mental status
Focal neurologic findings
New seizure

History	Pain Assessment Time of onset Pain characteristics typical of previous VOE? Location, quality, duration, intensity Analgesics Medications used Frequency, dose, time of last dose Usual pain regimen Medications that work best for individual child Non-pharmacologic interventions that help Heat, blankets, distractions Chronicity Pain most days? Complications of Sickle Cell Disease Acute chest syndrome Aplastic crisis (parvovirus Infection) Documented bacteremia Stroke, transient ischemic attack Splenic sequestration Gall bladder disease Osteomyelitis, septic arthritis Pulmonary embolism Priapism Past Medical History Baseline pulse oximetry reading Previous admissions, ICU admissions Transfusion history Vaccination history, including Prevnar Medications Penicillin prophylaxis Hydroxyurea Folic acid Chronic pain medications L-glutamine Voxelotor Crizanlizumab Allergies
Physical	VS, pulse oximetry reading General appearance, jaundice, pallor Pain assessment Respiratory, circulatory, neurologic status Evidence of focal infection Spleen size Presence of rash or petechiae Neurologic signs

History

Pain Assessment
- Time of onset
- Pain characteristics typical of previous VOE?
- Location, quality, duration, intensity

Analgesics
- Medications used
- Frequency, dose, time of last dose
- Usual pain regimen
- Medications that work best for individual child
- Non-pharmacologic interventions that help
  - Heat, blankets, distractions
- Chronicity
  - Pain most days?

Complications of Sickle Cell Disease
- Acute chest syndrome
- Aplastic crisis (parvovirus Infection)
- Documented bacteremia
- Stroke, transient ischemic attack
- Splenic sequestration
- Gall bladder disease
- Osteomyelitis, septic arthritis
- Pulmonary embolism
- Priapism

Past Medical History
- Baseline pulse oximetry reading
- Previous admissions, ICU admissions
- Transfusion history
- Vaccination history, including Prevnar

Medications
- Penicillin prophylaxis
- Hydroxyurea
- Folic acid
- Chronic pain medications
- L-glutamine
- Voxelotor
- Crizanlizumab

Allergies

Physical

VS, pulse oximetry reading
General appearance, jaundice, pallor
Pain assessment
Respiratory, circulatory, neurologic status
Evidence of focal infection
Spleen size
Presence of rash or petechiae
Neurologic signs

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

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Sickle Cell Disease with Pain Clinical Pathway – Emergency Department and Inpatient

History and Physical

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Sickle Cell Disease with Pain Clinical Pathway – Emergency Department and Inpatient – History and Physical

Sickle Cell Disease with Pain Clinical Pathway – Emergency Department and Inpatient

History and Physical