Sickle Cell Disease Management in the Emergency Department: What Every Emergency Nurse Should Know

Abstract

I n 2004, the Agency for Healthcare Research and Quality reported that nearly 80% of the 80,000 hospital admissions for acute sickle cell disease (SCD) began their course in the emergency department. SCD is a chronic disease associated with serious pathophysiologic complications (eg, stroke, pulmonary embolus, sepsis, and acute chest syndrome [ACS]), severe pain crises, debilitating chronic pain, and a shortened life span. Morbidity and mortality rates remain high, as reflected by the median age of death: 42 years for men and 48 years for women. Because of the potential for underlying pathophysiologic complications, in addition to the severe pain crises, patients should be evaluated rapidly in the emergency department and receive emergent intervention. The frequency of pain episodes and the need for hospital re-admission after ED visits has been associated with an increased risk of death, suggesting that rapid and thorough evaluation and management of these episodes is indicated. In actual practice, recent data demonstrated lengthy delays before the administration of initial doses of analgesia to patients with SCD. Although some of these delays may be related to overcrowding, other reasons such as general frustration and a poor understanding of the disease may explain suboptimal analgesic management. The literature suggests that caring for patients with SCD is a very frustrating experience for emergency nurses and physicians, and that patients with SCD often are perceived to be addicted to opioids and “drug seeking.” However, studies of addiction in the United States suggest that the incidence of addiction in patients with SCD is no higher than that in the general population. The goal of this article is to describe the pathophysiologic manifestations and associated complications of SCD relevant to the emergency nurse and to recommendmanagement strategies through the 3 distinct phases of ED care: triage and early interventions, medical and nursing management at the bedside, and disposition (admission versus discharge).