Sickle cell crisis - Revision history

Danbot: Add MedicationDose SMW entry for ketorolac; dose verified against sickle cell pain management guidelines

2026-03-20T18:03:24Z

Add MedicationDose SMW entry for ketorolac; dose verified against sickle cell pain management guidelines

← Revisión anterior		Revisión del 18:03 20 mar 2026
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	*Provide home care instructions		*Provide home care instructions
	*Ensure resource for follow-up		*Ensure resource for follow-up


			==Medication Dosing==
			===Pain Management===
			*{{MedicationDose\|drug=Ketorolac\|dose=15 mg q6hr\|route=IV\|context=NSAID for vaso-occlusive crisis\|indication=Sickle cell crisis\|population=Adult}}

	==See Also==		==See Also==

Benalexander: /* Respiratory distress and chest pain */ Add pulmonary embolism

2025-08-05T19:12:29Z

Respiratory distress and chest pain: Add pulmonary embolism

← Revisión anterior		Revisión del 19:12 5 ago 2025
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	*[[Pulmonary Hypertension]]		*[[Pulmonary Hypertension]]
	**Develops in 15-35% of children with SCD		**Develops in 15-35% of children with SCD
	***[[Chest pain]], [[dyspnea\|DOE]], [[hypoxia]], right-sided [[heart failure]], [[syncope]], [[PE]]		***[[Chest pain]], [[dyspnea\|DOE]], [[hypoxia]], right-sided [[heart failure]], [[syncope]]
			*[[Pulmonary embolism]]
			**Increased risk in SCD
			**Consider especially if signs of [[DVT]]

	===[[Abdominal pain]]===		===[[Abdominal pain]]===

Rossdonaldson1 at 11:03, 23 April 2022

2022-04-23T11:03:50Z

← Revisión anterior		Revisión del 11:03 23 abr 2022
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	==Background==		==Background==
	[[File:Sickle cell 01.jpg\|thumb\|(A) normal red blood cells flowing freely through a blood vessel. (B) abnormal, sickled red blood cells sticking at the branching point in a blood vessel. Cross-section shows long polymerized sickle haemoglobin (HbS) strands stretching and distorting the cell.]]		[[File:Sickle cell 01.jpg\|thumb\|(A) normal red blood cells flowing freely through a blood vessel. (B) abnormal, sickled red blood cells sticking at the branching point in a blood vessel. Cross-section shows long polymerized sickle haemoglobin (HbS) strands stretching and distorting the cell.]]

	===Precipitating Factors===		===Precipitating Factors===
	*For [[vaso-occlusive crisis]]:		*For [[vaso-occlusive crisis]]:
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	==Clinical Features==		==Clinical Features==
	~~[[File:Sickle Cell.png\|thumb\|Algorithm for the Evaluation and Management of Sickle Cell Crises]]~~
	===Vaso-Occlusive Crisis<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref>===		===Vaso-Occlusive Crisis<ref>Lovett P. et al. Sickle cell disease in the emergency department. Emerg Med Clin North Am. 2014 Aug;32(3):629-47</ref>===
	''See [[Vaso-occlusive pain crisis]]		''See [[Vaso-occlusive pain crisis]]
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	==Evaluation==		==Evaluation==
			[[File:Sickle Cell.png\|thumb\|Algorithm for the Evaluation and Management of Sickle Cell Crises]]
	===Work-up===		===Work-up===
	''Based on clinical presentation, but may include:''		''Based on clinical presentation, but may include:''

Rossdonaldson1: /* Background */

2022-04-23T11:03:08Z

Background

← Revisión anterior		Revisión del 11:03 23 abr 2022
Línea 1:		Línea 1:
	==Background==		==Background==
			[[File:Sickle cell 01.jpg\|thumb\|(A) normal red blood cells flowing freely through a blood vessel. (B) abnormal, sickled red blood cells sticking at the branching point in a blood vessel. Cross-section shows long polymerized sickle haemoglobin (HbS) strands stretching and distorting the cell.]]
	===Precipitating Factors===		===Precipitating Factors===
	*For [[vaso-occlusive crisis]]:		*For [[vaso-occlusive crisis]]:

SMReel: /* Dactylitis */

2022-04-20T14:58:22Z

Dactylitis

← Revisión anterior		Revisión del 14:58 20 abr 2022
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	*Radiographs will show soft tissue swelling in the acute phase. Recurrent episodes can lead to a mottled appearance of hand and feet small bones on radiography. <ref>George, A., DeBaun, M., & DeBaun, M. (2021, April 28). Acute and chronic bone complications of sickle cell disease. Retrieved April 20, 2022, from https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link</ref>		*Radiographs will show soft tissue swelling in the acute phase. Recurrent episodes can lead to a mottled appearance of hand and feet small bones on radiography. <ref>George, A., DeBaun, M., & DeBaun, M. (2021, April 28). Acute and chronic bone complications of sickle cell disease. Retrieved April 20, 2022, from https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link</ref>

	===[[Avascular necrosis]] of femoral head=== <ref>George, A., DeBaun, M., & DeBaun, M. (2021, April 28). Acute and chronic bone complications of sickle cell disease. Retrieved April 20, 2022, from https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link</ref>		===[[Avascular necrosis]] of femoral head===
			<ref>George, A., DeBaun, M., & DeBaun, M. (2021, April 28). Acute and chronic bone complications of sickle cell disease. Retrieved April 20, 2022, from https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link</ref>
	*Due to occlusion of blood vessel lumens, which causes microfractures, leading to collapse of cancellous bone and the articular surface		*Due to occlusion of blood vessel lumens, which causes microfractures, leading to collapse of cancellous bone and the articular surface
	*Occurs in 30% of patients by age 30yr, prevalence increases with age		*Occurs in 30% of patients by age 30yr, prevalence increases with age

SMReel: /* Avascular necrosis of femoral head */

2022-04-20T14:57:52Z

Avascular necrosis of femoral head

← Revisión anterior		Revisión del 14:57 20 abr 2022
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	*Radiographs will show soft tissue swelling in the acute phase. Recurrent episodes can lead to a mottled appearance of hand and feet small bones on radiography. <ref>George, A., DeBaun, M., & DeBaun, M. (2021, April 28). Acute and chronic bone complications of sickle cell disease. Retrieved April 20, 2022, from https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link</ref>		*Radiographs will show soft tissue swelling in the acute phase. Recurrent episodes can lead to a mottled appearance of hand and feet small bones on radiography. <ref>George, A., DeBaun, M., & DeBaun, M. (2021, April 28). Acute and chronic bone complications of sickle cell disease. Retrieved April 20, 2022, from https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link</ref>

	===[[Avascular necrosis]] of femoral head===		===[[Avascular necrosis]] of femoral head=== <ref>George, A., DeBaun, M., & DeBaun, M. (2021, April 28). Acute and chronic bone complications of sickle cell disease. Retrieved April 20, 2022, from https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link</ref>
	*Due to occlusion of blood vessel lumens, which causes microfractures, leading to collapse of cancellous bone and the articular surface		*Due to occlusion of blood vessel lumens, which causes microfractures, leading to collapse of cancellous bone and the articular surface
	*Occurs in 30% of patients by age 30yr, prevalence increases with age		*Occurs in 30% of patients by age 30yr, prevalence increases with age

SMReel: /* Dactylitis */

2022-04-20T14:57:15Z

Dactylitis

← Revisión anterior		Revisión del 14:57 20 abr 2022
Línea 29:		Línea 29:
	*May have low-grade [[fever]]		*May have low-grade [[fever]]
	*Occurs in <2yr old, extremely rare >5yr old		*Occurs in <2yr old, extremely rare >5yr old
	Radiographs will show soft tissue swelling in the acute phase. Recurrent episodes can lead to a mottled appearance of hand and feet small bones on radiography. <ref>George, A., DeBaun, M., & DeBaun, M. (2021, April 28). Acute and chronic bone complications of sickle cell disease. Retrieved April 20, 2022, from https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link</ref>		*Radiographs will show soft tissue swelling in the acute phase. Recurrent episodes can lead to a mottled appearance of hand and feet small bones on radiography. <ref>George, A., DeBaun, M., & DeBaun, M. (2021, April 28). Acute and chronic bone complications of sickle cell disease. Retrieved April 20, 2022, from https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link</ref>

	===[[Avascular necrosis]] of femoral head===		===[[Avascular necrosis]] of femoral head===

SMReel: /* Avascular necrosis of femoral head */

2022-04-20T14:56:54Z

Avascular necrosis of femoral head

← Revisión anterior		Revisión del 14:56 20 abr 2022
Línea 32:		Línea 32:

	===[[Avascular necrosis]] of femoral head===		===[[Avascular necrosis]] of femoral head===
	*Occurs in 30% of patients by age 30yr		*Due to occlusion of blood vessel lumens, which causes microfractures, leading to collapse of cancellous bone and the articular surface
	*Patients present with afebrile, inguinal pain with weight-bearing		*Occurs in 30% of patients by age 30yr, prevalence increases with age
			*Patients present with afebrile, inguinal pain with weight-bearing but can be asymptomatic
			**Decreased ROM and pain with ambulation or passive ROM
			*Other common sites of involvement are the humeral head and the area above the knee

	===[[Respiratory distress]] and [[chest pain]]===		===[[Respiratory distress]] and [[chest pain]]===

SMReel: /* Dactylitis */

2022-04-20T14:52:05Z

Dactylitis

← Revisión anterior		Revisión del 14:52 20 abr 2022
Línea 29:		Línea 29:
	*May have low-grade [[fever]]		*May have low-grade [[fever]]
	*Occurs in <2yr old, extremely rare >5yr old		*Occurs in <2yr old, extremely rare >5yr old
	*Radiographs will show soft tissue swelling in the acute phase. Recurrent episodes can lead to a mottled appearance of hand and feet small bones on radiography. <ref>[https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link]</ref>		Radiographs will show soft tissue swelling in the acute phase. Recurrent episodes can lead to a mottled appearance of hand and feet small bones on radiography. <ref>George, A., DeBaun, M., & DeBaun, M. (2021, April 28). Acute and chronic bone complications of sickle cell disease. Retrieved April 20, 2022, from https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link</ref>

	===[[Avascular necrosis]] of femoral head===		===[[Avascular necrosis]] of femoral head===

SMReel: /* Dactylitis */

2022-04-20T14:47:06Z

Dactylitis

← Revisión anterior		Revisión del 14:47 20 abr 2022
Línea 29:		Línea 29:
	*May have low-grade [[fever]]		*May have low-grade [[fever]]
	*Occurs in <2yr old, extremely rare >5yr old		*Occurs in <2yr old, extremely rare >5yr old
	*Radiographs will show soft tissue swelling in the acute phase. Recurrent episodes can lead to a mottled appearance of hand and feet small bones on radiography. <https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link>		*Radiographs will show soft tissue swelling in the acute phase. Recurrent episodes can lead to a mottled appearance of hand and feet small bones on radiography. <ref>[https://www.uptodate.com/contents/acute-and-chronic-bone-complications-of-sickle-cell-disease?search=sickle%20cell%20disease%20children&topicRef=110699&source=see_link]</ref>

	===[[Avascular necrosis]] of femoral head===		===[[Avascular necrosis]] of femoral head===