EVALUATION AND MANAGEMENT OF SICKLE CELL DISEASE IN THE EMERGENCY DEPARTMENT (AN 18-YEAR EXPERIENCE)
| Autor: | Louise Dorn, Thomas Lebby, Margaret C. Telfert, Jerrold B. Leikin, Nasrin Talischy, Mabel Koshy |
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| Rok vydání: | 1994 |
| Předmět: |
Pharmacology
medicine.medical_specialty medicine.diagnostic_test Anemia business.industry Physical examination General Medicine Emergency department Disease medicine.disease Triage Acute chest syndrome Emergency medicine medicine Outpatient clinic Pharmacology (medical) Prospective cohort study business |
| Zdroj: | American Journal of Therapeutics. 1:309-320 |
| ISSN: | 1075-2765 |
| DOI: | 10.1097/00045391-199412000-00011 |
| Popis: | Painful episodes are the most frequent complaints of patients with sickle cell disease. The Emergency Department (ED) has provided management for acute events using the usual triage format for emergencies. A prospective study evaluated the role of the ED in the care of adults with sickle cell disease (SCD). The protocol, thus, addressed issues of acute events related to SCD and provided better care for patients with SCD in the ED. Approximately 37% of ED visits were for painful events. An inciting cause was identified in 35% of painful events and 75% of these required admission to the hospital. A 15-year follow-up prospectively showed similar results and that uncomplicated pain crisis can be treated with ED protocols. Outpatient clinics and urgent centers could reduce these visits. Absolute indications for admission include sepsis, fever >102 degreeF, white cell counts >20 000, worsening anemia, hypoxemia, acute chest syndrome and new CNS events. Patient database in the ED must be revised annually to avoid extensive workup in the ED and a complete history/physical examination, and a CBC could be sufficient for triage in an uncomplicated pain crisis. An acceptable protocol for care should be available at all EDs and a registry and information system for SCD will discourage overutilization of investigational tests and visits to multiple EDs. |
| Databáze: | OpenAIRE |
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