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Acute Chest Syndrome in Sickle Cell

8/17/2016

3 Comments

 
Adapted from Colton Hood's August 17th 2016 Grand Rounds lecture.
One of the most common and severe complications of sickle cell disease, clinically may resemble a pneumonia, and can develop suddenly, and is more common in patients with asthma or those with prior acute chest events. ​Typically presents with cough, shortness of breath, and rales accompanied by a new infiltrate on chest X-ray. 

Mortality of acute chest syndrome is 9% in adults, and can lead to pulmonary hypertension, right heart failure, and risk of sudden death. 
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Source: http://www.ssajm.org/text.asp?2014/1/3/111/138930
Evaluate patients with sickle cell disease with acute onset of lower respiratory tract disease with or without fever for acute chest syndrome, including chest x-ray and pulse oximetry to measure oxygen saturation (NHLBI Consensus-Panel Expertise)

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3 Comments

Equianalgesia

7/7/2016

2 Comments

 
Adapted from Dr. Doberman's Principles of Analgesia, Palliative & Geriatrics
Make sure you are appropriately treating your patient's pain!
Use the appropriate dosages at the appropriate intervals; PO medications should be redosed every 3-4 hours for short-acting medications. IV opioids should be redosed every 1-2 hours. Titrate your dosing to patient comfort. 

In severe pain, titrate rapidly with short acting opioids, and change to longer acting medications when pain relief is achieved. During in-patient services, always remember to provide a breath through pain medication that provides 10-20% of their normal 24 hour oral dose, or 50-100% of their hourly IV rate. 
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2 Comments

Sickle Cell Pain & Ketamine Use

6/1/2016

4 Comments

 
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Diagram Credit: S Rezaie
Adapted from Abdulla Alhmoudi's GR presentation May, 2016.

The management of sickle cell pain crises can be difficult due to our inability to rely on vital signs to lead our management, as well as the need for maintaining a broad differential in a patient with sickle cell disease. 


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4 Comments

Naproxen With Cyclobenzaprine, Oxycodone/Acetaminophen, or Placebo for Treating Acute Low Back Pain

1/6/2016

2 Comments

 
According to this new article from JAMA, the addition of Percocet or Flexeril to Naproxen does not improve functional outcomes in acute low back pain. The article compared functional outcomes in lower back pain at 1 and 3 weeks between Naproxen, Flexeril, and Percocet. Via a randomized, double-blind study in NYC, 323 patients were randomized to Naproxen + Placebo, Naproxen + Flexeril, and Naproxen + Percocet. Using an improvement in the Roland-Morris Disability Questionnaire (RMDQ), the study found that adding cyclobenzaprine or oxycodone/acetaminophen to naproxen alone did not improve functional outcomes or pain at 1-week follow-up. These findings do not support use of these additional medications in this setting.
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2 Comments

Evidence-Based Pain Management

11/21/2015

3 Comments

 
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Tainter CR. An evidence-based approach to traumatic pain management in the
emergency department. Emerg Med Pract. 2012 Aug;14(8):1-26. Epub 2012 Jul 20.
PubMed PMID: 22916717.
http://www.ncbi.nlm.nih.gov.proxygw.wrlc.org/pubmed/22916717
3 Comments
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This site is independently owned and operated and not affiliated with the George Washington University, George Washington University Hospital, or Medical Faculty Associates. All information on this site is the opinion of the author alone and in no way should be seen to represent the views of the George Washington University, George Washington University Hospital, or Medical Faculty Associates. The information on this page is for personal use only and should not be see as medical advice or used directly for patient care. The author provides no guarantee of the accuracy of the information provided on this page. ​

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  • Clinical
    • Discharge Macros
    • Suboxone
    • Procedure Macros
    • Exam Macros
    • Pediatric Macros
    • Antibiogram
    • Follow Up
    • 2023 MDM
    • Heart Pathway
    • Jeromy's Macros
  • Education
    • EM Education
    • Critical Care
    • FOAM
  • Orientation
    • Dept Orientation
    • Cerner
    • Dragon
  • Links
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    • ICU Bootcamp
  • Private
    • MCS
    • GWU Contacts & Map