Sickle Cell Crisis question

Specialties Med-Surg

Published

Without giving too much info, I just need to know if I could have/should have handled this situation better.

Pt came in with sickle cell crisis. Morphine ordered 10mg IV Q3H PRN pain. Also had a few other meds but only the morphine would touch his pain. He was tearing up, sweating, moaning--obviously in severe distress, altho O2 sat spot check was ok (we don't have cont monitoring). When I took report on him and then went in to check him out, I had that feeling about him...so I propped his door for the evening and stayed nearby to do all my charting, etc. He was snoring loudly, and I could his his rate creeping up--it had been 24, went up to 36 (about 2 hours post-morphine)...HR was 144, grabbed the sat monitor---28% :eek: Threw a simple facemask on him and cranked up the O2 and he got up to 58% sat. It would go higher if I could get him to talk to me, but he was really sleepy. Finally got him up to 90's. We ended up transferring him to a higher acuity floor.

Now...

I had much more seasoned nurses (I am a new grad) tell me that I had oversedated. Well...I don't really agree with that because his rate was UP up up--his drive wasn't gone. He was able to wake up and request more meds (he was still in pain). I haven't had a sickle cell patient before, and if I handled things poorly, I'd like to know so I can provide better care next time.

Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Another student here: Can't you not give demerol for SS pain? I forget why as my text books are hidden away until June 1st. Anyone know or am I thinking of something else? OP, I think you did a great job judging from your post. You trusted you instinct and stayed close to this pt., and responded quickly when things wen't wrong. :)

Yes you can give demerol. Demerol has fallen out of favor and is no longer recommended for pain relief due to the complications of seizures.

Sometimes it's a fine with line with SCC and other chronic pain patients and over sedation. They are in severe pain and keep asking and getting prescribed medications and before you know it, they are overly sedated and it happens quickly and without notice (doesn't seem to happen often at all with SCC patients that I've had and I've had plenty.) Nurses are always trying to blame the nurse. I don't think you overmedicated the patient. There are plenty of other reasons for this kind of hypoxia.

A little narcan would have done the trick to see if it was medication induced.

Up Vote Up Vote ×
Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
I would've popped him on a non-rebreather mask at 15L if his O2 sat was 28%. That way his sats would've recovered a little quicker and then the O2 could've been titrated down after reaching a satisfactory level. Good luck.

Agree, for a sat that low a NRB would have been best. Of course with a sat that low, I would have been getting out ambu bags and intubation trays. :)

Up Vote Up Vote ×
Specializes in MS Home Health.

If I had a bad sickler I always moved the cart near their room.

renerian

Up Vote Up Vote ×
Specializes in Med-Surg.

Ok, so today if I had the same patient I would handle it a bit differently! However to go back and clarify a few things that have been left out...

I put the simple facemask on him first because it was right there in the room, and we better than the nasal cannula that he had been using. Got a non-rebreather on him a few minutes later. Got him transferred about 20 minutes after the episode started.

Up Vote Up Vote ×
Specializes in NICU.
I put the simple facemask on him first because it was right there in the room, and we better than the nasal cannula that he had been using. Got a non-rebreather on him a few minutes later. Got him transferred about 20 minutes after the episode started.

Sounds to me like you did everything right.

Just wondering (as I work ICU and not floor) why patients in SS crisis, on oxygen, aren't on continuous pulse oximetry? Between the possibility of oversedation causing respiratory distress, and changing oxygen needs, why are they just on spot checks?

Up Vote Up Vote ×
Specializes in Med-Surg.

We don't have continuous O2 sat monitors available on the regular floors. IMO he shouldn't have been put on a regular floor at all, he should have been on the "step-down" floor where continuous monitoring is available. However I also know that you have to rely on your eyes and ears as much as or more than the monitors.

Up Vote Up Vote ×
Specializes in hospice.

I would have as well done 15L NRB, until sats climbed......28% is scary.

Up Vote Up Vote ×
+ Add a Comment