Help!!! What is the priority for a sickle cell crisis.

  1. I'm currently using Lacharity PDA and today I came across with this question about Sickle cell anemia:

    A 32-year-old patient with sickle cell anemia is admitted to the hospital during a sickle cell crisis. Which action prescribed by the healthcare provider will you implement first?
    1. Give morphine sulfate 4 to 8 mg IV every hour as needed.
    2. Administer 100% oxygen using a non-rebreather mask.
    3. Start a 14-gauge IV line and infuse normal saline at 200 mL/hr.
    4. Give pneumococcal (Pneumovax) and Haemophilus influenzae (ActHIB) vaccines.



    I piked #3 because hydration helps to decrease the viscosity of the blood, fluids will help with better blood flow, improving oxygenation and tissue perfusion. However, the book states that the priority is #2 oxygenation because hypoxia and deoxygenation is the priority. but how will it help if there is a problem with occlusion of RBC?.

    I need clarification. Thanks
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    About Solarod

    Joined: Sep '15; Posts: 32; Likes: 5
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    14 Comments

  3. by   C0SM0
    ABC's
  4. by   OcMurse93
    The key word in the question is "FIRST." A patient in the midst of a sickle cell crisis is experiencing excruciating pain related to tissue death resulting from hypoxia.

    A sickle cell blockage is not necessarily always a TOTAL occlusion, therefore the blood cells that are actually perfusing need to be 100% oxygenated to get as much o2 to the tissue as possible.
  5. by   EveYeti
    I honestly would have gone with 3 too. However 2 indeed would make sense too since the sickled cell have much decreased ability to transport oxygen, and thus more oxygen is given.
  6. by   RNNPICU
    It is the O2.
    Remember Airway, breathing and Circulation would be met by applying Oxygen.
    Then you may need to give fluids and pain medication, you can't do any of the other if your patient isn't circulating blood
  7. by   Solarod
    Thanks
  8. by   Solarod
    Thanks to everyone for the response. I really appreciate
  9. by   Collor
    And as a side note...a 14 gauge IV? Must be the size of a garden hose! Ouch!
  10. by   Wuzzie
    Quote from Collor
    And as a side note...a 14 gauge IV? Must be the size of a garden hose! Ouch!
    Yeah, good luck finding a vein a sickle cell patient that you could use a 14!
  11. by   meanmaryjean
    Whenever you are asked a question about prioritization- ask yourself "What will kill my patient the fastest?" Therein lies your answer.
  12. by   Winterblew
    I've learned that sickle cell crisis is due to the blood getting clogged. You'd need to push fluids. O2 won't help if the RBCs aren't able to carry them to where it's needed. Hydration is very important.
    I've answered this question multiple times, and it's always fluids. The large gauge is to get it into the system quicker. Most patients get the normal 18-20g, now considered a DEHYDRATED, SICKLE CELL patient--you'd need a large bore IV.

    SICKLE CELL CRISIS: Oxygen or Fluids??
  13. by   Apple-Core
    I would go with administer O2. It's pretty much always going to be breathing as a priority, even though they will be in agony, they won't die from the actual pain - but they will die from lack of oxygen.

    Think ABC - airway, breathing, circulation. If all those are in order, then you can start focusing on pain relief. No point in providing pain relief if they've died from lack of O2!
  14. by   OcMurse93
    Quote from Winterblew
    I've learned that sickle cell crisis is due to the blood getting clogged. You'd need to push fluids. O2 won't help if the RBCs aren't able to carry them to where it's needed. Hydration is very important.
    I've answered this question multiple times, and it's always fluids. The large gauge is to get it into the system quicker. Most patients get the normal 18-20g, now considered a DEHYDRATED, SICKLE CELL patient--you'd need a large bore IV.

    SICKLE CELL CRISIS: Oxygen or Fluids??
    I disagree. Its always oxygen first. You can improve oxygenation in a matter of seconds, but it takes waaaaay longer to reverse the effects of dehydration. So you would do oxygen first.

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