SICKLE CELL CRISIS: Oxygen or Fluids??

[SiempreBella]

Which one do you do first? I have done a couple of questions and some books say fluids others say oxygen. I'd like to know which one the NCLEX people want. Any input is appreciated. Thank you.

[BabyLady, BSN, RN]

I do not think it's pain relief. If you unclump the sickled cells by giving fluids there wouldn't be any pain.

They are not 100% sure what causes the sickling...if it was always dehydration and an increase in blood viscosity, then it could be 100% controlled.

But we know it has other triggers and that some people have chronic sickling and they don't know why.

You cannot deliver fluids fast enough to unclump sickling to where someone will be able to "sit and wait".

That is another reason why pain is the priority.

Understand that when I am talking pain, someone would probably rate it 15 on a 10 scale.

[CoffeeGeekRN]

Can we all agree beer isnt the right answer?? But fluids is??

What about vodka?

[kgh31386, BSN, MSN, RN]

I know they're in pain for sure. Usually they have a PCA, but no one has really given a clear answer....if given the choice, Pain relief or fluids..

[BabyLady, BSN, RN]

I know they're in pain for sure. Usually they have a PCA, but no one has really given a clear answer....if given the choice, Pain relief or fluids..

In a sickle cell crisis?

You relieve the pain first.

They are not going to be on a PCA if they come into the ER in the midst of a sickle cell crisis...they are going to receive immediate pain relief....and to be honest...the pain may be so great that "tolerable" may be all that you can temporarily achieve.

The sickling can also be so great that it can actually occlude vessels causing a DVT-like effect...which can cause part of the tissue, or even the limb to die....in that case, you are going to treat it with clot-busting drugs.

It's very, very important that folks understand the level of pain that is involved. This is going to be your patient that is going to come in screaming.

You are going to treat with fluids first if the client is either mildly uncomfortable or shows signs/symptoms of dehydration..the fluids are to prevent a full-blown crisis.

[kgh31386, BSN, MSN, RN]

Oh I meant they'd be on a PCA once they get to the floor, not in the ED. But I was thinking pain over fluids if given those 2 choices...and if you're given O2 or fluids..I'd pick fluids.

[BabyLady, BSN, RN]

Oh I meant they'd be on a PCA once they get to the floor, not in the ED. But I was thinking pain over fluids if given those 2 choices...and if you're given O2 or fluids..I'd pick fluids.

You've got it!

[kgh31386, BSN, MSN, RN]

I want to make sure, hydration is the PRIORITY....but I would still put oxygen FIRST..anyone disagree? Plus I've heard that Kaplan says the exact opposite of Saunders in certain situations, this being one of them. Kaplan says to give Demerol, Saunders says do NOT give Demerol because of induced seizures. Apparently Saunders is evidence based..

[canoehead, BSN, RN]

Fluids would be what I'd want to get into them first, but o2 takes 5 seconds to put on, so I'd actually DO that first, then get the IV started with lots of fluid. Of course you'd need the IV to give the pain meds (and an order) so pain relief would be last, even though it is high, high priority. So I'd answer the NCLEX question with pain relief being 1st priority but in real life it would be done in a hurry, but still, last.

[annfaith, DNP, NP]

When taking the NCLEX-RN exam keep in mind you want to choose the answer that if not done will cause the greatest harm to the patient. So having said that fluids if not given will make the crisis more harmful to the patient. Giving 02 will only relieve symptoms and not assist in assisting the clumping of the blood cells. Even though in the real world 02 would be given first as it is easiest to do. Hope this helps.

[kgh31386, BSN, MSN, RN]

That makes sense and I could answer that in NCLEX world, especially if it said priority. But if it says first, in any world, Oxygen takes 2 seconds. Priority sounds like...what, if not done, would kill them or do the most harm? I mean I understand the patho and how each intervention affects the body, but still. Why is there "real world" and "NCLEX" world anyway? Shouldn't they ask questions and expect a real world answer? I think that's partly why there's a mentality that it's so hard before people take it. I'm not complaining or anything, just wondering why their answers aren't always what you would do in the real world.

[marian14312]

Remember HOP ( Hydration, Oxygenation,pain relief ). Umbrella effect....oxygen do less if cells are still clump.

[kgh31386, BSN, MSN, RN]

I think I answered my own question about real world vs. book world, hold that thought. And yeah I understand the fluids do more to fix the problem.