Archive for the ‘Sickle Cell’ Category
Peds Sickle Cell Crisis
Please be aware of the following recommendations for Pediatric pain control, in particular for our sickle cell patients, discussed at the most recent pain meeting:
Anesthesia pain team can now be called at any time to begin management of a pediatric sickle cell patient who is in pain. This team may begin a PCA pump for the patient.
If the physician covering the anesthesia consult service (resident) is resistant to the addition of a basal rate, and the patient has a history of requiring one, the physician requesting the consult may ask to speak to the fellow.
Once the patient is admitted to P4, the team managing the PCA/analgesia will be decided on a case by case basis (heme/onc vs pediatrics vs anesthesia)
As per Jeff Glassberg ,who attended:
The Chief of Anesthesia expects that the response to our consultation request be immediate and that the fellow or resident actually appear in person in our ED within 15 minutes of being called. Consultation recommendations over the phone are to be discouraged.
Please note that the goal is adequate pain control not only for those pts that are being admitted but also for those who are in the ED in pain, so that they may have the possibility of being discharged to home.
Thanks
Sylvia
Sickle cell pain admits – call chronic pain service, not hematology
For all sickle cell admissions for pain only (no concern for infectious/ischemic or other complication of sickle cell disease), no longer call the hematology fellow. Admit to medicine service, lead hospitalist. Call the chronic pain cell phone upon admission (646-592-0145). The chronic pain service will see the patient promptly and write admitting analgesic orders. Call the heme-onc fellow if there is an emergent need for a hematologist.
Sickle Cell Pain Crisis Admissions
For sickle cell pain crisis admissions, the chronic pain service wishes to be called instead of the hematology fellow. They will come down 24/7 to write analgesia orders. The resident/fellow covering this service carries a cell phone:
(646) 592-0084
If a sickle cell patient has another reason for admission (e.g. medically ill with an infection, chest crisis, hemolytic crisis, etc.) the case should be discussed with the heme fellow.
Sickle Cell Disease Update
Any patient screened positive or with known sickle cell disease must have a hematology consult before elective surgery, procedures or admission.