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I am all for compasion. Some of our patients do not have opioids at home.
Some haven't given anything at all and I have a few patients that get nearly
pain free with NSAIDS. Especially if they are not on hydroxyurea ( more
severe sicklers) . Our hematologists want us to try NSAIDS before we give
morphine. So our protocol for the HgbSS, SC, and S-Thal pts is to give
motrin or Toradol first.

Actually this discussion though interesting is a little off point. Bill had
asked if the sickle cell pts should be Level II or not. I posited that a
triage intervention may obviate the need to Level them a II. If you want to
have a policy of giving Lortab or VIcodin in the triage or starting and IV
and giving IV MS before being seen, I guess you can do that. Questionis,
does the pt with sickle cell pain who rates the pain as a 8 or 9/10 but
whoose bp, pulse and resp are nml. WHo is talking normally on their cell
phone or necking with their girlfreiend really need to be brought back
before a baby with a fever? or a kid with an earache?

Marty


On Wed, Jan 7, 2009 at 2:02 PM, Amy Baxter <[log in to unmask]> wrote:

> Hmmmm    Motrin?
>
> A pediatrician I worked with happened to have HgbSS and two children.  We
> were discussing pain control for labor -- she had delivered both kids
> naturally.  When I expressed the respect women give other women who have
> "gone natural", she taught me more about sickle cell pain than I'd learned
> in residency and two fellowships:
>
>        "Labor?!?  Compared to a sickle cell crisis, labor is nothing.
>  Sickle
> cell pain is like having your bone crushed, like your whole world is
> focused on something that takes your breath away.  Over time you realize
> that crying doesn't help, sucking up to doctors for pain medicine doesn't
> help, only trying to put your mind somewhere else can help a little.
> Believe me, after dealing with SS all my life, labor was nothing."
>
> So when children whose parents almost always have oral opioids at home
> bring them to the ED for relief, having them wait or offering Motrin just
> really isn't fair.  We can't always fix what's wrong with people, but with
> the subset of humans who were dealt a definitively crappy hand, let's err
> on the side of believing them and on the side of compassion.
>
> Morphine for everyone!!!!
>
> -Amy
>
> William Zempsky <[log in to unmask]> writes:
> >Because especially in adult EDs sickle cell patients (adolescents and
> >adults) can languish in the waiting room for hours.  Early and agressive
> >managment of sickle cell pain is an effective method to prevent
> >hospitalization, and there is an emerging body of evidence that
> >coinciding with pain episodes is end organ damage from sickling.
> >Agressive treatment may diminish this as well (not yet proven)
> >
> >Bill
> >
> >
> >William T. Zempsky, MD
> >Associate Director, Pain Relief Program
> >Connnecticut Children's Medical Center
> >282 Washington Street
> >Hartford, CT 06106
> >860-545-9041
> >Fax 860-545-9969
> >[log in to unmask]
> >>>> "Martin Herman, M.D." <[log in to unmask]> 01/07/09 12:20 PM
> >>>
> >WHy a triage level 2 . I think some patients can be handled as triage
> >3,especially if you allow the triage nurses to administer motrin in the
> >WR.
> >
> >Marty
> >
> >
> >On Wed, Jan 7, 2009 at 9:09 AM, William Zempsky
> ><[log in to unmask]>wrote:
> >
> >> My colleagues and I in connecticut are tryng to develop statewide
> >> guidelines for triage of patients with sickle cell disease.  These
> >guidlines
> >> will target both adult and pedatric facilities.
> >>
> >> There appears to be a wide range of approaches to this issue especially
> >in
> >> adult EDS
> >>
> >> As a first step I would like to get all EDs in our state assgning all
> >> sickle cell patients who present with pain to level 2 triage status.  I
> >am
> >> looking for published triage guidelines from national/international
> >> organizations which list sickle cell pain as a level 2 triage criteria.
> >>  Please contact me if you know of any.  Thanks.
> >>
> >> Bill
> >>
> >> William T. Zempsky, MD
> >> Associate Director, Pain Relief Program
> >> Connnecticut Children's Medical Center
> >> 282 Washington Street
> >> Hartford, CT 06106
> >> 860-545-9041
> >> Fax 860-545-9969
> >> [log in to unmask]
> >>
> >> For more information, send mail to [log in to unmask] with the
> >> message: info PED-EM-L
> >> The URL for the PED-EM-L Web Page is:
> >>                 http://listserv.brown.edu/ped-em-l.html
> >>
> >
> >
> >
> >--
> >Marty
> >Martin Herman, M.D.
> >Pediatric Emergency Specialists, P.C.
> >Lebonheur Children's Medical Center
> >Memphis Tn 38103
> >
> >901 287 5986 ( ED office)
> >901 287 6226 ( ED fax)
> >
> >For more information, send mail to [log in to unmask] with the
> >message: info PED-EM-L
> >The URL for the PED-EM-L Web Page is:
> >                 http://listserv.brown.edu/ped-em-l.html
>
>
>
> Amy Baxter MD
> Pediatric Emergency Medicine Associates
> 404 371-1190
>
>
> For more information, send mail to [log in to unmask] with the
> message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html
>



-- 
Marty
Martin Herman, M.D.
Pediatric Emergency Specialists, P.C.
Lebonheur Children's Medical Center
Memphis Tn 38103

901 287 5986 ( ED office)
901 287 6226 ( ED fax)

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html