Ralph Chadkirk
Journal of Paramedic Practice, Vol. 9, Iss. 7, 07 Jul 2017, pp 312 - 315

Sickle Cell Disease and its acute manifestation as a sickle cell crisis has a severely
deleterious effect on predicted mortality and quality of life of its sufferers. Serious
sequelae can occur, resulting in severe neurological and cardiovascular impairment.
In the majority of cases these patients will present to pre-hospital clinicians with
acute intractable pain unmanaged by the patient's own analgesia. Unfortunately,
some evidence reports that pain is commonly under-treated with assumptions
made about drug-seeking behaviour. The evidence presented in this paper will
indicate that Entonox should no longer be routinely used for the management of
sickle cell pain. Instead, emphasis should turn to the use of potent intravenous
opiates (where intravenous access can be reliably and aseptically gained). The
use of diamorphine and ketamine for extreme pain should be investigated by
pre-hospital services, as should the use of non-steroidal anti-inflammatory drugs.

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