After evaluation in the ED (including physical examination and laboratory and radiographic studies as indicated), conservative supportive therapy, and observation, a diagnosis usually can be established that will dictate the disposition of the patient.
The following are some guidelines for hospital admission for sickle cell patients:
1. Patients with pulmonary, neurologic, or infectious crisis
2. Patients with splenic sequestration or aplastic crisis
3. Patients with other types of vasoocclusive crises who do not have adequate pain control after analgesics in the ED, the determination to be made after 4 to 6 h and no more than 2 doses of narcotic analgesics.
4. Patients who are unable to maintain adequate hydration
5. Patients in whom the diagnosis is uncertain
Patients with SCD who are discharged from the ED need to have the following:
1. The ability to maintain adequate oral hydration
2. A 2- or 3-day supply of oral analgesics that provide adequate pain relief
3. Instructions to return to the ED for increased pain, fever greater than 38°C (100.4°F), or a change in their symptoms
4. Follow-up, preferably with their primary care physician, in 12 to 24 h for children or 24 to 48 h for adults.
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