Some have been asking about Sickle Cell

What Is a Sickle Cell Crisis?

A sickle cell crisis occurs when red blood cells become stiff, sticky, and “sickle-shaped.” These abnormal cells can block small blood vessels, causing poor tissue perfusion, ischemia, and severe pain.

The most common EMS presentation is a vaso-occlusive pain crisis, but sickle cell disease can also cause serious complications such as stroke, acute chest syndrome, splenic sequestration, infection, and priapism.

How the Patient May Present

Common findings include:

Severe pain, often in the back, chest, abdomen, arms, or legs
Pain may be described as deep, throbbing, or intense
History of sickle cell disease
Fatigue or weakness
Tachycardia
Fever, if infection is present
Shortness of breath or chest pain, concerning for acute chest syndrome
Pale skin or signs of anemia
Swelling of hands/feet, especially in children
Priapism in males
Stroke-like symptoms in severe cases

Red Flags

Treat these as high-risk findings:

Chest pain
Shortness of breath
Hypoxia
Fever
Altered mental status
Stroke symptoms
Severe abdominal pain
Signs of shock
Priapism
Severe uncontrolled pain

Chest pain, hypoxia, or respiratory distress in a sickle cell patient should raise concern for acute chest syndrome, which can be life-threatening.

EMS Management

EMS care is supportive and focused on oxygenation, pain control, hydration, and rapid transport.

Assessment

Assess airway, breathing, and circulation.
Obtain vital signs.
Check SpO₂.
Consider EtCO₂ if available.
Assess pain severity and location.
Ask about prior sickle cell crises and usual treatment.
Ask about fever, chest pain, shortness of breath, neurologic symptoms, or recent illness.
Check blood glucose if altered mental status is present.

Treatment

Give oxygen if hypoxic, short of breath, or in respiratory distress.
Keep the patient warm.
Establish IV access if ALS.
Provide fluids per local protocol, especially if dehydrated.
Avoid overhydration, especially if respiratory symptoms are present.
Treat pain aggressively per protocol.
Monitor ECG, SpO₂, blood pressure, and mental status.
Transport to an appropriate emergency department.

EMS Pain Management Point

Sickle cell crisis can cause extreme pain. These patients are not “drug-seeking” just because they require strong pain medication. Pain should be treated seriously and reassessed frequently.

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