# An 18-year-old with sickle cell disease arrives in vaso-occlusive crisis with severe back and leg pain rated 9 of 10. Which interventions are appropriate? Select all that apply.

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> language: en  
> subject: Reduction of Risk Potential  
> category: ROR

## Question

An 18-year-old with sickle cell disease arrives in vaso-occlusive crisis with severe back and leg pain rated 9 of 10. Which interventions are appropriate? Select all that apply.

1

Administer supplemental oxygen only when SpO2 falls below baseline

2

Apply cold packs to painful joints to reduce inflammation

3

Administer IV crystalloid at 1 to 1.5 times maintenance

4

Obtain chest x-ray and continuous SpO2 to screen for acute chest syndrome

5

Initiate IV opioid analgesia using a standing order or PCA

## Explanation

VOC requires aggressive analgesia (IV opioids, often PCA), isotonic fluid at 1 to 1.5 times maintenance (over-hydration worsens pulmonary edema in acute chest syndrome), screening for ACS with chest imaging and pulse oximetry, and oxygen for hypoxia. COLD application is contraindicated because vasoconstriction worsens sickling — WARM packs are preferred. Routine supplemental oxygen in normoxic patients can suppress erythropoiesis and is not recommended; oxygen is targeted to baseline saturation.

## In-depth explanation

Acute chest syndrome triad: new infiltrate plus fever plus respiratory symptoms. Leading cause of mortality in adult SCD. Anticipate exchange transfusion if severe.

## Clinical scenario

Temp 38.4 C, HR 118, RR 22, SpO2 95 percent, pain 9/10. Lab: Hb 7.6, retic 12 percent. Last hospitalization 3 months ago.

## Key concepts

- **vaso-occlusive crisis** — Sickled RBCs occluding microcirculation causing ischemic pain.
- **acute chest syndrome** — New pulmonary infiltrate with respiratory symptoms in SCD; medical emergency.
- **hydroxyurea** — Increases fetal hemoglobin reducing VOC frequency.

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