### What you need to know A 54 year old woman with sickle cell disease presents to the emergency department with severe back and chest pain after swimming in the sea. On examination, she is tachycardic and afebrile, and has no other clinical signs apart from pallor of the mucous membranes. She has had similar episodes of pain previously which have responded to oral analgesia and hydration at home but these interventions have been ineffective on this occasion. What is the next stage of acute management and what advice would you give her to prevent future episodes? Sickle cell disease (SCD) is a multisystem disease that shortens life, and acute painful crisis is the hallmark of the condition. The clinical course is usually one of well compensated chronic anaemia interspersed with episodes of pain.1 With advances such as hydroxyurea therapy, chronic transfusion programmes, and stem cell transplantation, the life expectancy of patients in high income countries has risen from the mid 40s in the 1980s to the late 50s today.2 Clinicians working in primary and secondary care are therefore more likely to encounter patients with sickle cell disease and manage acute painful crises. This article aims to help readers identify and assess patients with suspected acute painful crisis, and how to recognise and manage the complication of acute chest syndrome, optimise management in the inpatient and outpatient settings, and deliver care compassionately. Management principles are largely similar for …

中文翻译：

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镰状细胞病成人急性疼痛危机


### 您需要了解的信息 一名患有镰状细胞病的 54 岁女性在海里游泳后出现严重的背部和胸部疼痛，到急诊室就诊。经检查，她出现心动过速且无发烧，除了粘膜苍白外没有其他临床症状。她以前也曾出现过类似的疼痛症状，在家中口服镇痛剂和水合疗法有效果，但这次这些干预措施无效。紧急处理的下一阶段是什么？您会给她什么建议来防止未来再次发生？镰状细胞病（SCD）是一种会缩短寿命的多系统疾病，急性疼痛危象是该病的标志。临床病程通常是代偿良好的慢性贫血，并伴有疼痛发作。1 随着羟基脲疗法、慢性输血计划和干细胞移植等技术的进步，高收入国家患者的预期寿命已从 40 多岁提高到 20 多岁。从 20 世纪 80 年代到今天的 50 年代末。2 因此，从事初级和二级护理的临床医生更有可能遇到镰状细胞病患者并处理急性疼痛危机。本文旨在帮助读者识别和评估疑似急性疼痛危象的患者，以及如何识别和管理急性胸部综合征的并发症，优化住院和门诊环境的管理，并提供富有同情心的护理。管理原则在很大程度上相似......