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Name of treatment regimen
University Hospitals/Ireland Cancer Center Sickle Cell Inpatient Treatment Guidelines Supportive Care Sickle Cell Guidelines
• If patient is hypovolemic on admission, hydrate with Normal Saline @ 300 - 500
• If patient is euvolemic on admission or becomes euvolemic after hydration,
hydrate with D5W1/2NS at 75-125 ml/hr continuously.
Laboratory/Radiology
All patients on admission should have the following parameters obtained: • CBC with diff and reticulocyte count, basic metabolic and hepatic panels. • Women: urine beta-HCG
• Blood cultures, urinalysis with culture if needed
Transfusions
• Transfuse PRBC's if the Hgb drops >3 g below baseline.
• Transfuse PRBC's for symptomatic anemia i.e. shortness of breath, dyspnea on
exertion or orthostasis. Sickle Cell Crisis is NOT a symptom of anemia.
Pain Medications
• All narcotic bolus doses should be given as IVPB • If there is no IV access, analgesics may be given IM or SQ.
• If the patient is on chronic long acting narcotics, continue the same.
• For initial pain relief give Morphine 5 - 10 mg IV and repeat every 1 hr prn pain
until pain improves or Dilaudid 1 - 2 mg IV and repeat every 2 hr prn pain until pain improves.
• When patient has obtained adequate pain relief with bolus narcotics within the
first 2 hours of admission begin PCA with morphine at 1 - 2 mg demand or dilaudid at 0.2 - 0.4 mg demand with a 6 min lock out.
• If the patient is not on chronic long acting narcotics consider adding a basal rate
• Breakthrough pain medications to be given equivalent to a 1 hour demand if
needed. Give one time doses. If frequent breakthrough doses needed, increase PCA demand dose.
• If no contraindications to NSAID such as renal dysfunction, GI bleed, PUD or
GERD may add ketorolac 30 mg IV every 6 hrs x a maximum of 5 day.
• Re-assess frequently. Increase PCA doses by 25% if needed.
MD Signature: ____________________Printed Name: ____________________Beeper:________ Date order written__________________
University Hospitals/Ireland Cancer Center Sickle Cell Inpatient Treatment Guidelines Supportive Care Sickle Cell Guidelines
Respiratory
• Incentive spirometry at bedside • Routine use of supplemental oxygen is not recommended unless oxygen
Ancillary Medications
• For itching: diphenhydramine 25-50 mg po every 4-6 hrs or hydroxyzine 25-50
• Antibiotics, other home meds as needed as needed.
Chronic Care
• Ferritin concentration if not drawn in the previous 12 months
• Echocardiogram if not done in the previous 24 months • Pneumococcal, meningococcal and influenza vaccinations if not previously given
• Pulmonary Hypertension consult if needed.
Special Situations
• Acute chest syndrome presenting as new infiltrates, hypoxia, and chest pain may
require exchange transfusion and a transfusion medicine consult should be obtained. For mild symptoms PRBC's should be given.
MD Signature: ____________________Printed Name: ____________________Beeper:________ Date order written__________________
Tai Chi, also known as Tai Chi Chuan, was handed down from different generations since its creation by ChangSan-Feng. It was during the Sung Dynasty that this was introduced and from that moment on, there werenumerous accounts of the form. The form, or kung chia in Chinese language, are the different movements made through Tai Chi. One of the mostcommon and famous form is the manipulation of the
ASSISTANCE TO ENERGY SECTOR TO STRENGTHEN ENERGY SECURITY AND REGIONAL INTEGRATION This publication was produced for review by the United States Agency for International Development. It was prepared by Tetra Tech ES, Inc. ASSISTANCE TO ENERGY SECTOR TO STRENGTHEN ENERGY SECURITY AND REGIONAL INTEGRATION The author’s views expressed in this publication do not necessarily reflect the views of t