Tratamiento de la Crisis de Células Falciformes: Manejo del Dolor Agudo en el Entorno de Urgencias
La crisis de células falciformes que se presenta en un entorno de atención aguda con dolor requiere una respuesta estructurada y oportuna. El enfoque basado en evidencia enfatiza la evaluación rápida y la analgesia desde el momento de la llegada, junto con una monitorización estrecha y repetida para guiar la atención continua.
Control óptimo del dolor con una reducción documentada en la intensidad del dolor, reevaluada cada 30 a 60 minutos durante todo el encuentro agudo.
El protocolo se centra en iniciar la analgesia dentro de la primera hora de llegada al servicio de urgencias mediante una estrategia multimodal. Esto implica adaptar la terapia con opioides al historial individual del paciente junto con medidas farmacológicas complementarias, combinadas con intervenciones no farmacológicas como parte integral del manejo.
DOI: 10.1182/bloodadvances.2020001851
For adults and children with SCD presenting to an acute care setting with acute pain related to SCD, the ASH guideline panel recommends rapid (within 1 hour of ED arrival) assessment and administration of analgesia with frequent reassessments (every 30 to 60 minutes) to optimize pain control (strong recommendation based on low certainty in the evidence about effects).
For adults and children with SCD presenting to an acute care setting with acute pain related to SCD for whom opioid therapy is indicated, the ASH guideline panel suggests tailored opioid dosing based on consideration of baseline opioid therapy and prior effective therapy (for adults: conditional recommendation based on moderate certainty in the evidence about effects; for children: conditional recommendation based on low certainty in the evidence about effects).
For adults and children with acute pain related to SCD, the ASH guideline panel suggests a short course (5 to 7 days) of NSAIDs in addition to opioids for acute pain management (conditional recommendation based on very low certainty in the evidence about effects).
For adults and children who seek treatment of acute pain, the ASH guideline panel suggests massage, yoga, TENS, VR, and guided AV relaxation in addition to standard pharmacological management (conditional recommendation based on very low certainty in the evidence about effects).
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