Analgesia<unk>  assessment comes from the patient or patient family. No lab or clinical findings determine, confirm, or change if a patient has<unk> . Absence of hemolysis or baseline hemoglobin level should not be used to withhold or decrease<unk>  medication dosing. 
Ask the patient what medications have worked for them in the past<unk>  medication should be dosed within 30 minutes, IV route preferred with SC or IN routes for those with access issues 
IV opioids (morphine or hydromorphone)
Redose in 30min if inadequate
Can also use IN fentanyl particularly in pediatric patients. Restrict to 2 doses in the ED. See below. 
Non-opioid analgesia
NSAIDs (e.g. ketorolac 15mg q6h)
Acetaminophen
IV/IM haloperidol or droperidol 5-10mg
Ketamine (IN 1mg/kg 1ml per nostril or IV 0.3mg/kg)
Nonpharmacologic measures (e.g. heating packs, distraction)
Hydration
Controversial
Dehydration promotes sickling
IVF bolus may lead to atelectasis, pulmonary edema, and acute chest syndrome. Hyperchloremic metabolic acidosis due to normal saline may further precipitate sickling.   
There are no randomized controlled trials that have assessed the safety and efficacy of different routes, types or quantities of fluid.
O2 if hypoxia; otherwise may inhibit erythropoiesis<unk>  assessment comes from the patient or patient family. No lab or clinical findings determine, confirm, or change if a patient has<unk> . Absence of hemolysis or baseline hemoglobin level should not be used to withhold or decrease<unk>  medication dosing. 
Ask the patient what medications have worked for them in the past<unk>  medication should be dosed within 30 minutes, IV route preferred with SC or IN routes for those with access issues 
IV opioids (morphine or hydromorphone)
Redose in 30min if inadequate
Can also use IN fentanyl particularly in pediatric patients. Restrict to 2 doses in the ED. See below. 
Non-opioid analgesia
NSAIDs (e.g. ketorolac 15mg q6h)
Acetaminophen
IV/IM haloperidol or droperidol 5-10mg
Ketamine (IN 1mg/kg 1ml per nostril or IV 0.3mg/kg)
Nonpharmacologic measures (e.g. heating packs, distraction)
Redose in 30min if inadequate
Can also use IN fentanyl particularly in pediatric patients. Restrict to 2 doses in the ED. See below. 
NSAIDs (e.g. ketorolac 15mg q6h)
Acetaminophen
IV/IM haloperidol or droperidol 5-10mg
Ketamine (IN 1mg/kg 1ml per nostril or IV 0.3mg/kg)
Controversial
Dehydration promotes sickling
IVF bolus may lead to atelectasis, pulmonary edema, and acute chest syndrome. Hyperchloremic metabolic acidosis due to normal saline may further precipitate sickling.   
There are no randomized controlled trials that have assessed the safety and efficacy of different routes, types or quantities of fluid.
Dehydration promotes sickling
IVF bolus may lead to atelectasis, pulmonary edema, and acute chest syndrome. Hyperchloremic metabolic acidosis due to normal saline may further precipitate sickling.   
There are no randomized controlled trials that have assessed the safety and efficacy of different routes, types or quantities of fluid.
Transfusion PRBCs 10 mL/kg over 2hr period
Indications:
Aplastic<unk> 
Sequestration<unk> 
hemoglobin <6 with inappropriately low retic count
Transfusion is not a treatment for vast-occlusive<unk>  without anemia 
Aplastic<unk> 
Sequestration<unk> 
hemoglobin <6 with inappropriately low retic count
Transfusion is not a treatment for vast-occlusive<unk>  without anemia 
Ideally should have institutional protocols to initiate<unk>  management at triage
Consider early intranasal fentanyl even prior to establishing IV
Dosage 2 mcg/kg intraNASAL
IV<unk>  medication options
Morphine 0.1 mg/kg
Hydromorphone 0.02 mg/kg
Toradol 0.5 mg/kg
PO options
Oxycodone 0.1 mg/kg
Morphine 0.5 mg/kg
Hydromorphone 0.05 mg/kg
Ibuprofen 10 mg/kg
Dosage 2 mcg/kg intraNASAL
Morphine 0.1 mg/kg
Hydromorphone 0.02 mg/kg
Toradol 0.5 mg/kg
Oxycodone 0.1 mg/kg
Morphine 0.5 mg/kg
Hydromorphone 0.05 mg/kg
Ibuprofen 10 mg/kg
Repeat<unk>  medications q20 minutes at 50% of initial loading dose until adequate<unk>  control achieved
Vaso-occlusive pain crisis
Acute arterial ischemia
Bony infarction
Crotaline envenomation
Dactylitis
Neurogenic shock
Avascular necrosis of femoral head
Heat stroke