Best case ever.

Best case ever.

Yes, this is EMK's Best Case Ever, and I'm your host by Dr. Richard Ward, a sickle cell disease specialist from Toronto General Hospital.

He's going to tell us his best case ever when it comes to a

sickle cell pain crisis gone bad. Dr. Ward, let it rip. Thanks, Anton. So I suppose this is not

really a best case ever. It's most disastrous misadventure I've come across in sickle cell.

So this is a 24-year-old gentleman who

presented to Janus General Hospital with a sickle cell pain episode. It had about a three-day

history of adrenalized bone pain, quite typical for his sickle cell, a little bit of a cough,

a little bit breathless, but nothing that he really played up too much when he was

interviewed by the emergency physician. His vital signs were quite stable. He had a little bit

of hypoxia, O2 saturations were about 92% on air, blood pressure and heart rate was fairly

normal. And the examination, he had a few crackles at the lung basis, but nothing particularly

dramatic or concerning to the emerged physician. And the liver and spleen were not enlarged.

There was no sign of any ulceration or osteomyelitis going on. And his routine blood works were

fairly unremarkable for someone's sick or cell. So his hemoglobin was about 70, which is more or less his baseline.

His bilirubin was slightly high in keeping with ongoing chymolosis from his sickle episode.

And his renal function was normal, with a low normal creatin as we would expect for someone

who's hyper-filtrating from some sick or renal disease.

So there are really no red flags for the emergency physician.

He was parked and emerged and monitored over the next few hours.

Now, unfortunately for him, this was not just a simple pain episode.

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