A 44-year-old male with priapism and sickle cell anemia presents for EMS. What is the initial intervention you should perform?

• A. Transport and monitor his vital signs.
• B. Apply a cold pack to the affected area.
• C. Administer aspirin.
• D. Administer oxygen.

Answer: (D)

In this scenario, the priority is to correct hypoxemia to reduce sickling during a vaso-occlusive crisis from sickle cell disease. Providing supplemental oxygen helps raise blood oxygen levels, which decreases the polymerization of hemoglobin S and slows the process of red blood cell sickling. That reduction in sickling can limit further vaso-occlusion and tissue ischemia, making oxygen the most immediate, beneficial intervention in the field.

After establishing oxygen, you’d continue with airway and breathing assessment, establish IV access for hydration as appropriate, provide analgesia, and rapidly transport for definitive care. The other options don’t address the underlying issue as directly: cold packs can worsen ischemia by causing vasoconstriction, aspirin isn’t indicated for this presentation, and while monitoring and transport are important, starting oxygen first is the quickest, most impactful initial step.