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EM@3AM: Scleroderma and Severe Sequelae

A 45-year old African American woman presents with progressive fatigue over the past week and has experienced intermittent episodes of severe hand pain that typically self-resolve. She has also noted a worsening headache over the last day. Her blood pressure is 197/105 mm Hg and heart rate is 90 bpm. The physical exam is notable for smooth and taut skin on the patient’s face and hands. Laboratory values show a creatinine of 3.1 mg/dL. What is the likely diagnosis?

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    Articles

    R.E.B.E.L. EM – Auricular Hematoma Management

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    While not as common, auricular hematomas are equally important to both understand and know how to manage.
    Auricular hematoma management REBEL CORE header
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    ToxCard: Cotton Fever

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    What's cotton fever and its mechanism of action? How should you manage a patient you suspect is suffering from cotton fever?
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    emDOCs Podcast – Episode 13: Tibial Plateau Fracture and Knee Dislocation

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    The emDocs Podcast returns with two orthopedic conditions: tibial plateau fractures and knee dislocation.
    emDocs podcast logo
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    Evidence Based Disposition in Heart Failure – Who needs to be admitted and who can be discharged?

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    Do all patients with heart failure in the ED need admission? Are there any tools we can use for risk stratification?
    Heart failure disposition header
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    • In the Literature

    Journal Feed Weekly Wrap-Up

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    Clay is back with some great literature summaries on balanced fluids in sepsis, the ACEP Opioid Policy, and drug-induced arrhythmias.
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    Ultrasound G.E.L. – POCUS in Preeclampsia

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    Point of care ultrasound can be used for a great many things, but I don't think many people grab for the probe when a patient comes in with suspected pre-eclampsia.
    Ultrasound G.E.L. - POCUS in Preeclampsia infographic
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    Anticoagulation with heparin in PE

    If patient needs heparin, consider using LMWH instead of UFH

     

    LMWH more effective in PE, less bleeding, uses subcutaneous route

     

    UFH may be preferred for cardiac arrest or persistent shock, ESRD, invasive procedure or surgery required, or active major bleeding

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