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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

    • In the Literature

    Journal Feed Weekly Wrap-Up

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    Journal Feed covers compression location, DOACs versus warfarin for AFib, and modified valsalva in pediatric SVT.
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    • electrocardiography

    ECG Pointers: When should you cardiovert atrial fibrillation?

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    When should you electrically cardiovert the patient with atrial fibrillation and rapid ventricular response?
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    emDOCs Podcast – Episode 137: Acute Mastoiditis

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    We cover acute mastoiditis in today\'s podcast.
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    • em@3am

    EM@3AM: Alpha-2 Agonist Toxidromes

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    A 42-year-old male with a past medical history of substance use presents to the ED for chest pain, shortness of breath, nausea, and vomiting. He reported snorting fentanyl two days ago and has a remote history of IV drug use. Vital signs include 98.8°F, HR 150, RR 23, SpO2 98%
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    • electrocardiography

    ECG Pointers: CALS versus ACLS

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    What is Cardiac Advanced Life Support, and what does it entail?
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    • In the Literature, practice updates

    Policy Statement: NSTI Survival Guide

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    The Global Alliance for Infections in Surgery published a position statement comprised of recommendations for evaluation and management of necrotizing soft tissue infections. We summarize the key takeaways.
    NSTI Featured
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    Anatomic urinary obstruction in septic shock

    Occurs in 10% of those with septic shock due to urinary source

     

    Associated with 27% mortality

     

    Administer antibiotics, resuscitate, consult urology for source control

     

    PMID: 26905806

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