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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 brings you NIPPV for severe asthma, CT for diagnosis of globe rupture, and non-IV ketamine for pediatric sedation.
    Journal Feed
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    • electrocardiography

    ECG Pointers: Another Crashing Patient at Sign Out? Well Flec me…

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    ECG Pointers covers flecainide toxicity and the ECG findings.
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    • practice updates

    Dengue: ED presentation, evaluation, and management

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    What do you need to know about dengue fever?
    Dengue
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    EM@3AM: Cranial Nerve Syndromes

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    A 15-year-old female with PCOS, obesity, asthma, and recurrent otitis media with bilateral tympanostomy tube placement reports three weeks of increasing sanguineous drainage, ear pain, fevers, and worsening left-sided headaches not improving with NSAIDs. She localizes the pain behind the left eye and additionally reports loss of lateral vision in
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    • perspectives

    Medical Malpractice Insights: Two kids die hours after discharge… Is it your fault? Here’s why (not).

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    Dr. Pilcher covers two difficult cases in this month's medical malpractice insights.
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    emDOCs Podcast – Episode 134: Acute Acetaminophen Toxicity

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    Today on the podcast, Rachel Bridwell and Brit Long cover acute acetaminophen toxicity, as well as some evidence updates.
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    Non-convulsive status epilepticus

    Underdiagnosed and associated with significant morbidity/mortality

    Major risk factor is convulsive status/history of seizure

    Look at eyes, face, fingers, feet for subtle movements -> If present, patient seizing

    Be concerned if patient remains post ictal/does not improve for significant time

    Treatment: Benzos + anti-seizure meds
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