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EM@3AM: Liver Transplant Complications

A 32-year-old female with a history of hypertension and autoimmune hepatitis status post liver transplant 6 weeks prior on tacrolimus and mycophenolate presents to the ED with abdominal discomfort. For the past two days, she describes worsening pain and intermittent vomiting. She came today because her sister is a nurse who noticed her eyes were yellow. She denies fever or a new rash. She has been taking her medications as prescribed. Vital signs: HR 118, BP 103/68, RR 20, T 99.8. On exam the patient is tachycardic with RUQ pain to palpation and scleral icterus. LFTs are in the thousands.

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EM@3AM: Crush Injury

A 17-year-old girl, in moderate distress, is brought in by EMS after a motor vehicle collision. EMS reports that she was “pinned” underneath the dashboard, and it took several hours to extricate her. Triage vital signs significant for BP 103/69, HR 99, SpO2 99% on 2 L NC, RR 25, Temp 98.6. She has normal mental status but is in distress with severe pain in her legs. On exam she has erythema, ecchymosis, and gross deformities to bilateral lower extremities but intact distal sensation and palpable pulses. She refuses to move her legs secondary to pain. Laboratory testing reveals elevated potassium and CK. What is the diagnosis?

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