• Scleroderma = autoimmune mediated widespread collagenous deposition
  • limited form: Calcinosis, Raynauds, Esophageal dysfunction, Sclerodacytaly and Telangiectasia (CREST syndrome)
  • widespread form: aggressive diffuse cutaneous form


  • above
  • fatigue
  • decreased ROM @ joints
  • tough skin


  • AIRWAY: mouth narrowing and tightening of skin around neck
  • CVS: pericarditis, myocardial fibrosis, conduction defects, pulmonary hypertension, malignant hypertension
  • RESP: pulmonary fibrosis
  • RENAL: renal failure
  • GI: GORD
  • HANDS: distal ulceration with gangrene, fixed flexion deformity of fingers, Raynauds, ischaemia with pallor of the digits, sclerodactaly, calcinosis


  • FBC
  • U+E
  • ECG
  • anti-centromere antibodies (80%)



  • ABCDE approach
  • possible difficult airway – may need AFOI
  • difficult IV access

Specific treatment

  • immunosuppression (methotrexate)
  • steroids
  • care with vasoconstrictors
  • risk of ileus, malabsorption, nutritional deficiencies, GORD, stress ulceration
  • optimise right ventricular function

Supportive care

  • protective lung ventilation
  • SpO2 monitoring can be difficult

CCC 700 6

Critical Care


Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.