What is the management approach for a patient with Crest syndrome (limited systemic scleroderma) involved in a road traffic accident (RTA)?

From the Guidelines

Management of a patient with CREST syndrome (limited systemic scleroderma) involved in a road traffic accident requires a multidisciplinary approach addressing both trauma care and the underlying autoimmune condition, with a focus on preventing complications such as pulmonary hypertension, renal crisis, and digital ulcers, as recommended by recent guidelines 1.

Key Considerations

• Initial management should follow standard trauma protocols with primary and secondary surveys, but with special attention to the patient's scleroderma-related complications, such as microstomia and skin tightening around the face and neck, which may require specialized equipment or fiberoptic intubation.
• Vascular access can be difficult due to skin thickening and fibrosis, so consider ultrasound guidance, and continue the patient's regular medications including calcium channel blockers (such as nifedipine 30-60mg daily) for Raynaud's phenomenon and esophageal dysfunction, proton pump inhibitors (such as omeprazole 20-40mg daily) for gastroesophageal reflux, and immunosuppressants if prescribed.
• Be vigilant for pulmonary hypertension, which may complicate anesthesia and fluid management, and monitor for signs of renal crisis, such as hypotension, and maintain adequate blood pressure, as recommended by recent studies 1.
• Digital ulcers should be protected during positioning and handling, and skin care is essential due to fragility and poor healing; avoid adhesive tapes when possible and use careful padding to prevent pressure injuries, as suggested by recent research 1.

Organ-Specific Considerations

• Pulmonary involvement: monitor for signs of pulmonary hypertension and interstitial lung disease, and consider screening for these conditions, as recommended by recent guidelines 1.
• Renal involvement: monitor renal function closely and maintain adequate blood pressure to prevent renal crisis, as suggested by recent studies 1.
• Digital ulcers: protect during positioning and handling, and consider local wound care, such as autologous adipose tissue grafting or oxygen-ozone therapy, as recommended by recent research 1.

Overall Management

• A multidisciplinary approach is essential, involving trauma care, rheumatology, and other specialties as needed, to address the complex needs of patients with CREST syndrome involved in a road traffic accident.
• Recent studies and guidelines, such as those published in 2023 and 2025 1, provide valuable insights into the management of CREST syndrome and its complications, and should be consulted to inform clinical decision-making.

From the Research

Management Approach for Crest Syndrome Patients Involved in RTA

• The management approach for a patient with Crest syndrome (limited systemic scleroderma) involved in a road traffic accident (RTA) requires careful consideration of the patient's underlying condition and the injuries sustained in the accident 2, 3.
• Crest syndrome is a variant of progressive systemic sclerosis (scleroderma) characterized by calcinosis, Raynaud's phenomenon, esophageal dysfunction, sclerodactyly, and telangiectasia 4.
• Patients with Crest syndrome are at risk of developing pre-capillary pulmonary hypertension, which can be a life-threatening complication 2, 3.
• In the context of an RTA, the patient's injuries should be assessed and managed promptly, taking into account the potential for underlying pulmonary hypertension and other systemic complications 5, 6.
• The management approach should include:
  • Immediate assessment and stabilization of the patient's vital signs and injuries
  • Evaluation for potential complications such as pulmonary hypertension and cardiac involvement
  • Consideration of the patient's underlying Crest syndrome and its potential impact on their response to injury and treatment
  • Collaboration with a multidisciplinary team, including specialists in emergency medicine, cardiology, and rheumatology, to ensure comprehensive care

Considerations for RTA Injuries

• RTA injuries can range from minor soft tissue injuries to life-threatening head and spinal cord injuries 5.
• The management of RTA injuries in patients with Crest syndrome requires careful consideration of the patient's underlying condition and the potential for systemic complications 2, 3.
• The use of conservative preventive measures, such as seatbelts and airbags, can help minimize the risk of injury in RTAs 6.
• Education and awareness campaigns can also play a crucial role in preventing RTAs and promoting a safe road environment 6.