Background: The relationship between functional status and outcomes following in‐hospital cardiac arrest is not well described. We hypothesized that decreased functional status would correlate with worse outcomes following in‐hospital cardiopulmonary resuscitation (CPR). We further theorized [...]
Background: Narcotic‐induced constipation (NIC) is a common complaint among patients taking narcotics and significantly impedes optimal pain control and recovery. Its most feared and potentially fatal complication is fecal impaction with subsequent bowel perforation, Although [...]
Background: Clostridium difficile–associated disease (CDAD) is the most common cause of health care–associated infectious diarrhea. The past decade has witnessed an unprecedented increase in CDAD incidence, fatality rate, and resistance to metronidazole. catalyzing the search [...]
Background: High doses of erythropoietin and iron, usually required for the treatment of anemia in hemodialysis patients, are associated with longterm adverse consequences. Ascorbic acid, an antioxidant, can increase the available functional iron, decrease iron [...]
Background: Pocket hematoma formation is a common complication after pacemaker and implantable cardioverter‐defibriIlater (ICD) placement. In this study, we investigated the influence of patients' comorbidities on the rate of pocket hematoma formation after pacemaker and [...]
Background: Metabolic syndrome (MetS) portends an increased risk of coronary artery disease (CAD), independent of traditional risk factors, and is also associated with increased carotid intimal wall thickness. Metabolic syndrome has also been associated with [...]
Background: The study sought to determine the outcomes of patients with metabolic syndrome (MetS) who received an implantable cardiovertor defibrillator (ICD) for primary prevention of sudden cardiac death. Methods: This was a retrospective study of [...]
Background: The purpose of this study was to assess the predictors and prognosis of worsening renal function (WRF) in patients hospitalized with acute diastolic heart failure. Methods: We retrospectively evaluated 149 patients who were admitted [...]
Background: According to the guidelines from the American Thoracic Society, posteroanterior and if possible lateral chest radiographs should be obtained if pneumonia is suspected in adults, The chest radiograph continues to be the initial imaging [...]
Background: For treatment of acute decompensated congestive heart failure (CHF), intravenous loop diuretics are usually administered as intermittent bolus injections. However, these bolus injections can cause significant hemodynamic effects because of fluctuations in intravascular volume, [...]
Background: Methylnaltrexone, a quaternary derivative of naltrexone, is a peripheral mu‐opioid receptor antagonist recently approved for the treatment of opioid‐induced constipation (OIC) in patients with advanced illness who are receiving palliative care when response to [...]
Background: Measuring health care quality is increasingly important. Reliably assessing quality requires a review of the care provided and linking the care to a provider. Payers, patients, and regulators have access to quality reporting at [...]
Background: As further limits in resident duty hours are considered, anecdotes of detrimental effects of work intensification (same amount of work in less time) and the continued reliance on residents for tasks of limited educational [...]
Background: Thoracentesis is a relatively safe procedure. Despite a lack of supporting evidence, common assumptions regarding safety guidelines include: (1) limit fluid removal to < 1.5 L; (2) avoid bilateral procedures; (3) do not tap patients on [...]
Background: Thoracentesis is a commonly performed procedure to remove fluid from the pleural space. When repeat thoracenteses are required, patients are often referred to thoracic surgery to undergo more definitive treatment in the form of [...]
Background: The Wells rule is commonly used when investigating suspected pulmonary embolism (PE), but its effectiveness when applied to hospitalized patients receiving prophylactic anticoagulation is not known. To explore the utility of the Wells rule [...]
Background: Infective endocarditis (IE) has been recognized as a complication of hemodialysis (HD) since 1966. The incidence is estimated to be 308 per 100.000 patients year, which is 50‐ to 180‐fold higher than the 1.7‐6.2 [...]
Background: Hip and knee arthroplasty surgeries are among the most painful surgical procedures, with half of patients reporting severe postoperative pain, Unrelieved postoperative pain is associated with diminished rehabilitation, delirium, disrupted sleep, and slower healing, [...]
Background: Whether an unplanned intensive care unit transfer (UICUT) results from an error in care and whether these transfers can be prevented has not been previously investigated. We sought to determine the causes of UlCUTs [...]
Background: Serious or fatal iatrogenic complications occur in 2.9% to 3.7% of hospitalized patients, and medical procedures are the second most common cause of these complications. In prior work we showed that a mastery learning [...]
Background: The Joint Commission core measures for hospitalized patients with acute decompensated heart failure (ADHF) include: use of ACE inhibitors for left ventricular systolic dysfunction, discharge instructions with specific information, left ventricle ejection fraction assessment, [...]
Background: The rising incidence of patients seeking hospital services with flulike illness and related complications has every health care system preparing for busy flu seasons. Based on lessons from previous pandemic flu events, there are [...]
Background: Academic medical centers have tripartite missions focused on education, research, and clinical care. Promotion decisions are largely based on research accomplishments. Excellence in patient care in academia had not been well defined until recently, [...]
Background: The time of hospital discharge is a pivotal period in the care of hospitalized patients and one during which patients are at particular risk for adverse events. This is especially true for patients with [...]
Background: Crilical hyperkalemia is a serious life‐threalening situation. However, we often encounter fictitious laboratory hyperkalemia due to specimen contamination or hemolysis during phlebotomy. This study determined the frequency of true critical hyperkalemia (potassium > 6.5 mEq/L) among [...]
Background: The diagnosis of acute cholecyslitis is usually straightforward, but determining whether common bile duct (CBD) stones are present is usually not. Clinicians rely on clues such as a dilated CBD, intrahepatic ductal dilation, elevated [...]
Background: In 2007, the British Department of Health developed guidelines for health care workers regarding uniforms and work wear that banned the traditional white coat, long sleeves, jewelry, and neckties in the United Kingdom. To [...]
Background: Rapid response teams (RRTs) assist in the assessment, treatment, and triage of hospitalized patients with physiologic instability, but their effectiveness in reducing transfers to the intensive care unit (ICU), cardiopulmonary arrests, and in‐hospital mortality [...]
Background: Readmission to the hospital is a burden not only to patients, families, and health care workers but also to the health care system. The U.S. government spends an estimated $12 billion a year on [...]
Background: Pneumonia is a common entity associated with significant morbidity and mortality. Guidelines for the management of both CAP and HCAP have been recently published, with evidence that compliance is associated with better outcomes. These [...]
Background: Death in the United States frequently occurs in institutions, despite the majority of persons indicating a preference to die at home. Little research has examined how well individual preferences compare with actual site of [...]
Background: Admitted patients boarded in the emergency department (ED) leads to hospital diversion. Active bed management by hospitalists can improve throughput. Minimizing wasted patient movement and inappropriate bed utilization may improve throughput for hospitals routinely [...]
Background: Hospitalists play an increasing role in resident education. The acquisition of new knowledge is a primary goal of residency training. Retrieving and retaining influential primary and secondary medical literature can be challenging for house [...]
Background: Demand for hospitalists continues to rise. Despite reports of high overall provider satisfaction, hospitalist retention and recruitment remain challenging. Identifying specific issues most important to hospitalists may guide efforts to improve and sustain morale. [...]
Background: Better sleep is associated with improved cognition, mood, and physical health in older adults. Despite the potential health benefits, obtaining quality sleep when hospitalized has been described as difficult. Additionally, perceived control may be [...]
Background: Interhospital transfer (IHT) is a common event whereby patients are transferred from community hospitals to tertiary‐care hospitals for specialized care or further workup in the setting of a diagnostic dilemma. Hospitalists are frequently the [...]
Background: Urinary tract infections (UTIs) are the most common type of nosocamial infection, with 80% associated with indwelling urinary catheters. The relative frequency of catheter‐associated UTIs (CAUTIs) imparts greater clinical and cost implications to patients [...]
Background: Although numerous professional organizations recommend routine screening for intimate partner violence (IPV), and the Joint Commission for Accreditation for Health Care Organizations requires screening for IPV in in patient admissions, screening rates in outpatient [...]
Background: With increasing pressure to shorten the length of stay of hospitalized patients, physicians are discharging more patients with tests pending at discharge (TPAD). Little is known about how physicians currently manage TPADs. Methods: Using [...]
Background: Approximately 40% of medical patients are discharged with tests pending, and these test results change patient care over one third of the time. Little is known, however, about what types of tests are pending [...]
Background: Hospitalists frequently participate in the perioperative care of hip fracture patients. Hip fracture repairs in the elderly carry high rales of postoperative morbidity, including heart failure and other adverse cardiac events. Heart failure also [...]
Background: It is estimated that 7%–15% of all strokes occur in the hospital. It might be expected that strokes occurring in the inpatient setting would receive higher quality of care, more rapid evaluation, and a [...]
Background: A 2‐year quality improvement campaign at a single teaching hospital was launched to improve the identification, documentation, and treatment of pressure ulcers (PUs) in the wake of the CMS declaration that severe hospital‐acquired PUs [...]
Background: Learning to write inpatient notes is an integral part of the internal medicine (IM) clerkship. Anecdotal evidence suggests variation in students' assessment/plan (A/P) sections; students tend to follow either a system‐based or problem‐based A/P [...]
Background: Patients undergoing hip replacement surgery are at particularly high risk of venous thromboembolism (VTE) and require thromboprophylaxis. Unlike clinical trials, real‐world surgery includes patient populations with comorbidities or on concomitant drugs, who may require [...]
Background: Federal regulations require health care organizations to provide language services for limited English proficiency (LEP) patients. The National Standards on Culturally and Linguistically Appropriate Services (CLAS standards) in Health Care include 4 that outline [...]
Background: Rehospitalizations are costly and can be disruptive for patient cane. To our knowledge, no study has examined the impact of patient agreement with recommendations for the place of discharge as a cause of rehospitalization. [...]
Background: For the last 20 years, efforts have focused an improving survival from out‐of‐hospital cardiac arrest and multiorgan failure. Given the many known nephrotoxic insults of postresuscitation care, it is a common belief that renal [...]
Background: Obesity has been associated with increased morbidity and mortality. In addition to that it has been noted to increase the duration of hospital stay and also readmissions for overall admissions. We wanted to find [...]
Background: Although supervision is central to resident education and patient safety, there is little to guide the use of effective supervision strategies. The aim of this study is to describe effective supervision for on‐call internal [...]
Background: Medication reconciliation (med rec) is an active process, occurring at transition points in care, whereby medications received by the patient prior to the transition are reviewed and considered when developing the next medication regimen. [...]
Background: In July 2003, the Accreditation Council for Graduate Medical Education implemented duty‐hour rules for all U.S. residents. In December 2008, the Institute of Medicine released a report urging additional restrictions. The issues at stake [...]
Background: Patients' accurate identification of their hospitalist likely leads to increased satisfaction with the quality of care and better communication, especially during the discharge transition. A recent study found that 75% of patients on a [...]
Background: Hospitals are increasingly interested in patient satisfaction as an outcome measure. The Press‐Ganey (PG) patient satisfaction survey contains items related to satisfaction with individual physician's communication. On receipt of the completed survey these results [...]
Background: Prior research has shown that hypoglycemia is associated with worse outcomes for the elderly, in sepsis, and in children with pneumonia. The purpose of this study was to examine whether hypoglycemia (< 70 mg/dL) is [...]
Background: Many patients that hospitalists care for have complex social situations and poor access to medical care. These vulnerable populations often do poorly after discharge and may repeatedly return to the hospital for unresolved medical [...]
Background: With 1%–2% of patients leaving the hospital against medical advice (AMA), the potential for these patients to suffer adverse health outcomes is of major concern. Prior studies have shown an increased rate of hospital [...]
Background: Hospitalists must help find innovative solutions to challenging problems that face hospitals today. Hospitals face a physician shortage for both hospitalists and other specialty physicians. And hospitals face falling revenues and are under intense [...]
Background: Coombs‐positive (DAT+) infants are commonly encountered in the newborn nursery. These infants are at risk for developing severe hyperbilirubinemia and bilirubin encephalopathy. Multiple hospitalists may care for each infant daily, with diverse approaches to [...]
Background: Preventable hospital readmission is a prominent consideration in policy discussions aimed at reducing morbidity and cost in the United States health care system. Research shows patients are more likely to be readmitted after discharge [...]
Background: Project BOOST (Better Outcomes for Older adults through Safe Transitions) is being implemented at 30 U.S. hospitals to enhance the hospital discharge process. Pilot sites began implementing Project BOOST'S core elements in January 2009. [...]
Background: Up to three quarters of hospital readmissions may be avoidable, incurring a total cost from unplanned readmissions of $17.4 billion annually. Knowledge regarding the characteristics of patients at highest risk of readmission has been [...]
Background: Increasing numbers of hospitalized infants and children are cared for by pediatric hospitalists. Transitions in care and transfer‐of‐care providers at the time of hospital discharge place patients at risk for failure to achieve postdischange [...]
Background: Obesity is a major contributor of morbidity and all‐cause mortality, and is associated with decreased life expectancy. The long‐term risk of excessive weight gain increases during adulthood and currently more than 70% of the [...]
Background: Perioperative medicine platforms (PMPs) are being adopted by many hospitals and HMOs. Despite a growing body of evidence around pre operative medical optimization, the full impact of a dedicated preoperative consultation service on patient [...]
Background: The use of patient safety indicators such as pressure ulcer rate, allows institutions to monitor and compare their level of efficacy with other hospitals. Medicare and Medicaid have instituted quality measures and payment based [...]
Background: Highly functional teams require cohesiveness, communication, role clarity, and goal clarity. Although in patient physicians and nurses may ideologically agree on the importance of teamwork, weaknesses in these domains may still exist. To understand [...]
Background: Obesity is an epidemic that has increased dramatically over the past 50 years in the United Stales, A disproportionate number of obese patients are admitted to hospitals, largely because of diseases associated with or [...]
Background: Obesity is a growing epidemic in the United States. A disproportionately high percentage of the obese population is admitted to our nation's hospitals, and once admitted these patients have lengths of stay almost twice [...]
Background: Read mission to the hospital soon after discharge is a significant burden to patients and our health care system, We aimed to study the predictors of readmissions within 30 days of discharge from our [...]
Background: Unfractionated and low‐molecular‐weight heparins are widely used for venous thromboembolism prophylaxis (VTEP). Heparin‐induced thrombocytopenia (HIT) is a rare but potentially devastating reaction to heparins, with an incidence of 0%‐5% of exposed medical and surgical [...]
Background: Increasing the use of computed tomography (CT) imaging over the past 10 years has been accompanied by rising concerns about the effects of radiation exposure, especially in children. One approach to limiting radiation exposure [...]
Background: Ethical obligations and patient safety principles support prompt and full disclosure of harmful medical errors. In an era of high malpractice premiums, debate on whether disclosure increases or decreases liability claims and costs persists. [...]
Background: African Americans suffer nearly double the annual estimated mortality rate of whites in acute lung injury (ALI), and genetic factors may be involved The Duffy blood group antigen is a chemokine receptor on red [...]
Background: Venous thromboembolism prophylaxis (VTEP) decreases rates of deep vein thrombosis among inpatients, and increasing VTEP use is a common target for quality improvement initiatives. However, little is known about the balance of appropriate versus [...]
Background: Language barriers present a major challenge to patient education in the rapidly growing population with limited English proficiency. Although professional translations of standard educational material can help to address this challenge, clinicians often encounter [...]
Background: Blood cultures are one of the most commonly performed and valuable diagnostic procedures in hospitalized patients. Contaminated blood cultures, however, result in significant resource utilization and potential complications from exposure to unnecessary therapies. Various [...]
Background: Project BOOST (Better Outcomes for Older Adults Through Safe Transitions) is a SHM‐mentored quality improvement program targeted at improving the discharge transition process and now has 30 participating sites. Our hospital, one of the [...]
Background: Cigarette smoking is the leading cause of preventable death in the United Stales, accounting for approximately 440,000 deaths from smoking‐attributable illness each year. Smokers hospitalized for acute illnesses may be more receptive to smoking [...]
Background: In previous studies, type 2 diabetes mellitus (DM) has been associated with increased incidence of hospitalization for pneumonia as well as increased pneumonia‐associated morbidity and mortality. It is unknown if decreased lung diffusion capacity [...]
Background: Tobacco smoking is the leading preventable cause of death in the United States, Most interventions for hospitalized smokers have used some combination of physician advice to quit, behavioral counseling, and self‐help materials including booklets, [...]
Background: Patients' ability to accurately report their preadmission medication regimen is a vital basis for medication reconciliation in the hospital. Understanding of the medication regimen may also affect postdischarge adherence and medication safety. We examined [...]
Background: Despite the widely recognized risks of anticoagulant therapy, most pediatric patients are started on oral warfarin in the absence of standardized clinical protocols. Given the differing intensity of anticoagulation recommended for clinical and surgical [...]
Background: Sepsis is a common, highly morbid, costly condition, yet little is known about hospital‐level variation in treatment costs or outcomes. We aimed to characterize variations in hospital costs and mortality rates for patients with [...]
Background: Engaging hospitalized patients in their medical care is a National Patient Safety Goal, but methods to achieve this goal remain challenging. Efforts to create “goals for the day” are traditionally provider driven and fail [...]
Background: Hospital discharge represents a potentially dangerous transition in care requiring active engagement with patients and their caregivers. Ensuring that patients undersland any new diagnoses, medications and dosing changes, and follow‐up is essential to preventing [...]
Background: Vancomycin is commonly used in an empiric antimicrobial regimen. The joint 2009 AHSP/IDSA/SIDP guidelines recommend a minimum trough of 10 μg/mL to avoid development of rcsistance and troughs up to 20 μg/mL to improve [...]
Background: Survival following in‐hospital cardiac arrest has remained poor, at about 14%. The goal of this study was to determine the factors related to survival, and to evaluate the role of BMI and central venous [...]
Background: Establishing intravenous (IV) access can be difficult, especially in children with dehydration, who often have small, volume‐depleted veins. Subcutaneous (SC) rehydration therapy is an alternative to IV rehydration therapy when parenteral treatment is indicated [...]
Background: Many guidelines recommend aspirin for primary prevention of myocardial infarction and cerebrovascular accidents in high‐risk patients. Aspirin use has increased in indicated populations; however, the percentage is still suboptimal. Currently, data from the 1993 [...]
Background: The discharge summary is an important tool for communicating essential information as patients transition from the hospital, yet it frequently does not arrive for outpatient physicians in a timely manner Furthermore, residents are often [...]
Background: Providing efficient, interdisciplinary care in academic centers today is greatly challenged by work‐hour restrictions, the resulting fragmented team structures, and frequent geographic discontinuity of physician teams. Our objective was to geographically localize physician teams [...]
Background: Delirium and other forms of cognitive impairment are clinically important patient charactenistics that have been shown to be strong predictors of outcomes. Although mental status assessment is the subject of national quality indicators, considerable [...]
Background: Several studies have found that hospitalists reduce cost and length of stay compared to nonhospitalists, with no adverse effect on quality of care or inpatient outcomes. However reduced length of stay could be accomplished [...]
Background: Congestive heart failure (CHF) is characterized by multiple hospital readmissions and increased risk of death. Some studies suggest using serial changes in N‐terminal probrain natriuretic peptide (NT‐proBNP) as a predictor of adverse events in [...]
Background: Evidence‐based order sets have been shown to improve clinical and financial outcomes. However, most order set studies have been conducted in academic medical centers or stand‐alone hospitals. The Iowa Health System (IHS) is an [...]
Background: Recent studies suggest that there is an increase in cardiovascular disease after pneumonia; however, there is little information on incidence of a new diagnosis of congestive heart failure (CHF) after pneumonia. The aim of [...]
Background: Academic medical centers face new challenges in providing access to safe and efficient inpatient procedures while balancing house staff autonomy and education. Internal medicine residents at many medical centers perform invasive bedside procedures without [...]
Background: A better understanding of how resident physicians allocate their time is critical to making informed changes in resident schedules, given duty‐hour restrictions. Little is known about how much work residents defer to their off [...]
Background: In recent years, a number of residency training programs have adopted “procedure teams” that supervise residents in performing and troubleshooting invasive bedside procedures. These services have been shown to increase resident comfort and self‐perceived [...]
Background: When residents are exposed to tobacco‐dependence treatment (TDT) training, the teachings are mainly geared toward performing such practice in outpatient settings. However, hospitalized smokers may be more responsive to smoking cessation interventions than nonhospital‐iied [...]
Background: Communication among health care providers is critically important to provide safe care, as poor communication represents a major etiology of preventable adverse events (AE) in hospitals. The aim of this study was to assess [...]
Background: Research reveals deficiencies in teamwork on medical units involving hospitalists. The aims of this study were to assess the impact of an intervention, structured interdisciplinary rounds (SlDRs), on nurses' ratings of collaboration and teamwork [...]
Background: Research reveals deficiencies in teamwork on medical teaching units. The aim of this study was to assess the impact of an intervention, structured interdisciplinary rounds (SlDRs), on hospital care providers' ratings of collaboration and [...]
Background: Communication between nurses and physicians is instrumental in providing quality patient care. Nurse‐physician relations have been linked to nursing satisfaction and collaboration is associated with positive patient outcomes. Banner Good Samaritan Medical Center (BGSMC) [...]
Background: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey was developed by the Center for Medicare & Medicaid Services (CMS) and the Agency for Healthcare Research and Quality (AHRQ) as a standardized [...]
Background: Over the past decade, several studies reported a sharp increase in the use of proton pump inhibitors (PPIs) in the hospital setting. Between 33% and 65% of these prescriptions were found to be noncompliant [...]
Background: Clostridium difficile infection (GDI) is one of the most common hospital‐acquired infections, and its prevalence and severity have been increasing. It is crucial to make a timely and accurate diagnosis so that treatment and [...]
Background: The 200S CHRISTOPHER trial validated a diagnostic algorithm for pulmonary embolism (PE) using the Wells score, D‐dimer, and CT angiography (CTA). Thirty‐two percent of patients had a combination of low Wells score and negative [...]
Background: There is controversy over the use of D‐dimer to exclude pulmonary embolism (PE) in patients hospitalized for other reasons. Some authors have suggested that D‐dimer has limited clinical utility for inpatients because of its [...]
Background: The handoff of patient information and care is a vulnerable time during hospitalization. Inadequate communication during handoffs is associated with adverse events and near misses. Although recent guidelines from both the Institute of Medicine [...]
Background: Reducing hospital readmission rates will decrease medical costs and improve public health. Moreover, the Centers for Medicare and Medicaid Services (CMS) will no longer reimburse hospitals for certain “preventable readmissions.” The objective of this [...]
Background: Patients who are admitted to the hospital often get various diagnostic radiological studies. These tests reveal incidental radiological findings unrelated to their current illness. Purpose: This study was to evaluate the prevalence of these [...]
Background: Inhalers are often used incorrectly by patients. Therefore, guidelines recommend evaluation of patient comprehension and education of respiratory inhaler use at all points of care, including hospitals. Determining ways to target use of instruction [...]
Background: Risk‐based testing for HIV has been shown to have a limited impact on the rates of screening, and the latest CDC guidelines were expanded to recommend routine, voluntary HIV testing in all health care [...]
Background: The eighth National Patient Safety Goal, developed by the Joint Commission in 2009, emphasizes the importance of reconciliation of medications during the entire period of hospitalization. The medication reconciliation process starts with obtaining the [...]
Background: The Internal Medicine Preoperative Assessment Consultation and Treatment (IMPACT) Center is a referral‐based clinic providing standardized preoperative evaluation by staff hospitalists. Our aim was to determine whether referral to the IMPACT Center decreased the [...]
Background: Several randomized and observational trials in the past decade and the more recent ACC/AHA guidelines support the use of preoperative beta‐blockers (PBBs) in selected patients undergoing noncardiac surgery (NCS). The Internal Medicine Preoperative Assessment [...]
Background: Length of stay (LOS) is increasingly being recognized as an important quality measure. It reflects the total number of days a patient actually spends in the hospital until discharge and encompasses the cumulative time [...]
Background: Spurious hypoxemia is a very rare but known entity in patients with extreme leukocytosis. There are roughly only 15 cases that have been reported and documented spurious hypoxemia in patients with extreme leukocytosis and [...]
Background: Communication of incidental radiological findings identified during hosprealization is an important part of a successful transition of care. As these are not the source of current illness but do require follow‐up, the likelihood of [...]
Background: The last 15 years have seen tremendous advances in the care of HIV‐infected children. Kourtis et al. documented a 71% decline in pebiatric hospitalizations due to HIV from 1994 through 2003, especially after the [...]
Background: Hospital readmission is a common and costly problem, with an average 30‐day readmission rate of 20% for Medicare patients. HF is the most common reason for readmission. Inattention to care across transitions is a [...]
Background: Pressure ulcers are a significant source of morbidity in hospitalized patients. In 2006 the Centers for Medicare and Medicaid Services (CMS) identified the development of a stage 3 or 4 pressure ulcer while hospitalized [...]
Background: Proton pump inhibitors (PPIs) are one of the most prescribed medications and are frequently used in hospitalized patients. Although PPIs have well‐defined indications for both therapy and prophylaxis, they are often overutilized. Recently, there [...]
Background: Osteoporosis, the underlying cause of most hip fractures, is underdiagnosed and underrated. The Joint Commission's recent report on osteoporosis diagnosis and management showed that only 20% of patients with fragility or low‐impact fractures are [...]
Background: Published guidelines for treatment of health care‐associated pneumonia (HCAP) recommend initial broad‐spectrum antibiotic therapy with appropriate de‐escalation based on culture results. Guideline recommendations are heavily based on data from intubated patients, in whom cultures [...]
Background: Medication discrepancies, defined as unexplained differences in documented medication regimens across different sites of care, are prevalent and an important contributor to adverse drug events (ADEs) among hospitalized and recently discharged patients. In 2006, [...]
Background: For light glycemic control in the intensive care unit (ICU), recent studies attribute a lack of benefit and potential harm primarily to a higher frequency of hypoglycemia. Two caloric variations, caloric interruptions and caloric [...]
Background: Clostridium difficile infection (CDI) is a growing epidemic in U.S. hospitals. Much of the rapid rise in severe cases of CDI over the past 10 years is thought to be from the fluoroquinolone (FQ)–resistant [...]
Background: To increase the use of venous thromboembolism (VTE) prophylaxis, a multidisciplinary team at an academic medical center developed a VTE prophylaxis protocol that was added into medicine admission and surgical postoperative order sets. In [...]
Background: Patients with very long lengths of stay (LOS) comprising the tail of a normal distribution contributed significantly in raising the overall LOS in our academic teaching hospital. This finding held, even when cases were [...]
Background: In April 2009, a large academic medical center switched the low‐molecular‐weight heparin (LMWH] on its formulary from enoxaparin to dalteparin. This formulary change was studied to determine how venous thromboembolism (VTE) prophylaxis rates and [...]
Background: The hospital setting is an ideal environment to counsel patients on smoking cessation. The effectiveness of hospital‐based care for smoking is unclear, specifically among African Americans, who face a disproportionate burden of tobacco‐related disease. [...]
Background: Despite the removal of most internal medicine (IM) residency procedure requirements, residents at all levels continue to perform bedside procedures. Hospitalists may find themselves responsible for oversight of inpatient procedures performed by their residents. [...]
Background: Approximately 500,000 patients are discharged from U.S. hospitals against medical advice (AMA) each year. The clinical implications of discharge AMA are not known. We hypothesized that discharge AMA would be associated with a strong [...]
Background: Since the prospective payment system began in 1962, hospitals have been incentivized to shorten inpatient length of stay (LOS). Though average LOS has since become shorter, few studies have examined the impact of shorter [...]
Background: In the United States the elderly make up a disproportionately large percentage of acute hospitalizations. In 2003 persons older than 65 years old made up 12% of the U.S. population but accounted for 33% [...]
Background: There is increasing use of propofol by nonanesthesiologists to sedate children for ambulatory diagnostic imaging studies. There is little published data on the safety profile and frequency of adverse events when propofol is used [...]
Background: Although multiple studies have shown that inappropriate use of stress ulcer prophylaxis (SUP) is common for non‐intensive care unit (ICU) hospitalized patients, little is known about why physicians prescribe SUP without supporting evidence. This [...]
Background: Venous thromboembolism (VTE) is a common and potentially lethal problem. The 2009 Joint Commission has set new goals for the standard of care for all patients with VTE. To our knowledge, no research exists [...]
Background: Cost of medical care at the end of life is high, especially for hospitalizations that end in death. Palliative care services have been associated with decreased costs, including lower intensive care unit (ICU) costs. [...]
Background: Proper hand hygiene is one of the simplest interventions to reduce spread of infectious diseases in the hospital setting. CDC currently recommends hand washing with soap and water or alcohol‐based gel before and after [...]
Background: Providing quality care is a top priority in hospital medicine. Quality of patient care comprised not only “technical” components (correct diagnosis and medical management), but also “sefvice” elements. Quality of service pertains to the [...]
Background: Venous thromboembolism (VTE) is a common complication of hospitalization, with an estimated 600,000 cases in 2002, and is associated with substantial morbidity and mortality. The increasing focus on patient safety, with both financial implications [...]
Background: Venous thromboembolism (VTE) is an important cause of morbidity and mortality in hospitalized patients, so payers and regulators are encouraging hospitals to invest in systematic approaches to prevent them. Here, we describe an initiative [...]
Background: Venous thromboembolism (VTE) is frequently under‐ or overtreated in hospitals. Thus, regulators are encouraging hospitals to invest in systematic approaches to better manage anticoagulation. Here, we describe an initiative to implement VTE treatment best [...]
Background: Racial and ethnicity differences in health outcomes exist across many areas in medicine. Few studies have investigated race/ethnicity differences among critically ill patients and have not fully accounted for severity of illness, socioeconomic status [...]
Background: The long‐term health consequences related to obesity are well documented. Recent surgical and intensive care unit literature has reported no significant differences in morbidity or mortality related to obesity. However, the full consequences of [...]
Background: At our quaternary academic medical center the process of dictating discharge summaries historically led to delays such that discharge summaries were being completed on average of more than 5 days after discharge. Our geriatricians [...]
Background: Computer provider order entny (CPOE) systems with clinical decision support can alert providers to medication ordering errors such as duplicate medication orders. Yet many ordering errors persist despite these interventions. Duplicate orders after CPOE [...]
Background: Length of stay in U.S. hospitals has been trending downward, and correlations to both outcomes and patient satisfaction are mixed. We compared measures of patient satisfaction with hospitalists' communication skills to average patient length [...]
Background: Community‐acquired pneumonia is a clinical diagnosis determined by the presence of respiratory signs and symptoms. Unfortunately, these clinical findings are not specific and may represent manifestations of other conditions. In addition, pneumonia may be [...]
Background: Considerable resources have been devoted to improving hand hygiene compliance, yet true compliance remains unacceptably low, especially among physicians. Estimates from U.S. hospitals conclude that 2 million hospital‐acquired infections occur yearly, resulting in 100,000 [...]
Background: Urinary catheters are frequently used in acute care settings, resulting in substantial morbidity and costs from catheter‐associated urinary tract infection (CAUTI). National data from 2005 revealed that preventing CAUTI was a low priority for [...]
Background: Neutropenia is a serious and potentially fatal complication of drug therapy that can be induced by a number of medications. Failure to correctly identify and remove the offending agent can result in serious morbidity [...]
Background: High Wood pressure (BP) is frequently treated in patients hospitalized for reasons other than hypertension, but there are no evidence based guidelines for the management of asymptomatic high BP not associated with target organ [...]
Background: Over the past several decades, there has been a rapid influx ol new information lor diagnostic and therapeutic interventions. It is increasingly challenging for hospitalists to continue to integrate new knowledge while complying with [...]
Background: Proper coding is an essential skill necessary to capture the appropriate level of care provided by the physician. Both undercoding and overcoding are problematic, and few residency programs adequately educate trainees in this skill. [...]
Background: Contaminated blood cultures in the hospital setting are a potentially preventable cause of increased length of stay, unnecessary resource utilization, and unnecessary use of antibiotics. Estimates of the impact of contaminated blood cultures range [...]
Background: Interns, residents, and hospitalists conduct morning rounds in hospitals to determine the plan of care for the patients and to determine the learning needs of the house staff. At Virginia Mason Medical Center with [...]
Background: The delivery of safe and high‐quality patient care requires providers to learn from cases involving suboptimal events or outcomes. Although hospitai incident reporting systems generate triggers for case reviews, literature demonstrates insufficient representation of [...]
Background: Poor handoff communication poses a threat to patient safely. The medical literature to dale has focused on handoffs within a single facility or at hospital discharge. There are no assessments of the quality of [...]
Background: For institutions without a fully integrated EMR, providing a complete and legible discharge medication list is challenging. Medication reconciliation forms must serve the needs of both patient safety goal standards and the patient. In [...]
Background: An institutional requirement is lo conduct quarterly morbidity and mortality (M&M) conferences involving the internal medicine house staff. However, traditional MSM conferences often fail to address systems‐based factors or generate solutions to issues raised [...]
Background: The results of publicly reported patient care surveys, such as the Hospital Consumer Assessment of Hospitals and Health Systems (HCAHPS), suggest that physician communication with patients could be improved. Patient‐centered care: which attempts to [...]
Background: In 2004, the Centers for Medicare and Medicaid Services (CMS) and the Joint Commission (JC) determined a standard set of discharge instructions must be provided to patients with a principle diagnosis of congestive heart [...]
Background: Every hospitalist program needs night coverage. Noctumists are in high demand and short supply and rotating hospitalists from days to nights is a dissatisfier. Night coverage is Typically more expensive than day coverage because [...]
Background: Medication errors are common, costly, and have Ihe potential for harm. In 2006, Ihe Joint Commission challenged hospitals to implement medication reconciliation at transition points across the continuum. At our institution, compliance with this [...]
Background: With today's flow of information, on top of academic and clinical duties, hospitalist face the challenge of staying up‐to‐date to provide the besl care for palients. Web feeds are powered by an extensible markup [...]
Background: In 2005, CMS and JCAHO implemented the Heart Failure Core Measures Set along with other core measures, in launching their hospital Performance Measures Initiative. Virginia Mason Medical Center (VMMC) has been able to improve [...]
Background: Teaching quality improvement (01} to house staff is still in its infancy. Using modified root cause analyses (RCAs) in monthly resident‐run conferences has been suggested as one manner to improve resident Ql exposure and [...]
Background: Hospital efficiency and throughput has a great impact on available bed‐days. When hospitals run at high capacity, the need to care for patients in the most efficient manner possible is of paramount importance to [...]
Background: Medication reconciliation is a major patient safety concern nationally and is linked to CMS measures. In 2006 an audit of the discharge medication list given to patients and the hospital summary sent to The [...]
Background: Financial incentive programs have been successfully used lo encourage performance improvement, but until now. few such programs have engaged physicians‐in‐training. UCSF Medical Center and Office of Graduate Medical Education implemented a novel group financial [...]
Background: Delays in reporting inpatient routine morning laboratory tests to physicians lead to dissatisfaction and affect clinical decisions and safety and discharge plans. Test reporting limes and customer satisfaction have therefore been suggested as performance [...]
Background: Transition Irom hospital to home is a vulnerable time for the frail elderly, and the complex discharge process benefits from a multidisci‐plinary approach and care coordination. Asuboplimel discharge process may lead to dissatisfaction, early [...]
Background: The Joint Commission requires hospitals to conduct failure‐modes‐and‐effects analyses [FMEAs] to evaluate error‐prone care processes. The Accreditation Council for Graduate Medical Education (ACGME) similarly expects resident competency in quality improvement and patient safety but [...]
Background: Two years ago our academic hospitalists observed increasing difficulty in scheduling timely ambulatory follow‐up appointments for patients discharged from teaching and nonteaching hospital services. Several believed that this negatively affected patient care and was [...]
Background: Homeless persons have higher rates of emergency department visits and acule care hospitalizations than housed populations. They account for excess costs per hospitalization, largely because of an increased length of slay. A study from [...]
Background: Health care providers are searching for methods to improve patient satisfaction. A hospitaiwide survey at our institution studied 2 years of our patient satisfaction data, which indicated that problems with communication between caregivers, notably [...]
Background: Program directors are responsible for teaching and evaluating resident competence in quality improvement (QI) activities. Recent literature has highlighted various methods to accomplish this goal using varied curricula, facilitation tools, and rotational structures. The [...]
Background: Learning effective handoff skills is critical lo patient safety and continues lo grow in importance since the implementation of resident duty‐hour restrictions and will likely become more critical across specialties given recent recommendations by [...]
Background: Hospitalists care for an increasing number of older patients. As teachers of medicine, they are uniquely positioned to teach geriatric skills to residents. Faculty development programs focused on geriatrics leaching skills are often expensive [...]
Background: Mission Hospital is a regional community hospital serving Ihe population of western North Carolina, We repair around 500 hip fractures per year in patients older than 65, more lhan any hospital in North Carolina [...]
Background: An academic medical center added 15 adult hospitalists over the past 2 years. Many of the new faculty did not have prior experience with billing. Over the same time, the Department of Internal Medicine [...]
Background: Discharge transitions in care represent a high‐risk period for medication errors and adverse drug events such as medication discrepancies. Although there is literature on improving admission medication reconciliation (Cornish et al. Arch Mem Med. [...]
Background: Hospitalization and discharge‐associated transitions often involve changes in medication regimens that can lead lo adverse drug events and possible avoidable health care utilization. Studies have shown that discharge adverse events are prevalent, and medication [...]
Background: In 2007 our Department QI Hospital Medicine was responsible lor the care QI more than 90% QI admissions for adults wilh sickle cell anemia (SCA), the majority of which were for sickle cell crisis. [...]
Background: Asthma is responsible for a substantial proportion of ER visits and hospitalizations nationally, especially in minority communities. Since 2009, asthma patients have now been at increased risk because of a mandated replacement of the [...]
Background: Adverse events tallowing hospital discharge are common and represent a vulnerable time for patients. Unlike ambulatory practices That provide contact mechanisms for patients who have questions about their care, hospital medicine groups are faced [...]
Background: Transfusion of red hlnnri cells (RBCs) in the appropriate clinical setting can be a lifesaving procedure, but This therapeutic power does not come without cost. The latter cannot only be measured in dollars, but [...]
Background: National data on clinicians' documentation shows 60%‐80% inappropriate documentation on common hospital DRGs. We developed a documentation improvement project to improve clinicians' performance and to develop residents' core competency in system‐based practice (SBP) and [...]
Background: As quality improvement (Ql) and patient safety (PS) gain momentum as unquestioned core competencies in hospital medicine, residency Training programs are charged wilh educating the next generation of physicians in practice and promotion of [...]
Background: One of the barriers to the safe management of inpatients with hyperglycemia is the lack of coordination between bedside blood glucose (BBG) Testing, insulin administration, and food delivery. This results in potential for mismatch [...]
Background: Falls are a high‐risk, high‐volume, and high‐cost challenge for hospitals. As part of the 2009 national patient safety goals, the Joint Commission emphasized the need to reduce the risk of harm resulting from falls [...]
Background: Health care costs now comprise 16% of our gross national product. If we do not modify how we spend our health care dollars, this cost will increase to 50% by 2080. Gain‐sharing programs strive [...]
Background: The ACGME requires that residents achieve competence in systems‐based practice (SBP) and practice‐based learning and improvement (PBL). Residency programs are challenged to develop, teach, and measure the impact of educational curricula in These arenas. [...]
Background: In most internal medicine residency programs, house staff round on their patients each morning. This practice provides residents with the opportunity To review with patients the hospital course, results from previously completed tests, changes [...]
Background: Work rounds are an established part of internal medicine residency training and an essential component of patient‐centered care. Work rounds provide house staff with the opportunity to review patients' hospital course, test results, treatment [...]
Background: ACGME requires residents training in internal medicine residency programs to be active participants in quality improvement projects. ABIM offers practice improvement modules (PIM) to teach residents QI techniques. In 2008. Baystate Medical Cenler (BMC) [...]
Background: There is growing demand for safe procedural sedation in pediatric hospitals around the country. Purpose: Through training with pediatric anesthesiologists, we have developed a successful model for a pediatric hospitalist‐administered sedation program. Description: In [...]
Background: Variations in physician practice are well documented, despite the existence of best practices. Difficulty in translating research inlc practice, as well as industry influence, may be factors responsible for such variation. For academic medical [...]
Background: The literature consistently demonstrates that trainees are more satisfied when hospitalist teaching models are implemented. Before implementation of our ward system, house staff Teams cared for patients with different attendingsof record, and each attending [...]
Background: Emergency department (ED) overcrowding remains a major problem in the United States, leading to ambulance diversions, treatment delays, and patients leaving prior to physician evaluation. In addition, the total number of inpatient hospital beds [...]
Background: Handoff skills continue to be a critical part of resident training. Few large‐scale studies exist to assess the most effective method 1c teach proper handoff skills. Purpose: A prospective, randomized, controlled trial was conducted [...]
Background: Inpatient quality measures, such as compliance with multidisciplinary ventilator bundles to prevent ventilator associated pneumonia and venolhromboembolism (VTE) prophylaxis have been linked to reduced morbidity and mortality. However, at many hospitals not all suitable [...]
Case Presentation: A 79‐year‐old female with a history of hypolhyroidism presented with recurrence of her symptoms within days of discharge. On her last admission she presented with a 2‐week history of recurrent high‐grade fevers, headache, [...]
Case Presentation: A 36‐year‐old woman with PMH significant for iron‐deficiency anemia, presented with weakness, dyspnea, blurry vision, and dizziness. She denied hemoptysis, hematemesis, or hematochezia. Her menstrual cycles were regular. Physical exam showed pale conjunctiva, [...]
Case Presentation: A 69‐year‐old woman was hospitalized with a 4‐month history of generalized weakness, paresthesias, and bilateral lower‐extremity pain. Her past medical history was significant for hypertension, dyslipidemia, and surgically treated ovarian cancer Review of [...]
Case Presentation: A 45‐year‐old white female with no significant past medical history presented with bilateral lower‐extremitiy edema for 6 months. Physical examination was unremarkable except for pitting edema. Initial workup showed hypoalbuminemia and 24‐hour urinary [...]
Case Presentation: A 46‐year‐old man with diabetes meHitus, hypertension, and hyperlipidemia was admitted with history of myalgias, cough with sputum, emesis, chills, abdominal pain, and diarrhea. Examination was significant for an ill‐appearing male, normolensive, and [...]
Case Presentation: A 41‐year‐old woman was admitted for evaluation of recurrent diarrhea and lightheadedness. She described recurrent episodes over the preceding year of nausea and diarrhea, followed by worsening dizziness. She also had bilateral hip [...]
Case Presentation: This is a 43‐year‐old white man who suffered blunt abdominal wall trauma from a collision with a teammate during a Softball game. The patient initially presented to the emergency department 1 day after [...]
Case Presentation: A 15‐year‐old male presented after 4 days with painful oral lesions preceded by nonspecific URI symptoms. Lesions were described as blisters on the lips and ulcers in the oral mucosa. The patient received [...]
Case Presentation: Case 1 is a 57‐year‐old African American female patient with morbid obesity, type 2 DM, HTN. and CKD stage 3 who was admitted for DKA. She had undergone Roux‐en‐Y gastric bypass surgery 2 [...]
Case Presentation: A 32‐year‐old African American male with sickle cell trait and congenital nephrogenic diabetes insipidus without previous sickle cell‐related complications traveled to Bogota, Columbia, located 8661 feet above sea level. On arrival to Bogotá, [...]
Case Presentation: A 54‐year‐old woman with no past medical history presented with a 2‐month history of increasing fatigue, fever, and loss of appetite. She denied any other symptoms. She was pale and febrile (101.7°F) and [...]
Case Presentation: A 73‐year‐old male with HTN presented with 1 month of bilateral UE throbbing pain in his upper arms followed by his hands. This was associated with swelling ascending up from his hands to [...]
Case Presentation: A 20‐year‐old healthy female presented with history of dizziness for 1 year, with recent increase in frequency and duration. She had no vertigo and no aggravating or relieving factors. She denied any hearing [...]
Case Presentation: Mr. B is a 68‐year‐old man with a history of melanoma and histoplasmosis infection who presented with an enlarged, painful left inguinal lymph node. This dramatically increased in size over 2 months, prompting [...]
Case Presentation: A 57‐year‐old while female presented with 9 weeks of diarrhea and abdominal pain. She characterized her stools as large volume and nonbloody. She had noticed an associated 20‐pound weight loss. She denied recent [...]
Case Presentation: This is a 2‐year‐old female who presented in status epilepticus with a fever. She had no previous history of seizures. She was stabilized and loaded with AEDs, and treated with empiric antibiotic therapy [...]
Case Presentation: An 82‐year‐old female with a history of hypertension and paroxysmal atrial fibrillation presented as a transfer to our institution She presented with fatigue, a 10‐pound weight loss, and right upper quadrant abdominal pain [...]
Case Presentation: An 18‐year‐old woman presented with 4 weeks of constant, painless vaginal bleeding. She had had a normal spontaneous vaginal delivery that required anepisiotomy 4 months prior to presentation. She noted associated nausea, vomiting, [...]
Case Presentation: A 26‐year‐old man presented with 1‐month history of abscesses on his neck. He reported recurrent abscesses for 6 years, on his scalp and posterior neck. The lesions periodically enlarged and partially regressed, emitting [...]
Case Presentation: A 49‐year‐old man presented with a diffuse, nontender, nonpruritic papular exanthem. He stated that it started on the chest and spread to his back and extremities. He has acute myeloid leukemia (AML), subtype [...]
Case Presentation: A 39‐year‐old male with a PMH significant for infantile seizures and a 3‐year history of bilateral lower‐extremity edema presented with a 1‐day history of seizures. Patient noted a 1‐week history of right‐sided scrotal [...]
Case Presentation: This 65‐year‐old man was transferred to the intensive care unit for acute shock on postoperative day 1 s/p laparotomy for ventral hernia mesh repair. Rapid intravenous fluid resuscitation was initiated, and central venous [...]
Case Presentation: An 83‐year‐old man was admitted to the hospital with suspected right upper load pneumonia. His physical exam and laboratory values were significant for a temperature of 38.4°C, a heart rate of 108, a [...]
Case Presentation: A 68‐year‐old woman with non‐small cell lung cancer (NSCLC), diffuse large B‐cell lymphoma (DLBCL), and chronic renal insufficiency was admitted from the infusion center with confusion. Recently diagnosed with both NSCLC and DLBCL, [...]
Case Presentation: Spontaneous coronary artery dissection (SCAD) is a very rare cause of acute coronary syndrome in young otherwise healthy patients with a striking predilection for the female sex. We describe a patient who underwent [...]
Case Presentation: A 35‐year‐old man presented with 4 days of right leg pain secondary to a chronic ulcer. Though the ulcer on his shin had been present for 2 months, he recently noted the pain [...]
Case Presentation: Dural venous thrombosis or cerebral vein thrombosis (CVT) is a rare but potentially fatal condition that can present as a severe headache and can be challenging to diagnose. A 46‐year‐old nonsmoking white female [...]
Case Presentation: A 34‐year‐old African American male with sickle cell trait and Gilbert's syndrome presented To Ihe emergency room with left‐sided, throbbing flank pain that radiated To the ipsilateral testicle. Four months ago, he underwent [...]
Case Presentation: We present a patient with massive cutaneous bleeding from a collateral site — Ihe caput medusa. A43‐year‐old man with history of alcoholic liver disease, Child‐Pugh class B, presented to the hospital with cutaneous [...]
Case Presentation: Our general medicine consultation service was asked to evaluate a 63‐year‐old woman who was admitted to the psychiatric ward with severe bipolar disorder. She initially presented with catatonia and severe depression. After undergoing [...]
Case Presentation: A 73‐year‐old white male with well‐controlled hypertension, type 2 diabetes, osteoarthritis, and gout presented to our preoperative clinic in anticipation of undergoing left hip arthroplasty. The patient had experienced left hip and back [...]
Case Presentation: An 18‐year‐old African American male brought in by his guardian with chief complaints of bizarre behavior for 10 days. The patient had (not unusually) “disappeared” for several days with friends. However, he had [...]
Case Presentation: A 60‐year‐old female presented with 5 days of abdominal pain and vomiting. She has diabetes treated with insulin and metformin. She noted malaise, poor oral intake, and decreased urination. Examination revealed an ill‐appearing [...]
Case Presentation: A 47‐year‐old woman presented with 2 days of painful rash over her bilateral thighs and buttocks. Six days prior, ultrasonography had revealed bilateral lower‐extremity deep vein thrombosis, and she had received intravenous unfractionated [...]
Case Presentation: A 70‐year‐old male with hypothyroidism, BPH, and alcohol dependence in the past presented to the hospital with a 3‐month history of weight loss (35 pounds), anorexia, and abdominal distention for 2 weeks. He [...]
Case Presentation: A 77‐year‐old white male with no past medical or surgical history presented with 36 hours of progressive, nonradiating, abdominal pain. His pain started in Ihe epigastric region and moved to the right lower [...]
Case Presentation: The baby girl was born at 34 and 3/7 weeks gestational age to a 21‐year‐old P0101 via C‐section secondary to chorioamnionitis and fetal tachycardia. Prior to delivery, the mother had flulike symptoms, highly [...]
Case Presentation: A 27‐year‐old woman with an unremarkable past medical history consulted her doctor because of a sore throat and difficulty swallowing consistent with a viral illness. Symptoms improved over the next 2 days until [...]
Case Presentation: A 76‐year‐old woman presented with complaints of severe epigastric pain radiating to the back of 8 hours' duration. Her pain was associated with anorexia and was aggravated by food. There were no associated [...]
Case Presentation: A 54‐year‐old white woman presented with complaints of lower‐extremity (LE) swelling and significant joint discomfort. Her PMH was remarkable for IgA deficiency, recurrent sinus infections, and UTI. Her PSH included multiple sinus surgeries, [...]
Case Presentation: A 30‐year‐old woman with history of obesity s/p gastric bypass 6 years ago presented for evaluation of hypoglycemia. Her initial day of hospitalization was for an elective calcium gluconate stimulalion study by interventional [...]
Case Presentation: A 49‐year‐old man presented with a 1‐week history of fevers, shortness of breath, dry cough, and myalgia. At presentation, his temperature was 103, pulse was 107, and oxygen saturation was 83% on room [...]
Case Presentation: A 53‐year‐old male with fibrosing mediastinilis presents with a 1‐day history of cough and hemoptysis. His past medical history was significant for hypertension and fibrosing mediastinitis diagnosed in 2005. On exam, the patient [...]
Case Presentation: A 30‐year‐old man African American with sickle cell trait presented to the ED with a complaint of lower back muscle spasms that began near the end of a basketball game earlier that day. [...]
Case Presentation: A 90‐year‐old female with a history of Alzheimer's presented with a 1‐day history of fever and confusion. Initial blood pressure was 91/56, and temperature was 102.8°F. The patient was oriented but had difficulty [...]
Case Presentation: A 29‐year‐old presented with sudden onset of chest pressure associated with palpitations, dizziness, and shortness of breath. EMS found her obtunded and hypotensive. A wide‐complex QRS tachycardia was observed, leading to defibrillation. Her [...]
Case Presentation: A 57‐year‐old presented with 1 week of worsening right lower‐extremity swelling and tendemess. He reported initially injuring his leg or a metal pot during a seafood boil. He did not seek medical care [...]
Case Presentation: This is a 28‐year‐old female whose past medical history includes juvenile rbeumatoid arthritis, obstructive sleep apnea, hypertension, and congenital blindness. She has been hospitalized twice for evaluation of dyspnea on exertion despite using [...]
Case Presentation: A 66‐year‐old smoker, hypertensive, diabetic male was admitted to the ICU with MSSA pneumonia resulting in severe septic shock with ventilator‐dependent respiratory failure and multiple organ failure. Subsequently, he developed acute, painless, bilateral [...]
Case Presentation: A 26‐year‐old woman was found unresponsive and surrounded by peritoneal dialysate. She was last known to be conscious 12 hours prior. Past medical history includes uncontrolled type I diabetes mellitus, hypertension, depression, schizoaffective [...]
Case Presentation: A 24‐year‐old man with no medical history presented with 2 weeks of intermittent night sweats and 2 days of crampy right upper quadrant abdominal pain without other associated symptoms. He denied any history [...]
Case Presentation: A 52‐year‐old female was admitted for the evaluation of recurrent atypical chest pain. Outpatient nuclear stress testing had suggested modest but reversible ischemia. Past medical history includes PTSD, depression, anxiety, GERD, hypertension, and [...]
Case Presentation: An 85‐year‐old female with complaint of pain located below her right costal margin described as severe, intermittent, and radiating down both legs. This was associated with nausea, vomiting, and diaphoresis. She reported 6 [...]
Case Presentation: A 27‐year‐old female day‐care worker with a history of childhood tonsillectomy noted fever, sore throat, and right ear pain for 1 week. Two days before admission she developed pain involving the right side [...]
Case Presentation: A 53‐year‐old man was transferred to our hospital for renal failure, uremic encephalopathy, and septic shock. The patient had recently become reclusive and family reported 3‐4 weeks of nausea, vomiting, and diarrhea without [...]
Case Presentation: A 57‐year‐old female presented in the emergency department with dyspnea and sharp chest pain radiating to the left shoulder. The pain was associaled with use of her left arm. She had a history [...]
Case Presentation: A 56‐year‐old Nigerian female presented to the ED with 2 weeks of malaise, anorexia, and nausea. At the symptoms onset, she had returned from a month‐long trip to Nigeria to visit friends and [...]
Case Presentation: A 28‐year‐old with a supratentorial primitive neuroectodermal tumor treated with resection and chemutlkerepy was admitted for a thigh wound. She had recently been hospitelized for declining mental slatus and was found to have [...]
Case Presentation: A 20‐year‐old previously healthy man presented with 1 month of lower back pain. He noted a 30‐pound weight loss, night sweats, fatigue, and bleeding from the gums over the same time period. He [...]
Case Presentation: A 23‐year‐old woman with history of hemoglobin SS disease presented with 4 days of sharp, right‐sided chest and back pain She was afebrile with clear lungs on exam and with CXR devoid of [...]
Case Presentation: A 57‐year‐old Hispanic male presented with altered mental status associated with progressive weakness over the preceding 2 months. On admission, he was found to have hypercalcemia, thrombocytopenia, hemolytic anemia and acute renal failure [...]
Case Presentation: Our patient is a 45‐year‐old female with a history of systemic lupus erythematosus and end‐stage renal disease requiring hemodialysis (HD) who was admitted to the hospital from her dialysis center after being found [...]
Case Presentation: A 69‐year‐old white female was seen by the rheumatology service at the request of the vascular service, regarding bilateral hand edema and severe pain. Two days previously, the patient had been made NPO [...]
Case Presentation: A 79‐year‐old woman with longstanding MGUS presented to her primary MD with fatigue and was found to have anemia and renal failure. She was sent to the emergency department, where she was found [...]
Case Presentation: A 58‐year‐old male with history of extraskeletal osteosarcoma treated with left nephrectomy, splenectomy, and partial resection of stomach, pancreas, and colon was admitted for febrile neutropenia. History was remarkable for recent chemotherapy treatment [...]
Case Presentation: A 36‐year‐old healthy male presented with a 6‐hour onset of pain, swelling, and purplish discoloration of the left upper extremity after lifting weights at the gym. He denied any trauma to the shoulder [...]
Case Presentation: A 58‐year‐old man was admitted with a 5‐day history of shortness of breath, cough, and weakness. His medical history was remarkable for an 8‐month course of recurrent pneumonia and intermittent fevers He had [...]
Case Presentation: A 57 year‐old woman presented for a headache and nausea for 2 weeks. PMH was significant for depression, SLE controlled on no treatment, and previous episodes of aseptic meningitis. Vitals were stable, and [...]
Case Presentation: A 54‐year‐old man with a history of nonalcoholic steatohepatitis and hepatocellular carcinoma presented 2 months after an orthotopic liver transplant with fever and abdominal pain. Two weeks prior he had a hepatic artery [...]
Case Presentation: A 28‐year‐old previously healthy female with a history of intravenous drug abuse (IVDA) was referred to our hospital after 2 days of progressively worsening right monocular vision loss. Three days prior to symptom [...]
Case Presentation: A48‐year‐old woman was admitted to the hospital with shortness of breath and generalized weakness. She noted 3 months of a progressive weakness, and the recent onset of progressive eyelid swelling. She also noted [...]
Case Presentation: A 30‐year‐old woman presented with 1 month of progressively worsening dyspnea on exertion. Her exercise tolerance had decreased; she could barely take a few steps or even pick up her 6‐month old child. [...]
Case Presentation: An 82‐year‐old man with cervical spondylosis presented to his PCP in mid‐August for acute neck pain with radiation to the hghl arm. The patient was treated for similar pain with steroid injections in [...]
Case Presentation: A 16‐year‐old female lifeguard presented with a 2‐day history of black stools, diarrhea, abdominal pain, and lightheadedness. She noted easy bruising and frequent nosebleeds but denied fever, nausea, vomiting, or respiratory symptoms. In [...]
Case Presentation: A 73‐year‐old white male with a PMH of hypertension presented with a 5‐ to 6‐month history of intermittent fevers. During the initial onset he noted low‐grade fevers which progressed to range from 101°F [...]
Case Presentation: A 38‐year‐old right‐handed male presented with a chief complaint of slurred speech and difficulty ambulating. He had similar symptoms the previous day which resolved spontaneously over a few hours. On admission, all other [...]
Case Presentation: A 66‐year‐old male with a PMH of Charcot‐Marie‐Tooth disease and asbestosis presented with a 7‐day history of bilateral leg swelling with a painful rash. The patient also gave a history of having an [...]
Case Presentation: A 67‐year‐old male with metastatic colon cancer on treatment with irinotecan and bevacizumab presented with failure to thrive and ongoing weight loss not amenable to nutritional interventions. He denied headache, fever, chills, night [...]
Case Presentation: A 37‐year‐old nonsmoking female with a history of Raynaud symptoms presented to our hospital with 3 months of fatigue, progressive shortness of breath, and a painful, pruritic rash over her trunk and proximal [...]
Case Presentation: A 84‐year‐old male with a history of seizure disorder and in persistent vegetative state presented with recurrent UTI. Ultrasound of testis, performed in view of scrotal swelling, revealed marked bilateral scrotal edema with [...]
Case Presentation: A 37‐year‐old nondiabetic Hispanic male with past medical history of seizure disorder and intravenous drug abuse (IVDA) was brought to the hospital with altered mental status. For the past 2 days, he had [...]
Case Presentation: We report a case of profound recurrent hyperkalemia with no associated EKG changes in an 84‐year‐old female patient with normal baseline renal functions. Her past medical history was significant for hypertension, CHF, pulmonary [...]
Case Presentation: A 56‐year‐old female with a history of arthritis initially presented to the emergency room (ER) with progressive weakness, dyspnea, and chest pain. She also reported recent fever and cough, which had resolved spontaneously. [...]
Case Presentation: A 57‐year‐old female with history of stage IVB diffuse large B‐cell lymphoma presented to the emergency department 11 weeks postchemotherapy with altered mental status. Symptoms included confusion, “staring“ episodes, imbalance, and loss of [...]
Case Presentation: A 43‐year‐old female with a history of epilepsy presented after a witnessed seizure. The patient had been seizure free for more than 15 years and had been taking her medications as prescribed. In [...]
Case Presentation: A 51‐year‐old man presented with massive, persistent bright red hemalemesis requiring endotracheal intubation. History was only significant for surgically treated intestinal malrotation in the remote past. He denied alcohol consumption, peptic ulcer disease, [...]
Case Presentation: A 24‐year‐old white man presented with a 1‐month history of progressively worsening headache and blurred vision. He also reported a 27‐kg weight loss and persistent diarrhea with hematochezia in the previous 6 months [...]
Case Presentation: A 55‐year‐old male with a history of ulcerative colitis (UC) presented with left‐sided abdominal pain associated with nausea and vomiting. He denied associated diarrhea, hematochezia, melena, fevers or chills. His UC was well [...]
Case Presentation: A 64‐year‐old female with Hirschsprung disease was admitted to our hospital with fever and chills. She has history of multiple bowel surgeries and ileostomy with short bowel syndrome requiring TPN through a Hickman [...]
Case Presentation: A 44‐year‐old woman presented with 1 week of headaches and blurry vision. She complained of unsteady gait, weakness, fatigue, diarrhea, subjective fevers, rash, and lip and neck swelling. She noted a history of [...]
Case Presentation: A previously healthy 57‐year‐old African American man was admitted to the hospital with pain in the left hip and the epigastrium. He admitted to a 30‐pound weight loss over the preceding 6 months. [...]
Case Presentation: A previously healthy 37‐year‐old white woman was initially admitted to the hospital with fever, nausea, and vomiting of 2 days' duration. At admission, her blood pressure was 94/60, and temperature was 102°F. Laboratory [...]
Case Presentation: An active 83‐year‐old white female presented to Ihe emergency department (ED) with fever rigors and dyspnea for 1 day. The patient was discharged home about 5 days prior to presentation for right leg [...]
Case Presentation: A 47‐year‐old male white male with no significant past medical history presented with sudden onset of severe shortness of breath, diaphoresis, global amnesia, and weakness and paresthesia of the left upper extremity, which [...]
Case Presentation: A 69‐year‐old female was admitted with generalized weakness, hoarseness, and shortness of breath. She was initially treated as an acute asthma exacerbation. Her past medical history included asthma, type II diabetes mellitus, hypertension, [...]
Case Presentation: A 72‐year‐old man with coronary artery disease, atrial fibrillation, hypertension, gout, and obstructive sleep apnea presented to the hospital with progressively worsening dysphagia to soft foods and liquids for a few days. He [...]
Case Presentation: A 47‐year‐old Taiwanese male without significant past medical history presented with complaints of dizziness, decreased urination, and diarrhea. On exam he was noted to be markedly orthostatic. The abdomen was slightly distended. After [...]
Case Presentation: A 64‐year‐old male without a significant past medical history presented with a complaint of rectal pain. The pain was worse with bowel movements, and as a result the patient reported a fear of [...]
Case Presentation: A 54‐year‐old man with HIV presented with 2 weeks of flulike illness and 1 day of fever, dyspnea, and pleuritic chest pain. He had a recent CD4 count of 385/mm3, an undetectable viral [...]
Case Presentation: A 57‐year‐old man presented to the ED with a 5‐month history of persistent fever and weight loss. His past medical history was notable for pulmonary TB, which was partially treated with para‐aminosalicylic acid. [...]
Case Presentation: A 34‐year‐old man with end‐stage renal disease on hemodialysis and cirrhosis presented with 2 months of progressive abdominal distension and diffuse pain. He denied fever and had an otherwise negative review of symptoms. [...]
Case Presentation: A 76‐year‐old man presented with 10 days of persistent hematuria and lower abdominal pain. He also complained of fatigue and dyspnea on exertion. He denied dysuria, flank pain, or recent trauma. His vital [...]
Case Presentation: The patient is a 66‐year‐old man who was at work discussing a project with his colleagues when he had a sudden feeling of warmth and weakness come up from his legs toward his [...]
Case Presentation: A 7‐monlh‐old African American male presented to the ED with a 3 day history of vomiting. Emesis was initially nonbilious but had become bilious in the past 24 hours. ROS was noted for [...]
Case Presentation: A 56‐year‐old woman presented with 2 days of shortness of breath, cough, and fatigue. She denied sick contacts, chest pain, orthopnea, or extremity swelling. Her only change in daily routine was spending the [...]
Case Presentation: A previously active 91‐year‐old woman with a history of hypertension presented with fatigue and a 12‐pound weight loss over 3 months. Initial evaluation was notable for acute renal failure, anemia, and an E. [...]
Case Presentation: A 53‐year‐old man with an 11‐year history of HIV and medication noncompliance was evaluated for intermittent chest pain of 5 days. Three months before admission, he developed MRSA skin abscesses and was found [...]
Case Presentation: This is a 64‐year‐old man who presented with a tender, swollen, red left elbow. He reported no subjective levers. He had exfoliated the skin on his elbow using a stainless steel file. He [...]
Case Presentation: The patient is a 53‐year‐old female with a past medical history of psoriasis on methotrexate and pulmonary hypertension who presented with worsening psoriasis for several weeks with the appearance of erythroderma involving her [...]
Case Presentation: A 65‐year‐old man with past medical history significant for diverticulosis and irritable bowel syndrome presents with complaints of decreased visual acuity. He reported that his vision had been deteriorating for several months, and [...]
Case Presentation: Pulmonary artery sarcoma (PAS) is a rare tumor of the cardiovascular system Proper diagnosis can be a great challenge because clinical and radiological features are commonly indistinguishable from acute or chronic pulmonary embolism [...]
Case Presentation: A 51‐year‐old female who had previous multiple hospitalization for altered mental status and persistent diarrhea was admitted with complaint of twitching sensation on right side of her face and arm. Her past medical [...]
Case Presentation: A 45‐year‐old male was transferred from an outside hospital for evaluation of chronic diarrhea of unclear etiology. He had 6 weeks of profuse, painless, watery diarrbea up to 6L/day at its peak, associated [...]
Case Presentation: A 27‐year‐old woman, marginally housed, with a history of recreational carisoprodol (Soma) and acetaminophen (APAP)/hydrocodone use presented with abdominal pain and malaise. On physical exam, she was tachycardic and somnolent. Abdomen was soft [...]
Case Presentation: A 19‐year‐old African American male presented with 50‐pound of weight loss and poor appetite for 2 months. He reported difficulty in swallowing both solids and liquids. He experienced anterior and lower chest pain [...]
Case Presentation: A 40‐year‐old man with autoimmune hemolytic anemia status postsplenectomy was admitted 1 month ago for salmonella bacteremia and acalculous cholecystitis. His course has been complicated by transfusion‐dependent hemolytic anemia requiring plasmapheresis and acute [...]
Case Presentation: A 33‐year‐old G1P1 breastfeeding woman was admitted for hypotension and rash 3 days after suslaining a possible infant bite to the right nipple. She developed pain followed by expanding skin breakdown and erythema [...]
Case Presentation: A 70‐year‐old woman with a history of emphysema and recurrent deep venous thrombosis was admitted to the hospital with dysuria and acute renal failure. Physical exam was notable for mild fluid overload, and [...]
Case Presentation: Gout is a crystalline arthropathy characterized by the deposition of urate crystals in joints. Typically, it involves the first metatarsophalangeal joint (podagra), ankle, or knee joint, although other joints may be affected. Gout [...]
Case Presentation: A 35‐year‐old male was admitted for change in mental status. Past medical history was unremarkable, and he was not on any medications. Exam was significant for an awake but combative patient with incoherent [...]
Case Presentation: A 26‐year‐old white female with a past medical history of right patellar fracture that was surgically corrected with fixation in 2006 fell on her right knee 1 month prior To presenting to the [...]
Case Presentation: A 56‐year‐old HIV+ male presented with malaise and headache for the past 3 days. His CD4 count was 487 and HIV viral load 612,718 copies/mL, and he was not on HAART. He was [...]
Case Presentation: A 73‐year‐old African American male with history of TIA, atrial fibrillation on Coumadin, CHF, and HTN presented with acute onset of left facial paralysis, dysarthria, and confusion. Symptoms resolved by ED evaluation. Physical [...]
Case Presentation: A 34‐year‐old man, originally from India, presented with 6 months of polyarthralgias, sinusitis, episcleritis, intermittent hearing loss, and microscopic hematuria. He had signs of acute on chronic sinusitis and bilateral ground‐glass iung opacities [...]
Case Presentation: A previously healthy 2‐year‐old Asian girl presented on day of admission with left upper‐ and lower‐extremity weakness and facial droop. On arrival to ER her exam was benign except for: HR 260. dysarthria, [...]
Case Presentation: A 44‐year‐old previously healthy male presented with 3 weeks of severe sore throat, spiking fevers up to 103F, chills, and night sweats. A course of amoxicillin for presumed strep throat had failed. He [...]
Case Presentation: A 78‐year‐old male presented for a second opinion of 4 months of recurrent nausea, vomiting, and abdominal cramping with an inability to tolerate solid foods. He had early satiety and abdominal distension with [...]
Case Presentation: A 70‐year‐old woman developed sudden‐onset right upper quadrant pain that woke her up from sleep. She lost consciousness and was found to be pulseless by EMS. Cardiopulmonary resuscitation was performed, and she was [...]
Case Presentation: A 10‐year‐old African American girl known to have asthma and followed by her pediatrician for The disease presenTed To our emergency department (ED) in January with an acute exacerbation of asthma. After appropriate [...]
Case Presentation: The patient was a 71‐year‐old Indian businessman with a history of coronary artery disease, diabetes, and hypertension who presents with weakness. Three days PTA, the patient flew from Bombay to San Francisco, where [...]
Case Presentation: An SQ‐year‐old man sustained a large retroperitoneal bleed after a fall. He required transfusion of 13 units of packed red blood cells for continued bleeding. He was found to have an isolated elevation [...]
Case Presentation: We report an unusual case of a Pakistani housewife admitted for refractory ascites, fever, weight loss, and fatigue and found to have granulomatous hepatitis secondary to sarcoidosis. A 36‐year‐old woman was admitted to [...]
Case Presentation: We will discuss a case of unsuspected pulmonary embolism (UPE) to provide a framework for clinicians when approaching This newly encountered diagnosis. A 56‐year‐old female presented to our level 1 trauma center after [...]
Case Presentation: A 20‐year‐old African American male presented to the hospital for recurrent episodes of severe, diffuse crampy abdominal pain, fatigue, anorexia, vomiting, watery diarrhea, and a 20‐pound weight loss over 2 months. Although he [...]
Case Presentation: A 42‐year‐old white woman with a past medical history of hypertension was referred to cardiology for symptomatic bradyar rhythmia. She complained of a 1‐month history of dizziness, confusion, and generalized fatigue. She denied [...]
Case Presentation: This is case of a 64‐year‐old male who presented to the rheumatologists office with a lower‐extremity purpuric skin rash. His past medical history included porcine mitral valve replacement 3 years ago for subacute [...]
Case Presentation: A functionally independent 74‐year‐old female, resident of New England, presented with altered mental stalus for 2‐3 weeks. She had a history of diabetes and poorly controlled hypertension (HTN). One month ago she had [...]
Case Presentation: Acule epiglottitis is potentially fatal as it can cause sudden airway obstruction. With an infrequent occurrence in adults, it is underrecognized and misdiagnosed often. We report an adult patient with acute epiglottitis who [...]
Case Presentation: A 43‐year‐old man with a history of remote IV drug use, alcoholism, and heavy tobacco use presented to the ER after a car accident complaining of dyspnea and a cough productive of mucopurulent [...]
Case Presentation: A 62‐year‐old man was admitted for fever, dyspnea, cough, and hemoptysis for the past 4 months. His past medical history was notable for chronic lymphocytic leukemia and COPD (controlled with oral steroids). He [...]
Case Presentation: A 77‐year‐old woman presented with 2 episodes of severe back and leg pain. The patient had recently had hand swelling and a rash but no other complaints. Physical examination was noteworthy for a [...]
Case Presentation: A 48‐year‐old white female with no previous chronic disease presented with a 2‐week history of constitutional symptoms including fever, rhinorrhea, and malaise. After failure of the initial therapeutic trials, she underwent a complete [...]
Case Presentation: A 53‐year‐old woman presented with right arm numbness extending from the shoulder to the fingertips. She was taking a shower when she had difficulty raising her arm. The numbness and weakness spontaneously resolved [...]
Case Presentation: A 44‐year‐old man was admitted to the hospital for workup of recurrent localized sharp left‐sided abdominal pain associated with frequent loose stools for a year's duration. There was remote few rectal bleeding and [...]
Case Presentation: A 51‐year‐old male with history of diastolic heart failure, hypertension, MRSA bacteremia, and schizophrenia presented with desquamation of the skin that was initially a diffuse, pustular dermatitis of the body sparing the genitalia [...]
Case Presentation: An 88‐year‐old female with hypertension and no prior pulmonary disease presented with acute onset of dyspnea on exertion and chest discomfort. CT angiogram showed multiple acute pulmonary emboli as well as several chronic [...]
Case Presentation: John Doe (J.D.) is a 61‐year‐old undocumented man of African descent with no previous medical care admitted to our institution with renal failure and acute onset of bilateral lower‐extremity weakness. He was diagnosed [...]
Case Presentation: Scleroderma encompasses a spectrum of related disorders, most of which share a characteristic clinical feature of skin thickening due to an excess of collagen fiber deposition. Serologic testing is helpful in confirming, but [...]
Case Presentation: Emphysematous gastritis is a rare condition characterized by the presence of air in the wall of stomach because of invasion of gas forming organisms with mortality rates as high as 80%. We present [...]
Case Presentation: A 35‐year‐old white man with a past history significant for gastroesophageal reflux disease presented with a 1‐year history of unexplained arthralgias and a 2‐day history of hematochezia. His hematochezia was thought to be [...]
Case Presentation: A 47‐year‐old man with hypertension and depression presented with 2 weeks of right‐sided photophobia and retro‐orbital pain described as constant with increasing intensity over the last 4 days. Several days prior, the patient [...]
Case Presentation: A 53‐year‐old male with HIV (CD4 170 and VL 39,000) sought evaluation for excruciatingly painful perirectal sores and a new nodular rash covering his body. A few months prior he had been diagnosed [...]
Case Presentation: A 51‐year‐old man presented with a 1‐week history of back pain and fevers. He attributed the back pain to heavy lifting at his new job, but did not have an explanation for the [...]
Case Presentation: T.P. is an 18‐year‐old male with a past medical history significant for the recent onset of seizures who presented to his Pediatrician with a 2 week history of fever, right cervical lymphadenopathy, headaches, [...]
Case Presentation: This is a 24‐year‐old man of Filipino descent with no significant past medical history who presented with a 10‐day history of fever, chills, anorexia, and fatigue. He decided to seek medical attention after [...]
Case Presentation: A 50‐year‐old woman with a history of systemic lupus erythematosus, HIT, antiphospholipid antibody syndrome (APAS), s/p renal transplant, was admitted for urosepsis and severe left leg and back pain. Treatment included IV antibiotics [...]
Case Presentation: A 78‐year‐old man presented with 3 days of fever and intermittent, diffuse abdominal pain. He also reported loose stools and decreased appetite. He had a history of coronary artery disease, atrial fibrillation, syncope, [...]
Case Presentation: A 59‐year‐old male with a history of quiescent ITP with normal platelet counts, anxiety, and autoimmune pernicious anemia presented to the ER on postoperative day 19 from a total knee arthroplasty with weakness [...]
Case Presentation: A 35‐year‐old woman presented to the emergency room with nausea, vomiting and abdominal pain of 3 days duration. Her initial blood systolic blood pressure was 50. Her physical exam was normal other than [...]
Case Presentation: A 51‐year‐old female with no significant past medical history presented with a 1‐week history of left‐sided abdominal pain. The patient was aferile and physical exam revealed mild diffuse abdominal tenderness. Laboratory data were [...]
Case Presentation: A 34‐year‐old female with a history of MVP, 2 weeks postpartum, presented with left flank pain associated with nausea and vomiting. She did not take any medications and denied smoking or drug use. [...]
Case Presentation: A 47‐year‐old male with a history of chronic diarrhea for 10 years presented with diarrhea and hypokalemia. Potassium was 2.4 mEq/L. Further workup was negative for malabsorption or infectious causes of diarrhea. Stool [...]
Case Presentation: A 42‐year‐old woman with a history of asthma presented to her primary care physician with acute onsel of shortness of breath, chest discomfort and productive cough. She was diagnosed with bronchitis, but with [...]
Case Presentation: A 42‐year‐old man presented with 4 months of intractable nausea, vomiting, and a twenty‐pound weight loss. He noted no recent travel, and he had no tuberculosis risk factors. Outpatient attempts at antiemetic therapy [...]
Case Presentation: A 69‐year‐old white female presented with a 5‐week history of fatigue, myalgias, low‐grade fevers, increasing abdominal girth, concurrent hearing loss with bilateral serous otitis media diagnosed 3 days prior by otolaryngology, and 10 [...]
Case Presentation: A 67‐year‐old African American male presented to another hospital with COPD exacerbation. His medical history included chronic obstructive pulmonary disease (COPD), hypertension, and hypercholesterolemia. He was treated with albuterol, ipratropium nebulizer, and intravenous [...]
Case Presentation: This case is of a 92‐year‐old man who was admitted to the hospital following a syncopal episode. He was apparently found lying down for 1‐5 minutes and was nol able to recall anything [...]
Case Presentation: A 35‐year‐old woman presented with 1 month of fever and diarrhea. She had been diagnosed with HIV 1 year earlier with a current CD4 count of 22/mm3. She was on no anti‐retroviral therapy. [...]
Case Presentation: A 42‐year‐old female with an extensive psychiatric history of depression, fibromyalgia, and pseudo‐seizures, as well as obesity and chronic constipation, presented as an outpatient with fatigue, muscle pain, weight loss from poor oral [...]
Case Presentation: A 47‐year‐old woman presented with a 1‐week history of word‐finding difficulty, unclear speech and pareslhesias in her right leg. She denied neck pain, stiffness fever, chills, or problems with vision, memory, menlation, grasp, [...]
Case Presentation: A normally healthy 67‐year‐old African American male presented with 2 weeks of worsening shortness of breath, orthopnea, and lower‐extremity edema as well as some chest pains and joint aches. One week prior to [...]
Case Presentation: A 25‐year‐old Filipino female presented after being brought To the emergency department by a friend who noticed her “very abnormal behavior.” The patient was found wandering outdoors and was unaware of her surroundings [...]
Case Presentation: A 59‐year‐old man presented with a 3‐month history of a dry cough. He denied smoking. On further questioning, he noted a 9‐month history of dyspnea that began after an appendectomy. During that hospital [...]
Case Presentation: A 75‐year‐old woman with a history of stage II colon cancer in remission and PE 2 years ago presents with 3 days of progressive dyspnea and weakness She was admitted to an outside [...]
Case Presentation: A 24‐year‐old woman with sickle cell disease (SCD) presented with 1 day of progressive bilateral lower‐extremity pain. She was afebrile and had no chest, back, or joint pain. She had edema and tenderness [...]
Case Presentation: A 43‐year‐old healthy woman presented with painful lower‐extremity ulcers. Six weeks earlier, she had noticed a single red lesion on her left ankle. Over the next few weeks, the lesion enlarged, turned purple, [...]
Case Presentation: A 32‐year‐old African American male was referred from a corrections facility with severe uncontrolled hypertension for 2 weeks despite being on a regimen of 7 antihypertensive medications. He complained of persistent bitemporal headaches [...]
Case Presentation: A 36‐year‐old male with a known history of hereditary angioedema presented to an outside hospital ER with acute respiratory failure requiring endotracheal intubation. The patient received 2 units of fresh frozen plasma after [...]
Case Presentation: A 76‐year‐old woman presented with a 1‐day history of bloody bowel movements and syncope. She also noted weakness and lower abdominal pain but denied nausea or vomiting. She had been constipated for the [...]
Case Presentation: A 60‐year‐old man presented with 6 weeks of dizziness, nausea, and progressive headache Initial MRI was notable for a 2.6 × 1.6 × 2.3 cm cerebellar mass that was successfully resected. Its pathology was adenocarcinoma. Given his [...]
Case Presentation: A 59‐year‐old man with psoriatic arthritis, type 2 diabetes, and HIV presented with uncontrolled diabetes. His blood glucose level was 567 mg/dL. His diabetes had been previously well controlled with glimepiride 2 mg [...]
Case Presentation: A 72‐year‐old man was admitted with a 2‐day history ot lever, chills, headache, myalgias, diarrhea, and confusion. On admission, he developed respiratoryfailure and rapid atrial fibrillalion requiring intubation, and he was admitted to [...]
Case Presentation: A 55‐year‐old female with history of hypertension, hypothyroidism, and osteopenia presented with altered mental status for 4 days. She was found to have confusion, anorexia, abdominal pain, and generalized weakness. Family members reported [...]
Case Presentation: A 26‐year‐old previously healthy woman presented to the emergency department with a 1‐month history of fatigue, nausea, vomiting, and a 25‐pound weight loss. At the emergency department, she was hypotensive and tachycardic. The [...]
Case Presentation: Three previously healthy premenopausal women with negative past medical history presented with chest pain. The patients had positive biochemical cardiac markers and ECG changes showing acute cardiac injury. An emergent cardiac catheterization was [...]
Case Presentation: A 64‐year‐old woman presented with 1 day of worsening dizziness, nausea, and vomiting. She denied abdominal pain, chest pain, or shortness of breath. Past medical history was notable for cerebrovascular disease with TIA, [...]
Background: It is a common practice to measure troponin in hospitalized patients with AF/RVR. Tachyarrhythmia has been associated with leakage of troponins. Minor troponin leak with AF/RVR with chronic kidney disease (CKD) and congestive heart [...]
Case Presentation: A 36‐year‐old white woman presented to the emergency department with 1 day of hematochezia, crampy abdominal pain, and diarrhea. She denied recent travel, antibiotics, or sick contacts. She was a nonsmoker, without cardiovascular [...]
Case Presentation: This is a 26‐year‐old white male who presented to the emergency department with chest pain for 4 days. He described the pain as dull, achy, and located over the left chest. The pain [...]