To learn more about this meeting, visit hospitalmedicine2013.org

HM2013 Abstract Number: 530

Direct Admit System for Hospitals (Dash): Improving the Direct Admission Process Using Technology

Background: Many outpatient clinicians find obtaining a direct admission for the stable ill patient into the hospital difficult and time consuming; they instead send the patient to the ED, where critical time is lost and [...]

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HM2013 Abstract Number: 1

Exploring Intrateam Handoffs

Background: Inpatient continuity is difficult to achieve as house‐staff work‐hour limitations result in more frequent handoffs. Although research on handoffs between teams has been done, little information exists on handoffs within the same team. Our [...]

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HM2013 Abstract Number: 529

Culture Change in Infection Control: Applying Psychological Principles to Improve Hand Hygiene

Background: The CDC reports hospital adherence to hand hygiene is abysmal, with observational studies finding rates of 5%–81% and an overall average of only 40%. Psychological principles are rarely explicitly utilized in studies on reducing [...]

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HM2013 Abstract Number: 517

Medical Malpractice: Causes and Outcomes of Claims Against Hospitalists

Background: Information on the types and causes of medical malpractice claims may help to reduce legal malpractice risk and inform patient safety efforts. Research has shown that the most common medical malpractice allegations include missed [...]

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HM2013 Abstract Number: 518

National Quality of Care and Outcomes for In‐Hospital Ischemic Stroke: Severe Strokes, Frequent Comorbidities, and Room for Improvement

Background: In‐hospital strokes have distinctive risk factors compared with community‐onset strokes. Analysis of in‐hospital stroke quality of care and outcomes has never been performed at the national level. Methods: We conducted a retrospective cohort study [...]

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HM2013 Abstract Number: 516

Overutilization and Defensive Medicine in U.S. Hospitals: A Randomized National Survey of Hospitalists

Background: Defensive medicine is an unwanted side effect of the medical liability system that happens when physicians order clinically unnecessary treatment or diagnostic procedures to reduce medical liability risk. As a result, defensive medicine not [...]

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HM2013 Abstract Number: 528

Developing Hospitalist Leaders: The Hospitalist Training Program Leaders Track

Background: Hospitalists are increasingly taking on leadership roles in hospitals, health systems, and hospital medicine groups. As more hospitalists pursue careers as leaders in medicine, development of relevant knowledge, skills, and attitudes should be incorporated [...]

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HM2013 Abstract Number: 515

Comprehensive Care Physician/primary Care Hospitalist Cmmi Innovation Challenge Award

Background: Hospital medicine physicians may provide advantages in inpatient care compared with traditional ambulatory‐based primary care physicians (PCPs) because of hospitalists' greater focus and experience in inpatient care. However, hospitalists have disadvantages in inpatient care [...]

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HM2013 Abstract Number: 514

The Use of Individualized Dashboards and Pay‐for‐Performance to Improve Venous Thromboembolism Prophylaxis Compliance by Hospitalists

Background: Venous thromboembolism (VTE) accounts for more than 100,000 deaths per year and costs the health care system about $15,000 per event. Methods to increase appropriate prophylaxis have included computerized physician order entry (CPOE) with [...]

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HM2013 Abstract Number: 512

Creutzfeldt–Jakob Disease: A Case Presentation and Literature Review

Case Presentation: A 59‐year‐old otherwise healthy man initially developed mood changes 6 months prior to admission. Over the ensuing months, the patient developed decreased executive cognitive function and was noted to have difficulty walking. These [...]

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HM2013 Abstract Number: 510

A Rare Case of Isolated Spontaneous Myonecrosis

Case Presentation: We present a 65‐year‐old white woman with a history of long‐standing diabetes mellitus complicated by retinopathy, hypertension, coronary artery disease with prior placement of drug‐eluting stents, and chronic systolic heart failure. During a [...]

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HM2013 Abstract Number: 511

Septris: Improving Sepsis Recognition and Management Through a Mobile Educational Game

Background: Sepsis is common, deadly, and costly. More than 13 million people worldwide have sepsis each year, and the expected mortality can be as high as 25%–50%. In the United States the annual incidence is [...]

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HM2013 Abstract Number: 508

Vinegar Causing Chemical Pneumonitis and Subsequent Broken Heart: A Rare Case of Accidental Vinegar Inhalation, Resulting in Takotsubo Cardiomyopathy

Case Presentation: A 77‐year‐old woman with a history of controlled hypertension was doing a daily sinus treatment at home when she accidentally used distilled vinegar instead of distilled water. She began the sinus rinse and [...]

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HM2013 Abstract Number: 509

A Rare Cause of Cauda Equina Syndrome

Case Presentation: A 65‐year‐old man presented with left hip pain. He described frequent falls at home over several weeks with associated left hip pain and leg weakness. He insisted that his symptoms were due to [...]

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HM2013 Abstract Number: 506

Septic Arthritis of the Sternoclavicular Joint in an Intravenous Drug User

Case Presentation: Septic arthritis of the sternoclavicular joint (SCJ) comprises fewer than 1% of all cases of septic arthritis. Risk factors are diabetes mellitus, subclavian venous catheterization, intravenous drug use (IVDU), cirrhosis, and rheumatoid arthritis. [...]

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HM2013 Abstract Number: 507

Thirty‐One‐Year‐Old Man with Hookworm Infection and Complicated Treatment

Case Presentation: This is a 31‐year‐old man with no significant medical history who presented with 2 weeks of progressive lower abdominal pain, nausea, and anorexia. The patient otherwise denied fevers, chills, chest pain, shortness of [...]

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HM2013 Abstract Number: 504

A Rare Case of Herpes Zoster of Maxillary Branch of Trigeminal Nerve (V2)

Case Presentation: A 72‐year‐old man with a medical history of hypertension and hypothyroidism presented to a tertiary‐care center complaining of painless ulcers on his hard palate and a vesicular facial rash that started on the [...]

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HM2013 Abstract Number: 505

Hyperammonemic Encephalopathy in Multiple Myeloma

Case Presentation: A 70‐year‐old woman with progressive stage 3A IgA kappa multiple myeloma presented with a 4‐month history of intermittent delirium and multiple falls. Prior to her hospitalization, she received empiric treatment for a urinary [...]

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HM2013 Abstract Number: 502

Rash, Eosinphilia, and Renal Failure in a 40‐Year‐Old Man

Case Presentation: A 40‐year‐old man with a history of alcoholic cirrhosis and epilepsy was admitted with a progressive rash and acute kidney injury. Due to suboptimal seizure control, carbamazepine had been recently added to his [...]

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HM2013 Abstract Number: 503

Septic Shock in a Psychiatric Patient Is Not Always Just Infection

Case Presentation: It is quite challenging to obtain a proper medical history in a patient admitted to a psychiatric unit. At times, the diagnosis in these patients is made purely based on the imaging studies [...]

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HM2013 Abstract Number: 500

Iatrogenic Aortic Dissection — a Rare but Lethal Complication of Cardiac Catheterization. Series Case Report

Case Presentation: We present 2 case reports, within a 1‐year period, of patients with no underlying aortic dissection, presenting with complaints mandating cardiac catheterization that culminated into aortic dissection. A 48‐year‐old man with a history [...]

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HM2013 Abstract Number: 501

Obstructing Renal Calculi Masking an Epidural Abscess: A Rare Presentation

Case Presentation: A 65‐year‐old woman with a history of mild lumbar spinal stenosis and osteoarthritis came to the emergency room with a 4‐day complaint of progressively worsening back pain radiating to the abdomen. She suffered [...]

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HM2013 Abstract Number: 498

Cerebral Venous Thrombosis in Sickle Cell Trait — a Rare Entity

Case Presentation: Cerebral venous thrombosis is a rare type of cerebrovascular disease affecting about 5 people per million and accounts for 0.5% of all strokes. It is a challenging condition because of the variability of [...]

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HM2013 Abstract Number: 499

Clot Begets a Clot: Pfo As a Gateway to Paradoxical Arterial Embolism

Case Presentation: In patients with pulmonary embolism, patent foramen ovale (PFO) is associated with increased prevalence of silent brain infarcts (SBI). PFOs have been studied in patients with cryptogenic stroke with an increased likelihood of [...]

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HM2013 Abstract Number: 496

Laboratory Abnormalities As a Clue to Hypertriglyceridemic Pancreatitis

Case Presentation: A 24‐year‐old woman without chronic medical comorbidity presented with acute‐onset epigastric abdominal pain radiating to her back after a meal at a fast‐food restaurant. The patient had never experienced similar symptoms, but other [...]

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HM2013 Abstract Number: 497

The Importance of In‐Person Review of Imaging Test Results

Case Presentation: A 47‐year‐old Hispanic man with active intravenous heroin abuse presented with 2‐3 weeks of severe (“11”/10) chest discomfort. The pain was described as constant, though the severity waxed and waned, and located substernally [...]

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HM2013 Abstract Number: 494

Tricuspid Regurgitation Following Implantable Cardiac Defibrillator (Icd) Lead Extraction

Case Presentation: The major cardiac complications associated with lead extraction are cardiac and superior vena cava perforation. There are few reports of tricuspid regurgitation (TR) as a complication of extraction of chronically implanted leads. Most [...]

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HM2013 Abstract Number: 495

A Bleed and a Clot

Case Presentation: A 44‐year‐old white woman with no medical history presented with massive ascites that progressed over the last 6 months. Patient denied any history of alcohol use, blood transfusion, IV drug abuse, or hepatitis. [...]

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HM2013 Abstract Number: 492

Dengue Fever: A History‐Taking Lesson

Case Presentation: A 56‐year‐old man presented to our emergency department with a 4‐day history of fevers, myalgias, nausea, vomiting, and diarrhea. He had recently returned from a trip to Mumbai, India for which he had [...]

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HM2013 Abstract Number: 493

Acute Aseptic Meningitis Associated with Herpes Zoster Reactivation in an Immunocompetent Adult

Case Presentation: A 61‐year‐old woman with a history of hypertension and neurofibromatosis type 2 with chronic occipital headaches, presented to the emergency department with a 3‐day course of frontal headache and a painful rash on [...]

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HM2013 Abstract Number: 490

Clostridium Difficile–Associated Diarrhea and Disseminated Salmonella Coinfection: A Case Report from a Tertiary Cancer Hospital

Case Presentation: A 42‐year‐old woman with metastatic colon cancer presented from home to a tertiary cancer hospital's triage center with complaints of fevers up to 102°F, nausea with abdominal pain, new‐onset watery diarrhea and worsening [...]

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HM2013 Abstract Number: 491

Tremors After Coronary Artery Bypass Graft Surgery: A Case of Parkinsonism Following Heart Surgery

Case Presentation: This 67‐year‐old white male patient with a medical history of diabetes mellitus type 2, hypertension, dyslipidemia, coronary artery disease, and congestive heart failure (EF 20%) presented to the hospital with decompensated heart failure. [...]

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HM2013 Abstract Number: 488

First Do No Harm: Corticosteroids and Recurrent Pericarditis

Case Presentation: A 43‐year‐old man without any medical history presented to an urgent care clinic with cough, subjective fever, and wheezing. He was diagnosed with acute bronchitis and given a tapering dose of prednisone 60 [...]

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HM2013 Abstract Number: 489

Infectious Complications from Antithymocyte Globulin Outside the Peritransplant Period

Case Presentation: A 56‐year‐old man with treatment‐refractory aplastic anemia, secondary hemochromatosis, and a renal transplant in 1980 was admitted for fever and a positive blood culture. The patient had completed two weeks prior a course [...]

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HM2013 Abstract Number: 486

Eighteen‐Year‐Old Man with Neurofibromatosis and Hypertension

Case Presentation: An 18‐year‐old man with neurofibromatosis‐1 was admitted after surgery to correct a right cavus foot deformity and was noted to have postoperative hypertension. He was found to have systolic blood pressures above the [...]

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HM2013 Abstract Number: 487

A New Twist on Pancreatitis

Case Presentation: A 64‐year‐old woman with a history of Nissen fundoplication for gastroesophageal reflux disease presented with periumbilical abdominal pain that radiated to her back. The pain was associated with nausea. On physical exam she [...]

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HM2013 Abstract Number: 484

Painful Thigh — Are We Missing the Diagnosis?

Case Presentation: A 58‐year‐old white man with no significant medical history presented to the clinic with chief complaint of bilateral thigh pain of 4 weeks' duration. Pain was 10/10 constant, nonradiating, aggravated by walking, no [...]

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HM2013 Abstract Number: 485

Renal Infarcts: A Case Report and Literature Review

Case Presentation: A 73‐year‐old Hispanic woman with hypertension, atrial fibrillation, and a recent embolic stroke had acute onset of diffuse abdominal pain while cooking breakfast. This severe pain was exacerbated by movement, temporarily relieved by [...]

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HM2013 Abstract Number: 482

Acute Renal Failure in a Young Healthy Male

Case Presentation: A 20‐year‐old healthy man with no significant medical history presented to the emergency department with multiple episodes of watery, bilious, nonbloody vomiting associated with nausea and poor oral intake for 3 days. He [...]

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HM2013 Abstract Number: 483

Readdressing Vancomycin: A Case Study

Case Presentation: A 41‐year‐old man with a medical history significant for chronic osteomyelitis presented with generalized rash, high fever, scattered myalgias, and nonspecific right lower quadrant abdominal pain of two days duration. The rash was [...]

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HM2013 Abstract Number: 480

Bradycardia and HIV Screening

Case Presentation: A 52‐year‐old male patient without any medical history presented to the hospital with dizziness of 2 weeks' duration. He was afebrile, with blood pressure 140/80, respiratory rate 14, and pulse rate 35. Cardiac [...]

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HM2013 Abstract Number: 481

Sulfasalazine‐Induced Pulmonary Disease: A Case Report and Review of the Literature

Case Presentation: This is a 66‐year‐old woman with no diagnoses of any pulmonary diseases or any occupational exposures but with ulcerative colitis diagnosed 9 months prior to admission for which she was started on sulfasalazine, [...]

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HM2013 Abstract Number: 478

Infectious Endocarditis in Children: One Institution's Analysis

Case Presentation: Infectious endocarditis (IE) is a serious and sometimes fatal illness that affects very few children. It is typically seen in patients with underlying medical conditions, especially heart defects or indwelling central venous catheters [...]

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HM2013 Abstract Number: 479

A Rare Case of Upper Gastrointestinal Bleeding

Case Presentation: A 44‐year‐old woman with history of hypertension and GERD presented to the emergency department with dyspnea. Initial findings included hypothermia (36.3°C), hypotension (97/43), tachypnea (respiratory rate 28), and hypoxemia (oxygen saturation 90% on [...]

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HM2013 Abstract Number: 476

Antiphospholipid Antibody Syndrome with Severe Thrombocytopenia: A Conundrum in Anticoagulation

Case Presentation: A 30‐year old woman presented to the emergency department with chest discomfort and shortness of breath along with heavy menstrual bleeding for 3 days. She noted a history of 2 late first (?) [...]

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HM2013 Abstract Number: 477

An Unfortunate Case of Aortoesophageal Fistula with Herald Symptoms

Case Presentation: Aortoesophageal fistula is a rare but life‐threatening complication after surgical aortic repair and should be considered in patients with history of aortic graft placement who complains of unexplained gastrointestinal bleeding. The mortality rate [...]

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HM2013 Abstract Number: 474

When Superior Vena Cava (Svc) Syndrome Goes “Downhill”

Case Presentation: A 36‐year‐old man was seen for preoperative assessment before wound debridement. His history included sickle cell disease previously complicated by superior vena cava (SVC) syndrome, which required surgical jugular‐vein‐to‐right‐atrium bypass grafts. He denied [...]

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HM2013 Abstract Number: 475

Eosinophilic Pneumonia: An Important Adverse Reaction of Daptomycin

Case Presentation: A 65‐year‐old man with a medical history of hypertension, tobacco use, a recent L3–L5 laminectomy, and posterior spinal fusion was hospitalized with fever, dyspnea, and pleuritic chest pain of 2 days' duration. A [...]

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HM2013 Abstract Number: 472

The Role of Epstein–Barr Virus in Exudative Pleural Effusion

Case Presentation: A large number of exudative pleural effusions remain unexplained despite an intensive diagnostic workup. Epstein–Barr virus infections occur worldwide and affect majority of the population. A 50‐year‐old man was admitted with left‐sided anterior [...]

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HM2013 Abstract Number: 473

Vancomycin and Linear Iga Bullous Dermatosis

Case Presentation: Linear IgA bullous dermatosis is a rare autoimmune blistering disorder. Most cases are idiopathic but medications, infections and malignancies have also been reported. Although a variety of medications have been implicated in drug‐induced [...]

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HM2013 Abstract Number: 470

Acute Ebv Infection and HIV Antibody Cross‐Reactivity

Case Presentation: A 22‐year‐old sexually active female college student without chronic medical comorbidity presented with two weeks of fever, sore throat, malaise and fatigue. She subsequently developed jaundice and sought further evaluation. On admission, examination [...]

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HM2013 Abstract Number: 471

Can Weight Loss Be the Cause of Acquired Hemophilia A?

Case Presentation: A 62‐year‐old woman presented with severe left lower leg pain and swelling of 3 days' duration with diffuse ecchymoses for 6 months. She denied bleeding disorder or trauma. She admitted that due to [...]

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HM2013 Abstract Number: 468

A Weak Diagnosis: Thyrotoxicosis with a Twist

Case Presentation: A 37‐year‐old woman presented with complaint of 2 days of severe generalized muscle weakness. The weakness was described as more proximal rather than distal. She reported associated palpitations, diarrhea, and heat intolerance. She [...]

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HM2013 Abstract Number: 469

Aseptic Meningitis: Think Outside the Brain

Case Presentation: A 63‐year‐old man with no medical history presented with headache (HA) for 2 months. A week after his HA started, he had a normal CT of head. His HA worsened over next 2 [...]

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HM2013 Abstract Number: 466

Beware Postoperative Fever

Case Presentation: A 56‐year‐old woman with hypothyroidism and recurrent laryngeal squamous cell carcinoma underwent an uncomplicated total laryngectomy, modified neck dissection, and subtotal thyroidectomy. On postoperative day 10, she developed sudden‐onset abdominal pain, nausea, and [...]

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HM2013 Abstract Number: 467

Diagnosis and Management of Infectious Mononucleosis‐Like Syndrome Presenting As Toxoplasmosis Infection

Case Presentation: A 25‐year‐old white man presented with a fever of 100.4°F, pharyngeal erythema lymphadenopathy, and flu‐like symptoms. Laboratory evaluations revealed lymphocytosis, monocytosis, neutropenia, and abnormal liver enzymes. Given his clinical picture and these laboratory [...]

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HM2013 Abstract Number: 464

A Rare Cause of Upper Gastrointestinal Bleeding

Case Presentation: A 56‐year‐old woman presented with severe abdominal pain, nausea, vomiting, fever, and hypotension. Admission laboratory tests were significant for serum amylase 420 IU/L (17–95 IU/L) and serum lipase 292 IU/L (12–84 IU/L). Computed [...]

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HM2013 Abstract Number: 465

A Rare Cause of Obstructive Jaundice

Case Presentation: A 62‐year‐old woman with a history of stage IIB squamous cell carcinoma of the cervix was treated with total abdominal hysterectomy–bilateral salpingo‐oophorectomy and chemoradiotherapy in 2003. In September 2011 the patient presented to [...]

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HM2013 Abstract Number: 462

Recurrence of Kawasaki Disease

Case Presentation: A 3‐year‐old Hispanic male was hospitalized for fever and cervical lymphadenopathy. He was treated with antibiotics for suspected lymphadenitis but showed minimal improvement. He was eventually diagnosed with Kawasaki disease based on physical [...]

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HM2013 Abstract Number: 463

From One Sinus to Another

Case Presentation: A 19‐year‐old female with a history of juvenile rheumatoid arthritis on immunosuppressants presented with 3 days of fevers, flank pain, and headaches. Two weeks prior, she was treated with penicillin because of a [...]

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HM2013 Abstract Number: 460

Lumbosacral Osteomyelitis Caused by Candida Krusei: A Case Report

Case Presentation: A 54‐year‐old African American woman with a history of hypertension and intravenous drug abuse presented to the emergency room with a 2‐month history of lower back pain and new onset right lower leg [...]

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HM2013 Abstract Number: 461

You Found My Kidney in My Intestines?

Case Presentation: The patient is a 52 year‐old man with a history of alcohol abuse, occasional cocaine use, and recent NSAID use who presents with symptomatic anemia. Two days prior to admission he presented to [...]

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HM2013 Abstract Number: 458

Pancolitis and Near‐Total Colonic Occlusion — a Complicated Infection!!

Case Presentation: A 53‐year‐old woman with a history of HIV, chronic obstructive pulmonary disease was admitted for diffuse abdominal pain. She had profound diarrhea of 2 days. Eight weeks ago, she was treated for pneumonia [...]

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HM2013 Abstract Number: 459

Not Just Another Cause of Confusion — a Rare Case of Steroid‐Responsive Encephalopathy

Case Presentation: A 76‐year‐old white man with a medical history of Hashimoto's thyroiditis, atrial fibrillation, coronary artery disease and hypertension presented to the emergency department with clouding of consciousness for 1 day. His vital signs [...]

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HM2013 Abstract Number: 456

Communicating Hydrocephalus Complicating Cryptococcal Meningitis Presenting with Unusually High Cerebrospinal Fluid Protein

Case Presentation: A 52‐year‐old Hispanic woman presented with bilious vomiting of 1 day's duration. It was associated with worsening headache and weight loss of one‐month duration. She denied other systemic symptoms. She was being managed [...]

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HM2013 Abstract Number: 457

Left Ventricular Noncompaction Cardiomyopathy: “Spongy Heart”

Case Presentation: A 59‐year‐old man with a history of hypertension, hyperlipidemia, and type II diabetes mellitus presented with chest tightness, palpitations, and dizziness. He has a family history of premature coronary disease and sudden death. [...]

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HM2013 Abstract Number: 454

Clozapine‐Associated Mitral Valve Chordae Rupture

Case Presentation: A 67‐year‐old man with long‐standing bipolar disorder presented with acute psychosis. Two weeks after initiation of clozapine, the patient began to experience lethargy, vomiting, diarrhea, low‐grade fevers, and tachycardia. Physical exam revealed a [...]

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HM2013 Abstract Number: 455

The Sister Mary Joseph Nodule As Presentation of Advanced Malignant Peritoneal Mesothelioma

Case Presentation: A 63‐year‐old Puerto Rican man with a history of benign prostatic hyperplasia, hypertension, and chronic kidney disease presented with sudden onset of difficulty urinating and high blood pressure. On the day of presentation, [...]

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HM2013 Abstract Number: 452

Biopsy‐Proven Cirrhosis with a Third Heart Sound — a Common Presentation of Constrictive Pericarditis

Case Presentation: A 48‐year‐old man with history of hypertension, hyperlipidemia, congestive obstructive pulmonary disease, heart failure with preserved ejection fraction, and cirrhosis presented complaining of progressive shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea, slowly [...]

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HM2013 Abstract Number: 453

Recurrent Aspiration As a Complication of Gastric Banding

Case Presentation: A 42‐year‐old woman with multiple sclerosis presented with cough, fever, and malaise. The patient had been admitted 2 weeks prior with similar symptoms; she was given a diagnosis of community‐acquired pneumonia and discharged [...]

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HM2013 Abstract Number: 450

Another Differential for Wide QRS Complex

Case Presentation: A 74‐year‐old woman with a medical history of chronic obstructive pulmonary disease (COPD), hypertension, and paroxysmal atrial fibrillation presented to the preoperative clinic for optimization prior to her right hip replacement surgery. She [...]

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HM2013 Abstract Number: 451

Diabetes Insipidus As the Presenting Manifestation of a Rare Pituitary Disorder

Case Presentation: A 47‐year‐old man with a history of stroke presented after a fall without loss of consciousness. He reported increased thirst and urination as well as headaches without vision changes. Vital signs including orthostatics [...]

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HM2013 Abstract Number: 448

A “Pseudo”‐Pseudotumor

Case Presentation: A 62‐year‐old man with diabetes and recent subdural hematoma presented from another hospital with lethargy. At transfer, he was afebrile, hypertensive, disoriented to time and place but able to follow instructions. He had [...]

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HM2013 Abstract Number: 449

Erythema Multiforme “Walks” in

Case Presentation: A 64‐year‐old woman with a medical history of asthma, chronic obstructive pulmonary disease, and hypertension presented with painful swelling of the lips, tongue, and neck. She had been suffering from several weeks of [...]

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HM2013 Abstract Number: 446

Repeated Episodes of Neurological Symptoms and Severe Hypocalcemia, Thinking Beyond the Usual Causes

Case Presentation: A 61‐year‐old white man with a history of hypoparathyroidism, recently diagnosed ventricular septal defect, right aortic arch, atrial fibrillation, personality disorder, and seizure due to hypocalcemia presented to us with confusion, irritability, and [...]

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HM2013 Abstract Number: 447

Campylobacter and Pericarditis in the Setting of Common Variable Immunodeficiency: A Case Report

Case Presentation: A 46‐year‐old man presented with a weeklong history of abdominal cramps and sharp, substernal chest pain, with associated fevers up to 39.4°C, chills, and fatigue. On presentation, a CT of the abdomen and [...]

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HM2013 Abstract Number: 444

Twilight Trilogy: A Series of 3 Blood‐Letting Gi Bleeds

Case Presentation: During the past 8 months, we have had 3 patients with factitious GI bleeds. This is one case. Mrs. K. was a 36‐year‐old woman with a history of gastric bypass with a complicated [...]

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HM2013 Abstract Number: 445

Cut Loose the Anchor: In Search of the Life Aquatic

Case Presentation: A 30‐year‐old man with depression and alcohol abuse presented with a 4‐day history of vomiting, productive cough, dyspnea, pleuritic chest pain, and intermittent fevers. His family noted slurred speech, confusion, and auditory and [...]

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HM2013 Abstract Number: 442

Just a Coincidence? — a Rare Cause of Fatal Bleeding

Case Presentation: A 78‐year‐old white man presented with back and groin pain for a week. He was diagnosed with deep vein thrombosis 2 weeks prior to admission and was started with warfarin with therapeutic enoxaparin. [...]

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HM2013 Abstract Number: 443

The Diagnostic Dilemma in Fever of Unknown Origin

Case Presentation: A previously healthy 49‐year old woman presented for admission after a syncopal episode. She had a 4‐ month history of fever (104°F), sweats, rigors, 40‐pound weight loss, and abdominal pain associated with alternating [...]

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HM2013 Abstract Number: 440

Aortoesophageal Fistula As a Rare Cause of Chest Pain

Case Presentation: A 47‐year‐old Hispanic man with active intravenous heroin abuse presented with 2–3 weeks of severe (“11”/10) chest discomfort. The pain was described as constant, though the severity waxed and waned, and located substernally [...]

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HM2013 Abstract Number: 441

Helicobacter Pylori As a Possible Precipitant of Immune Thrombocytopenia Purpura

Case Presentation: A 28‐year‐old previously healthy Hispanic man presented for evaluation of bleeding gums and rash. Four days prior he noted mild fatigue, cough, headache, and subjective fever consistent with an upper respiratory tract infection. [...]

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HM2013 Abstract Number: 438

Upper Lobe Lung Cavities — Is Tb Always First in the Differential?

Case Presentation: A 44‐year‐old Vietnamese man with HIV presented with a cavitary pneumonitis after 1 week of subjective fever, nonproductive cough, 3‐ to 4‐pound weight loss, and 2 days of azithromycin therapy from his primary [...]

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HM2013 Abstract Number: 439

Death and Grief on an Inpatient Medical Team

Case Presentation: A lovely 56‐year‐old woman was admitted with ongoing issues pertaining to a recently diagnosed lower‐extremity deep vein thrombosis (DVT). She was originally diagnosed with heparin‐induced thrombocytopenia, but re‐presented with a new DVT despite [...]

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HM2013 Abstract Number: 436

Angiotensin‐Converting Enzyme Inhibitor–Induced Intestinal Angioedema: Rare Adverse Effect of a Common Drug

Case Presentation: The author reports a 50‐year‐old white female patient with a history of long‐standing, quiescent Crohn's disease who presented to the emergency department with a 1‐day history of severe abdominal pain, nausea, and vomiting. [...]

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HM2013 Abstract Number: 437

Acquired Hepatocerebral Degeneration: Case Report and Literature Review

Case Presentation: A 55‐year‐old woman with cirrhosis due to hepatitis C and hepatocellular carcinoma presented with 6 months of progressive cognitive impairment and gait imbalance despite treatment for hepatic encephalopathy. On exam, she was easily [...]

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HM2013 Abstract Number: 434

Invisible Hacek Endocarditis of Native Valves

Case Presentation: A 43‐year‐old man presented with 5 days of fever. The patient's history began in childhood when he was told he had a heart murmur. He was in his usual state of good health [...]

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HM2013 Abstract Number: 435

“Tips” for Avoiding Cavernous Sinus Thrombosis

Case Presentation: A 45‐year‐old man with no medical history presented for evaluation with 2 weeks of left eye swelling, double vision, headaches, and right‐sided neck pain. Review of systems was notable for fever and night [...]

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HM2013 Abstract Number: 432

Gemcitabine‐Induced Thrombotic Microangiopathy (Tma) in Pancreatic Cancer

Case Presentation: A 71‐year‐old woman with a medical history significant for hypercholesterolemia and COPD presented to the hospital with dyspnea and bilateral lower‐extremity edema for a few days. She was recently diagnosed with stage I [...]

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HM2013 Abstract Number: 433

When Eczema Changes

Case Presentation: A 5‐month‐old female with worsening skin rash for 2 months was admitted for evaluation. The rash began as generalized flesh colored papules on the upper chest and antecubital fossae. Initially, the patient was [...]

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HM2013 Abstract Number: 430

Catastrophic Hypereosinophilic Syndrome with Eosinophilic Cystitis: A Rare Association and Challenges in Treatment

Case Presentation: A 56‐year old previously healthy woman presented with 1‐month history of a pruritic ulcerated rash in both lower extremities associated with dysuria and intermittent chest pains. On presentation, the patient was hypotensive with [...]

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HM2013 Abstract Number: 431

Septic Arthritis of the Pubic Symphysis in a Young Athlete: Commonly Misdiagnosed

Case Presentation: Septic arthritis of the pubic symphysis is a rare condition that can affect healthy young athletes or women who have undergone a urologic or gynecologic surgery. It is usually misdiagnosed with osteitis pubis, [...]

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HM2013 Abstract Number: 428

A Rare Case of Disseminated Gonococcal Endocarditis

Case Presentation: A 23‐year‐old Asian female health care technician presented to the emergency department with left wrist pain, painful rash, fever, and occasional shortness of breath. She denied dysuria, vaginal discharge, sore throat, insect or [...]

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HM2013 Abstract Number: 429

Taking It from the Top — a Case of Apical Hypertrophic Cardiomyopathy

Case Presentation: A 30‐year‐old man originally from New Guinea presented to the hospital with two hours of palpitations associated with lightheadedness and diaphoresis. He had a similar presentation 10 years prior and was told there [...]

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HM2013 Abstract Number: 426

Systemic Mastocytosis — an Introduction to a Rare Hematological Disorder Requiring Careful Diagnostic Planning

Case Presentation: A 66‐year‐old man without any medical history presented with fatigue, weight loss, and generalized abdominal pain for 3 months. Physical exam revealed splenomegaly. Labs disclosed hemoglobin of 8.0 g/dL and platelets of 79,000/μL. [...]

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HM2013 Abstract Number: 427

The Mysterious Lesions on My Ear After That Nightclub Experience!

Case Presentation: A 38‐year‐old man presented with complaints of left ear pain and black discoloration for 1 day. He denied any hearing loss, aural fullness, discharge, or fever. His medical history included a history of [...]

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HM2013 Abstract Number: 424

Nine Lives

Case Presentation: A 49‐year‐old presented with 4 days of fever (99.8°F) and sharp right upper quadrant abdominal pain. White blood cell count was 33,000/mm3 with 72% neutrophils and 13% bands. Blood cultures were sent and [...]

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HM2013 Abstract Number: 425

A Rare Cause of Cholestatic Jaundice, Biliary Stenosis, and Calculi by a Tropical Intestinal Nematode

Case Presentation: A 28‐year‐old Hispanic woman from Honduras with a medical history of cholecystectomy and choledochojejunostomy at the age of 18 years for gallstones presented with recurrent right upper quadrant (RUQ) pain and jaundice. On [...]

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HM2013 Abstract Number: 422

Bilateral Complicated Otitis Media in a Young Marine Returning from Overseas

Case Presentation: This is a 35‐year‐old man who presented with fever and left‐sided ear pain for 1 week. He developed symptoms of right‐sided ear pain 6 months prior to admission while stationed in Korea as [...]

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HM2013 Abstract Number: 423

Warm Autoimmune Hemolytic Anemia As a Herald of Hiv‐1 Infection

Case Presentation: A 32‐year‐old West African man with a history of malaria presented to the ER with dizziness, severe fatigue, palpitations, and dyspnea on exertion. On initial assessment, he was found to have sublingual icterus, [...]

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HM2013 Abstract Number: 420

Bilateral Supernumerary Kidneys: How Much Is Too Much?

Case Presentation: A 58‐year‐old woman presented to our emergency room with low back pain and malaise to the point of being unable to perform activities of daily living for 1 week. She has a medical [...]

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HM2013 Abstract Number: 421

A Confusing Case of Chemotherapy Toxicity

Case Presentation: A 70‐year‐old man with biliary cancer was treated with a 5‐fluorouracil (5‐FU)–containing regimen. Three days after his first cycle, the patient presented with chemotherapy‐induced nausea and vomiting. Over the next week, he developed [...]

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HM2013 Abstract Number: 418

Magic Syndrome with Vision‐Threatening Keratitis

Case Presentation: A 24‐year‐old white man presented to our hospital with ulcerative skin lesions and scleritis. He had a history of relapsing polychondritis (RP) that was diagnosed 3 years back and was well controlled for [...]

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HM2013 Abstract Number: 419

Its All in the Rash: The Association of Parvovirus B‐19 and Type 1 Cryoglobulinemia

Case Presentation: A 62‐year‐old man with a history of exposure to his grandchild diagnosed with erythema infectiosum presented with a 1‐week history of fever, polyarthralgias, and myalgias. Evaluation revealed a platelet count of 68,000 and [...]

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HM2013 Abstract Number: 416

Smoking Mirrors: Shift to the Left?

Case Presentation: A 48‐year‐old woman with systemic sclerosis and secondary interstitial lung disease on 4–6 L/minute oxygen per nasal cannula at baseline presented to the emergency department with 2 days of new onset nonproductive cough, [...]

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HM2013 Abstract Number: 417

Dyspnea, Wheezes, and Cough: Not Always the Usual Suspect

Case Presentation: This is a 53‐year‐old woman with a history of asthma since childhood. Over the course of a year her dyspnea and wheezing worsened, severely limiting her functional status. She was treated with multiple [...]

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HM2013 Abstract Number: 414

Something Fishy in Dixie

Case Presentation: A 36‐year‐old man with no known medical history presented to a Georgia hospital after returning from a fishing trip to Florida complaining of severe watery diarrhea, perioral paresthesias, intense pruritis, dizziness, and chest [...]

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HM2013 Abstract Number: 415

A Rare and Unusual Cause of Syncope

Case Presentation: A 63‐year‐old man with a history of locally advanced (T4 — deep muscle invasion, N2b — multiple ipsilateral neck lymph nodes, M0), left‐sided base‐of‐tongue squamous cell cancer presented to the emergency room with [...]

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HM2013 Abstract Number: 412

Drugs Smarter Than the Bugs: Mirtazapine and Mefloquine for Non‐Aids‐Related Progressive Multifocal Leukoencephalopathy

Case Presentation: A 77‐year‐old man with chronic lymphocytic leukemia (CLL) and hypogammaglobulinemia was hospitalized for generalized seizures. Three weeks prior to admission he was found to have progressive psychomotor slowing. Head CT revealed an area [...]

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HM2013 Abstract Number: 413

You Can't Handl the Truth: Another Cause of Headache with Neurologic Deficits

Case Presentation: A 17‐year‐old boy presented with a 1‐week history of headache, confusion, and weakness. The headache was initially localized behind his left eye and was associated with emesis. He was given a prescription for [...]

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HM2013 Abstract Number: 410

Prepatellar Bursitis Due to Brucella Melitensis

Case Presentation: This is a 17‐year old Kuwaiti man without significant medical history, who presented to the emergency department (ED) of a tertiary‐care medical center in the United States after 1 week of fevers and [...]

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HM2013 Abstract Number: 411

Chronic Diarrhea in a Vietnam War Veteran

Case Presentation: A 63‐year‐old male Vietnam War veteran noted a 6‐month history of watery diarrhea; he was admitted for volume depletion. The patient had been in Vietnam for 1 year in 1970; there were no [...]

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HM2013 Abstract Number: 408

Acid‐Fast Foot

Case Presentation: A 57‐year‐old HIV‐negative Filipino man with a history of cerebrovascular accident, anemia, hypothyroidism, dyslipidemia, hypertension, gout, and chronic kidney disease was found to have EKG changes during presurgical screening for dialysis catheter placement. [...]

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HM2013 Abstract Number: 409

Presentation of Zinc Deficiency As a Perianal Ulcerative Rash in an Alcoholic Man

Case Presentation: A 54‐year‐old alcoholic homeless man was brought to the hospital by EMS after being found intoxicated on the street. Of interest, the patient used adult diapers in lieu of underwear while homeless. His [...]

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HM2013 Abstract Number: 406

Blame It on the Virus

Case Presentation: We describe a 59‐year‐old white man diagnosed with HIV for 16 years, noncompliant with antiretroviral therapy, who presented with combative behavior. Patient was complaining of fever, dry cough, and malaise for 2 days. [...]

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HM2013 Abstract Number: 407

Primary Hyperaldosteronism: More Common Than Our Expectations!

Case Presentation: This is a 36‐year‐old African American man who suffered from a 1‐year history of progressive decline in kidney function (lithium‐induced nephrotoxicity) leading to discontinuation of the lithium. However, during the hospital stay, he [...]

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HM2013 Abstract Number: 404

Life‐Changing Headache

Case Presentation: A 34‐year‐old Guatemalan man with unknown medical history presented with headache. He was seen in the ED 3weeks prior to admission with headache and nausea. He was discharged after physical examination (PE), neurological [...]

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HM2013 Abstract Number: 405

A Case of Emphysematous Gastritis: A Potentially Fatal Disease

Case Presentation: A 68‐year‐old man with known esophageal peptic stenosis, end‐stage renal disease, ischemic cardiomyopathy, severe peripheral vascular disease, and diabetes mellitus with gastroparesis presented to the emergency department with dull upper abdominal pain and [...]

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HM2013 Abstract Number: 402

Renal Failure: Another Potential Risk of Ppi Therapy

Case Presentation: A 64‐year‐old man with coronary artery disease, type 2 diabetes, and stage 3 chronic kidney disease (baseline creatinine, 1.7) was admitted for worsening renal failure noted routinely (creatinine 6.2, BUN 70). His only [...]

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HM2013 Abstract Number: 403

Brain Abscess Caused by Listeria Monocytogenes

Case Presentation: A 49‐year‐old man presents with acute‐onset fever and confusion for one day. He has a history of type 2 diabetes mellitus and polycythemia vera complicated by myelofibrosis, and he underwent bone marrow transplant [...]

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HM2013 Abstract Number: 400

The Advantage of a Simple Palpation

Case Presentation: A 30‐year‐old white woman was seen in the preoperative clinic for basic labs and cardiac risk assessment. She was healthy until 4 months prior, when she developed weakness and double vision, for which [...]

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HM2013 Abstract Number: 401

Orbital Immunoglobulin G4–Related Disease in a Diabetic Patient — a Case Presentation and Literature Review

Case Presentation: Mr. C. is a 56‐year‐old Korean man with a history of uncontrolled diabetes mellitus, hypertension, and alcohol and tobacco abuse for the past 30 years who presented with left eye swelling, itching, and [...]

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HM2013 Abstract Number: 398

Diabetic Ketoacidosis — Could Be a Pheochromocytoma!

Case Presentation: A 40‐year‐old man without any medical history presented to the emergency department with sudden onset of severe substernal chest pain. He described it as nonradiating, sharp, cramping, and constant. It was associated with [...]

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HM2013 Abstract Number: 399

Travel Trouble — Unexpected Finding

Case Presentation: A 29‐year old previously healthy white male patient presented with 1 day of shortness of breath, left‐sided pleuritic chest pain, cough, and hemoptysis. The patient had been on a trip a week prior [...]

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HM2013 Abstract Number: 396

Euglycemic Dka — Is It Rare or Frequently Missed?

Case Presentation: A 59‐year‐old Asian woman with a history of type 2 diabetes mellitus was brought to ED for confusion. She had multiple episodes of vomiting and diarrhea for 1 day. The Accu‐Chek on finger [...]

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HM2013 Abstract Number: 397

Derailing the Ex‐Lap Train: A 62‐Year‐Old Woman with Peritonitis After Colonoscopy

Case Presentation: A 62‐year‐old woman presented with the acute onset of severe abdominal pain of approximately 6 hours duration. Earlier that day, she had undergone a colonoscopy, during which one 18‐mm sessile polyp was removed. [...]

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HM2013 Abstract Number: 394

Hyponatremia Associated with Unilateral Hand Weakness and Numbness

Case Presentation: A 62‐year‐old male mechanic presented with a 3‐month history of worsening right hand numbness and weakness with difficulty operating machinery at work. He reported anorexia, unintentional weight loss of about 20 pounds over [...]

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HM2013 Abstract Number: 395

Takotsubo Cardiomyopathy in the Setting of Severe Hyperglycemia

Case Presentation: A 78‐year‐old African American woman with a medical history of hypertension, hypercholesterolemia, and type 2 diabetes was brought to ED with change in mental status. Patient was living by herself and the family [...]

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HM2013 Abstract Number: 392

Acute Motor Axonal Neuropathy, a Rare and Atypical Subtype of Guillain–BarrÉ Syndrome (Gbs)

Case Presentation: A 60‐year‐old African American man presented to hospital requesting admission for alcohol detoxification. He was a known polysubstance abuser and hepatitis C carrier. Review of systems was significant for a 2‐day history of [...]

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HM2013 Abstract Number: 393

Double Hit in a Postoperative Patient!

Case Presentation: A 57‐year‐old woman presented with severe headaches. She had a medical history of morbid obesity status post Roux‐en‐Y gastric bypass surgery 7 days prior to her present illness. A VTE prophylaxis with heparin [...]

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HM2013 Abstract Number: 390

A Complicated Case of Delirium: The Clue Lies in the Calcium

Case Presentation: A 73‐year‐old woman presented for further evaluation of refractory delirium. Her medical history included a remote stroke, atrial fibrillation on chronic anticoagulation, and falls. She had also recently started memantine for mild memory [...]

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HM2013 Abstract Number: 391

Another Source of Pulmonary Septic Emboli — Azygos Vein Septic Thrombosis

Case Presentation: A 32‐year‐old woman presented with a 2‐day history of progressively worsening back pain followed by weakness and numbness in both lower extremities. Her social history was significant for long history of IV heroin [...]

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HM2013 Abstract Number: 388

Graves' Disease — a Rare Cause of Acute Myopericarditis?

Case Presentation: This is the case of a 26‐year‐old woman who presented to the ED with complaints of sudden‐onset sharp substernal chest pain radiating to her back and neck for 1 day. The pain was [...]

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HM2013 Abstract Number: 389

Miliary Tuberculosis; the Other Great Masquerader

Case Presentation: This is a 37‐year‐old African American incarcerated man who presented with a chief complaint of abdominal pain and fever of 1‐month duration. Initial vital signs showed tachycardia to 121 bpm, blood pressure of [...]

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HM2013 Abstract Number: 386

Purple Urine Bag: A Case Report and Literature Review

Case Presentation: An 84‐year‐old white woman was admitted for fracture of her right hip. She underwent hemiarthroplasty and was transferred to the rehabilitation unit. It was noted that the patient's urine bag was turning purple [...]

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HM2013 Abstract Number: 387

Not Just Another Case of Cardiac Ischemia

Case Presentation: A 55‐year‐old woman presented with acute onset of chest pain at rest that radiated to her jaw and left arm. Her medical history was notable for hypertension, hyperlipidemia, OSA, and obesity status post [...]

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HM2013 Abstract Number: 384

Itchy and Scratchy: A 14‐Month‐Old Boy with Cholestasis

Case Presentation: A 14‐month‐old boy was admitted with failure to thrive. He had 10–14 stools daily, occurring within 15 minutes of eating. He had pruritis. There were no recent fevers or vomiting. There was no [...]

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HM2013 Abstract Number: 385

Ulcerative Cutaneous Lesions Synchronously Present with the Diagnosis of Primary Lung Cancer

Case Presentation: A 70‐year‐old male patient was admitted to the hospital with a 2‐month history of progressive worsening productive cough and exertional shortness of breath. His condition associated with malaise, loss of appetite and loss [...]

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HM2013 Abstract Number: 382

More Than Skin Deep: One Nosocomial Infection Not to Miss

Case Presentation: A 74‐year‐old man with left total hip and knee arthroplasties presented with 1 week of ipsilateral back, hip, and knee pain. He was diagnosed with Methicillin‐sensitive Staphylococcal aureus bacteremia, lumbar discitis, psoas abscess, [...]

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HM2013 Abstract Number: 383

A Subtle Suburban Poisoning: Palytoxin

Case Presentation: A 51‐year‐old man with a medical history of gastroesophageal reflux disease, herpetic whitlow, and nephrolithiasis presented to the emergency room (ER) with cough and headache after a zoanthoid coral from his home aquarium [...]

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HM2013 Abstract Number: 380

Granulomas and Aspergillomas: An Uncommon but Dangerous Intermingling

Case Presentation: A 59‐year‐old man with no medical history was referred for admission from a rheumatology clinic where he presented with night sweats, nonproductive cough, exertional dyspnea, nausea, decreased appetite, and loose stools. He also [...]

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HM2013 Abstract Number: 381

A Tale of the Tongue

Case Presentation: A 42‐year‐old woman presented with a 3‐month history of worsening mouth pain and weight loss. She also complained of hair loss, paresthesias, and generalized weakness. She attributed these changes to poor oral intake [...]

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HM2013 Abstract Number: 378

Inappropriate ICD Discharges Due to Qrs‐Complex Oversensing in a Patient with Hyperkalemia

Case Presentation: A 71‐year‐old man with a reduced left ventricular ejection fraction due to prior MI, diabetes mellitus, and a single‐chamber ICD presented with numerous ICD shocks. His medication list included glyburide, gabapentin, carvedilol, spironolactone, [...]

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HM2013 Abstract Number: 379

Acute Coronary Thrombosis As the Presenting Symptom in a Patient with Essential Thrombocytosis: A Case Report

Case Presentation: This is a 51‐year‐old man with no significant medical history who presented to an outside hospital with a 1‐day complaint of sudden‐onset left‐sided chest pain radiating to the left shoulder, associated with diaphoresis [...]

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HM2013 Abstract Number: 376

Seizures Secondary to Hypoglycemia in Nesidioblastosis in Adult with Systemic Lupus Erythematosus (Sle): A Case Report

Case Presentation: A 51‐year‐old‐woman was admitted to the emergency department in a postictal state after generalized tonic–clonic seizure; hypoglycemia of 23 mg/dL was identified. She had normal body weight (body mass index, 21). She reported [...]

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HM2013 Abstract Number: 338

A Costly, Stressful Unilateral Belladona

Case Presentation: A 49‐year‐old woman with a medical history significant for congenital hypofibrinogenemia and platelet dysfunction was admitted to the hospital for observation following percutaneous biliary drain removal. Because of a significant bleeding history, following [...]

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HM2013 Abstract Number: 335

A Case of Aspergillus and Norcardia Lung Infection in an Immunocompetent Patient

Case Presentation: A 36‐year‐old white woman presented with cough, wheezing, shortness of breath, and fever of 3 weeks' duration. She smoked daily but had no history of chronic obstructive pulmonary disease. She was initially evaluated [...]

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HM2013 Abstract Number: 336

A Case of Disseminated Blastomycosis

Case Presentation: A 53‐year‐old white man from Chicago presented with complaints of dysuria followed by right testicular pain and swelling, multiple painful skin lesion, productive cough, right middle finger painful swelling and significant weight loss [...]

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HM2013 Abstract Number: 333

Meningitis After Diagnostic Myelography

Case Presentation: A 32‐year‐old man with chronic low back pain presented with tonic–clonic seizures and altered mental status approximately 12 hours after he underwent an outpatient CT myelogram with Iopamidol contrast. Headache, nausea and vomiting [...]

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HM2013 Abstract Number: 334

A 23‐Year‐Old Man with Transient St‐Segment Elevation Induced by Fever

Case Presentation: A 23‐year‐old man had fever and palpitation on the second day following uncomplicated laparoscopic appendectomy. His medical history was significant for rheumatoid arthritis, which was well controlled with methotrexate and folic acid. Family [...]

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HM2013 Abstract Number: 331

An Indolent Case of Av Endocarditis: Heuristics and Mindfulness Over Matter

Case Presentation: A 29‐year‐old woman with a medical history of “heart murmur” and remote anxiety diagnosis presented to the ER with a 10‐day history of fever/chills (103°F–104°F), fatigue, and shortness of breath. The patient denied [...]

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HM2013 Abstract Number: 332

Gastrointestinal Bleed As Initial Presentation of Catastrophic Antiphospholipid Syndrome

Case Presentation: A 56‐year‐old white man presented to an outlying hospital with abdominal pain, melanotic stool. He had hemoglobin of 14 g/dL, white cell count of 19,000, and platelets count of 879,000. Initially the INR [...]

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HM2013 Abstract Number: 329

An Unexpected Guest: Leukocytoclastic Vasculitis Secondary to Vancomycin

Case Presentation: A 52‐year‐old white man presented with an infected ulcer and osteomyelitis of the right fifth toe requiring resection of the fifth distal metatarsophalangeal joint. He had poorly controlled diabetes, ischemic cardiomyopathy (EF 25%) [...]

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HM2013 Abstract Number: 330

A Unique Cause of Intractable Nausea and Vomiting: Cannabinoid Hyperemesis Syndrome

Case Presentation: Cannabis has gained worldwide recognition of its medicinal value hailed as “the aspirin of the 21st century.” It is common knowledge that cannabis has an antiemetic entity; proven to act as a partial [...]

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HM2013 Abstract Number: 245

Mpgn: A Treatable and Serious Cause of Nephrotic Syndrome

Case Presentation: A 58‐year‐old man presented with progressively worsening bilateral lower‐extremity edema over a 3‐week period. He noted that he had left lower‐extremity edema for the past 2.5 yers but in the past 3 weeks [...]

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HM2013 Abstract Number: 246

Colliding with the Very Air He Breathes

Case Presentation: An 81‐year‐old man presented with a 4‐ to 5‐day history of increasing confusion, combativeness, and personality changes. There were no associated fevers or chills. Patient denied photophobia, neck stiffness, headache, trauma, or recent [...]

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HM2013 Abstract Number: 327

Tuberculosis Peritonitis: A Diagnostic Challenge

Case Presentation: A 35‐year‐old Haitian woman with a history of untreated latent tuberculosis (TB) presented with progressive abdominal distention, fatigue, and weight loss. She denied fevers, chills, night sweats, or cough. She denied sick contacts [...]

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HM2013 Abstract Number: 328

Gout of the Symphysis Pubis, a Rare Pain in the Pelvis

Case Presentation: A 56‐year‐old woman with a history of atrial fibrillation, diabetes, and rheumatoid arthritis on chronic narcotics presented after being found unresponsive at home. She was hypopneic and intubated for airway protection. Pressors were [...]

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HM2013 Abstract Number: 325

Streptococcus Constellatus Bacteremia Associated with Complex Pulmonary and Hepatic Infections Following Perforated Appendicitis in a Patient Taking Adalimumab

Case Presentation: A 41‐year‐old man with a history of chronic plaque psoriasis and an appendectomy 3 months prior presented to our hospital with malaise, dyspnea, fever, and a productive cough for 1week. On arrival, the [...]

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HM2013 Abstract Number: 326

Diabetes Insipidus Without the Thirst

Case Presentation: A 56‐year‐old woman with a history of cerebral aneurysm status post clip placement, seizures, hypertension, diabetes insipidus, obesity, obstructive sleep apnea, and multiple DVTs presented to the ER after being found down in [...]

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HM2013 Abstract Number: 323

A Cocaine Masquerade

Case Presentation: This is a 53‐year‐old African American woman with a history of hypothyroidism and active cocaine and alcohol abuse who presented to the emergency department with acute‐onset altered mental status, hypotension, and tachycardia. She [...]

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HM2013 Abstract Number: 324

A Rare and Fatal Case of Shortness of Breath

Case Presentation: A 69‐year‐old man presented with 1 week of shortness of breath associated with lower‐extremity and scrotal edema. He had elevated JVP and distended external jugular veins, an enlarged liver, and bilateral leg edema. [...]

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HM2013 Abstract Number: 321

More Than Your Typical Mono: Idiopathic Intracranial Hypertension in Acute Ebv Infection

Case Presentation: An 18‐year‐old female with a known positive monospot presented to the emergency department with headache, abdominal pain, and intractable vomiting in the context of 10 days of low‐grade fevers and myalgias. Initial labs [...]

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HM2013 Abstract Number: 322

Left Ventricular Noncompaction Presenting As Systolic Heart Failure with Intraventricular Thrombus

Case Presentation: A 29‐year‐old man with no medical history presented with increasing shortness of breath and orthopnea for ten days. He denied alcohol and drug abuse. Family history was negative for any cardiac disease. Examination [...]

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HM2013 Abstract Number: 319

An Interesting Case of Acute Delirium

Case Presentation: We present a 61‐year‐old woman with no significant medical history who underwent outpatient surgical removal of a large vaginal mass. She was admitted to the hospital the next day for acute delirium. Physical [...]

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HM2013 Abstract Number: 320

A Case of Thrombotic Storm, Wolf at the Door

Case Presentation: A 24‐year‐old woman 25 weeks' pregnant with a history of nephrotic syndrome was admitted for diabetic ketoacidosis and pneumonia. On day 4, she delivered a nonviable fetus, which was followed by flash pulmonary [...]

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HM2013 Abstract Number: 317

The Worm in the Apple

Case Presentation: A 30‐year‐old woman was admitted with fever and headache. On physical examination temperature was 101.5°F; the jolt accentuation test was positive. Routine laboratory studies and head CT were normal. CSF analysis showed 220 [...]

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HM2013 Abstract Number: 318

Hypereosinophilic Syndrome: A Case Report of the Rare Cause of Cardiac and Pulmonary Disease in a 40‐Year‐Old Man

Case Presentation: A 41‐year‐old man with no medical history presented for a second opinion for chest pain, cough, fevers, and an 80‐pound weight loss in 2 months. Previous evaluation revealed peripheral eosinophilia, pericarditis, and pneumonia. [...]

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HM2013 Abstract Number: 315

Hypercalcemia Due to Sarcoidosis of the Bone Marrow

Case Presentation: A 49‐year‐old largely healthy woman was admitted to the hospital for hypercalcemia. She complained of fatigue, weight loss and anorexia for several months. She was not on any medications or supplements. She was [...]

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HM2013 Abstract Number: 316

Silicone but Not Smooth

Case Presentation: A 52‐year‐old woman was admitted with hypercalcemia. She had a 1‐year history of hypertension. One week before admission she presented to an outside hospital with weakness and a calcium level of 17 mg/dL. [...]

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HM2013 Abstract Number: 313

Hypercalcemia: Showing a Path from Stroke to Cancer

Case Presentation: A 68‐year‐old woman presented to the ER with 3 weeks of increased forgetfulness, confusion, headache, unsteady gait, and abdominal pain. Her medical history was significant for hypertension, depression, breast cancer, and endometrial cancer [...]

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HM2013 Abstract Number: 314

Respiratory Distress and Abdominal Pain: Are They Linked?

Case Presentation: A 21‐month‐old previously healthy girl presented with 5 days of cough, rhinorrhea, and fever. One day prior to presentation, she also developed emesis and diarrhea, followed by a decrease in oral intake and [...]

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HM2013 Abstract Number: 311

Aortoenteric Fistula: A Rare Cause of Gastrointestinal Bleeding

Case Presentation: A 55‐year‐old African American man with a medical history of abdominal aortic aneurysm repair with aortobiiliac reconstruction was admitted with a chief complaint of dark‐colored stools and fever. On examination, abdominal bruits were [...]

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HM2013 Abstract Number: 312

Moan and Groan: Deficiency or Excess? A Fascinating Case of Hypercalcemia

Case Presentation: A 26‐year‐old man who underwent recent resection of an ACTH‐secreting pituitary adenoma 1 month prior to admission presented to the hospital with 1 week of nausea, vomiting, and abdominal pain. Laboratory results were [...]

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HM2013 Abstract Number: 309

Cardiac Tamponade: A Rare Initial Presentation of Iatrogenic Hypothyroidism

Case Presentation: A 42‐year‐old woman with a history of Graves' disease status post thyroidectomy and type II diabetes presented with a 3‐day history of dyspnea on exertion. The patient has also had right‐sided chest pain [...]

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HM2013 Abstract Number: 310

Simultaneous Cns Antiphospholipid Antibody Syndrome and Lupus Nephritis in Systemic Lupus Erythematosus

Case Presentation: The patient was a 71‐year‐old white man with systemic lupus erythematosus who presented with confusion, gait impairment, and left‐sided visual neglect. A brain MRI showed multiple areas of ischemic infarct involving bilateral cerebral [...]

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HM2013 Abstract Number: 307

The Miserable and Irritable Heart

Case Presentation: A 25‐year‐old woman with no significant medical history presented with a 1‐week history of palpitation, dizziness, and fatigue that made her require 2 hospitalization in 1 week. The episodes were related to emotional [...]

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HM2013 Abstract Number: 308

Right Atrial Thrombus: A Hanging Question

Case Presentation: A 34‐year‐old woman with a stage IV infiltrative ductal breast carcinoma being treated with capecitabine and goserelin was admitted for management of a right atrial thrombus incidentally found on restaging contrast‐enhanced computerized tomography [...]

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HM2013 Abstract Number: 305

Seizure‐Induced Cardiomyopathy

Case Presentation: A 54‐year‐old previously healthy woman was admitted to our hospital for new‐onset seizure. Patient was sitting in the ready area with her flight crew, felt lightheaded, when she suddenly found herself on the [...]

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HM2013 Abstract Number: 306

Gastrointestinal Kaposi's Sarcoma Presenting As Ileocolic Intussusception

Case Presentation: A 42‐year‐old man presented with nausea, vomiting and periumbilical abdominal pain of a few hours' duration. Patient also had nonbloody diarrhea. He denied viral prodrome, sick contacts, recent travel, food poisoning, or any [...]

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HM2013 Abstract Number: 303

Home Remedy, Bad Malady

Case Presentation: A 79‐year‐old white man went to the emergency room with complaints of right upper quadrant pain and got an abdominal CT scan done, which revealed some abnormality in his chest. He subsequently underwent [...]

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HM2013 Abstract Number: 304

What to Expect When You're Not Expecting: Recurrence of Peripartum Cardiomyopathy in a Nonpregnant Patient

Case Presentation: A 29‐year‐old African American woman presented to the emergency room complaining of dyspnea on exertion and orthopnea of 2 weeks' duration. Her symptoms progressed gradually over this period and worsened to include paroxysmal [...]

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HM2013 Abstract Number: 301

Steakhouse Syndrome

Case Presentation: A 57‐year‐old man presented to the emergency room with complaints of dysphagia and midsternal chest discomfort after he ate a big lump of steak and felt it stuck in his throat. Chest discomfort [...]

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HM2013 Abstract Number: 256

Making a List, Checking It Twice, an Early Diagnosis of Arvc Is Awfully Nice

Case Presentation: A 62‐year‐old woman with no medical history presented with 1 month of recurrent palpitations and near‐syncope. Two weeks previously she had a normal EKG and exercise stress echocardiogram. The patient's symptoms continued to [...]

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HM2013 Abstract Number: 253

A Subacute Presentation of Staphylococcus Lugdunensis Endocarditis

Case Presentation: Five months prior to admission to our hospital, a 71‐year‐old man with end‐stage renal disease who undergoes hemodialysis 3 times per week via an upper‐extremity AV fistula, was diagnosed at his outpatient dialysis [...]

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HM2013 Abstract Number: 254

Painful Position

Case Presentation: A 61‐year‐old man developed acute renal failure and difficulty ambulating 2 days after radical perineal prostatectomy. He complained of bilateral lower leg pain, numbness, tingling in his toes, and shooting pains in his [...]

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HM2013 Abstract Number: 251

You Never Know What You Gada Bru‐Ing

Case Presentation: A 55‐year‐old previously healthy man presented with sharp and stabbing right‐sided chest pain occurring intermittently for 5 days. Pain was exacerbated by cough with no relation to movement or exertion. He reported 1 [...]

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HM2013 Abstract Number: 252

What Goes Down Must Come Up: Gastric Leiomyoma in a Patient with Dementia

Case Presentation: After 5 days of emesis and near‐syncope, an 86‐year‐old man presented with weakness, nausea, and altered mental status. His emesis appeared nonbilious and contained regurgitated food. He had known dementia and lived with [...]

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HM2013 Abstract Number: 249

Fever in a Patient with a Rare Adult‐Onset Neuroblastoma

Case Presentation: A 30‐year‐old woman with a medical history of ovarian cancer in remission developed a stage 3 neuroblastoma. CT scan of the head showed a heterogeneously enhancing mass involving bilateral sphenoid sinuses that extended [...]

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HM2013 Abstract Number: 250

Sneaky Sarcoidosis or a Metastatic Masquerade?

Case Presentation: A 53‐year‐old African American woman presented with 2 weeks of productive cough not responsive to antibiotics and 1 week of fever, headache, night sweats, and lightheadedness. She also reported a 25‐pound weight loss [...]

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HM2013 Abstract Number: 247

Let's Go Clubbing: Hypertrophic Osteoarthropathy and Lung Cancer

Case Presentation: A 56‐year‐old woman presented with worsening bilateral ankle and knee swelling for 10 months, causing difficulty walking. She reported a 20‐pound weight loss over the same time. She denied family history of arthritis, [...]

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HM2013 Abstract Number: 377

100 Pounds of Unintentional Weight Loss: An Old Foe with a New Presentation

Case Presentation: A 52‐year‐old previously healthy man with history of prior alcohol dependence and a Billroth II procedure 25 years ago for peptic ulcer disease presented with 100 pounds of unintentional weight loss associated with [...]

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HM2013 Abstract Number: 374

A Case of Strong Abdominal Pain

Case Presentation: A 59‐year‐old man presented with a 6‐month history of abdominal pain and nausea with alternating constipation and diarrhea. He did not seek medical attention until he was too weak to get out of [...]

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HM2013 Abstract Number: 375

The Pediatric Obesity Epidemic Strikes Again — Cholelithiasis in a 13‐Year‐Old Boy

Case Presentation: H.B. is a 13‐year‐old obese Hispanic boy with generalized sharp abdominal pain for 2 days, nonradiating, 6–7/10 intensity, improved by flexing the trunk, associated with loss of appetite. He had no nausea/vomiting/diarrhea, no [...]

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HM2013 Abstract Number: 372

Dangerous Dining

Case Presentation: A 42‐year‐old woman presented with fever and abdominal pain. She recently returned from Chennai, India, where she spent 1 month visiting family and friends. A week after returning, she developed epigastric pain, daily [...]

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HM2013 Abstract Number: 248

Incidental‐Oh‐My!

Case Presentation: A 72‐year‐old man with a history of coronary artery disease, diabetes mellitus type 2, hypertension, and nonfunctional left adrenal cortical adenoma resected 1 month ago presented after a syncopal episode lasting several minutes. [...]

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HM2013 Abstract Number: 243

Clinical Significance of Heparin‐Induced Thrombocytopenic Thrombotic Syndrome with Initial Negative Antiheparin Antibodies: A Case Report and Literature Review

Case Presentation: A 70‐year‐old man complained of left leg pain 2 days after coronary artery bypass graft (CABG) for an acute ST‐elevation myocardial infarction. Patient was treated with intravenous unfractionated heparin (UFH) during CABG. Platelet [...]

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HM2013 Abstract Number: 373

Common Celiacomesenteric Trunk Presenting with Mesenteric Ischemia: 2 Case Reports with a Review of the Literature

Case Presentation: We present 2 cases demonstrating variant branching of the abdominal aortic trunks along with radiographic imaging and correlation to a common disease state. The first case is a 67‐year‐old woman who presented with [...]

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HM2013 Abstract Number: 370

Blindness of the Heart: An Unusual Cause for Transient Bilateral Vision Loss

Case Presentation: This is an 87‐year‐old who who complained of 8 brief episodes of transient bilateral vision loss lasting eight seconds each time for the past 2 days. Episodes were associated with dizziness and a [...]

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HM2013 Abstract Number: 371

Unsteady Gait and Weakness — a Tropical Threat

Case Presentation: Conditions affecting the spinal cord are diverse and sometimes present with atypical, vague symptoms that evolve overtime. Etiologies for these conditions include autoimmune, infectious, neoplastic, vascular, and hereditary‐degenerative diseases. We present a case [...]

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HM2013 Abstract Number: 368

A 28‐Year‐Old Man with Recurrent Abdominal Pain and Hematochezia: A Case Report

Case Presentation: This is a 28‐year‐old man who presented to the hospital with a 1‐day history of severe abdominal pain and bright red blood per rectum. The patient reported having several intermittent episodes of abdominal [...]

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HM2013 Abstract Number: 369

The Antibiotics Are Just Not Helping: An Unusual Organism Masquerading As a Usual Pneumonia

Case Presentation: A 57‐year‐old man with HIV (CD4 count of 7), not currently on antiretroviral treatment, presented with 2 days of fever and cough. On physical exam, he was found to have fever, tachycardia, and [...]

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HM2013 Abstract Number: 366

A Bad Impersonation

Case Presentation: A 21‐year‐old healthy woman presented with headache, vomiting, and difficulty following commands. She had no fever, rash, head injury, or recent illness. She has mild seasonal allergies. She worked outdoors as a summer [...]

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HM2013 Abstract Number: 367

Obstructive Nephropathy Without Significant Hydroureteronephrosis

Case Presentation: The patient is a 48‐year‐old Hispanic man who was admitted for anuria. He had a recent diagnosis of colon cancer with liver and omental metastases accompanied by malignant ascites. Beginning 1 week prior [...]

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HM2013 Abstract Number: 364

The “Medical Home‐Less”: How Transitions‐of‐Care Issues May Be Magnified in the Uninsured Patient

Case Presentation: A 64‐year‐old man with alcoholism and end‐stage liver disease (ESLD) presented to the emergency department (ED) complaining of abdominal pain and swelling. In the previous 3 weeks, the patient had presented to 2 [...]

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HM2013 Abstract Number: 365

A Case Report of Idiopathic Cd4 Lymphocytopenia

Case Presentation: A 53‐year‐old woman presented with vomiting, severe headache, and neck stiffness. She had no recent sick contacts, travel or tick bites. She was without identifiable HIV risk factors or family history of immunodeficiency [...]

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HM2013 Abstract Number: 362

A Case of Endocarditis Diagnosed by Ekg

Case Presentation: A 69‐year‐old man with a medical history of coronary artery disease, ischemic cardiomyopathy, and heart block status post pacemaker (PPM) with AICD placement presented to the emergency department (ED) with complaints of fevers [...]

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HM2013 Abstract Number: 363

Abdominal Pain and Hearing Loss: An Unusual Presentation of Malignant Pheochromocytoma

Case Presentation: A 53‐year‐old African American man presented with 1 month of diffuse abdominal pain associated with nausea, emesis, and anorexia. He also reported 15 pounds of unintentional weight loss and fatigue. He denied any [...]

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HM2013 Abstract Number: 513

Association Between Hospital Performance for Pharmacologic Venous Thromboembolism Prophylaxis and Rates of Venous Thromboembolism

Background: Hospital‐associated venous thromboembolism (VTE) affects up to 15% of hospitalized medical patients and is believed to be one of the most common preventable causes of death in the hospital. Pharmacologic prophylaxis has been shown [...]

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HM2013 Abstract Number: 361

A Young Female Presenting with Acute‐Onset Psychosis

Case Presentation: An 18‐year‐old African American female with no medical history was brought in for 5 days of altered mental status. She was unable to perform activities of daily living, exhibited bizarre behavior, and had [...]

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HM2013 Abstract Number: 359

Eculizumab in a Case of Severe, Refractory Hemolytic Uremic Syndrome (Hus)

Case Presentation: HUS is a life‐threatening disease that causes microangiopathic hemolysis, thrombocytopenia, kidney failure, stroke, myocardial infarction, and death. Typical or enteropathic HUS (eHUS) occurs after a gastrointestinal infection (usually Escherichia coli O157:H7) and is [...]

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HM2013 Abstract Number: 360

Acute Renal Failure, Urinary Obstruction, and Elevated Psa: Slam Dunk Diagnosis?

Case Presentation: A 64‐year‐old man presented with a 4‐week history of abdominal fullness and urinary retention. He was recently seen at an urgent care clinic where he was diagnosed and treated for a UTI. He [...]

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HM2013 Abstract Number: 357

Fungal Meningitis Case Series: Lessons Learned

Case Presentation: Case 1 — This is a 67‐year‐old woman with a history of hypertension, chronic bronchiectasis, and chronic lumbar back pain who regularly received epidural steroid injections that was admitted 9/22/12 with a 2‐week [...]

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HM2013 Abstract Number: 358

A Rare Case of Candida Brain Abscess in a Patient with Cirrhosis

Case Presentation: A 41‐year‐old man with insulin‐dependent diabetes and hepatitis C cirrhosis with multiple variceal bandings presented with progressive right‐sided weakness had been seen at an outside hospital 6 months prior to admission, where ring‐enhancing [...]

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HM2013 Abstract Number: 355

Holy Bullae, Batman! the Case of the Vanishing Lung

Case Presentation: A 56‐year‐old African American man presented to the emergency room complaining of shortness of breath, wheezing, and productive cough with yellowish sputum. His symptoms began acutely 1 day prior to presentation and were [...]

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HM2013 Abstract Number: 356

A Weak Diagnosis: Myasthenia Gravis Presenting with Severe Orthopnea

Case Presentation: A 68‐year‐old woman presented to our hospital with worsening orthopnea 3 times during 1 month. On her first hospitalization, she was diagnosed with diastolic heart failure in the setting of a normal B‐type [...]

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HM2013 Abstract Number: 353

Amiodarone‐Induced Myxedema Coma: Don't Forget the Thyroid Gland

Case Presentation: A 78‐year‐old man with hypertension, atrial fibrillation, hypercholesterolemia, and gastroesophageal reflux disease presented to the hospital with confusion, new‐onset ascites, hypotension (BP 90/50), and hypothermia (temperature, 93.9°F). He underwent a paracentesis that did [...]

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HM2013 Abstract Number: 354

Refractory “Psoriatic Arthritis” Due to Infliximab?

Case Presentation: A 47‐year‐old woman with a history of psoriasis who had been on infliximab for more than 9 months presented with fevers, myalgias, worsening of her psoriatic rash, and painful swollen hand joints. She [...]

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HM2013 Abstract Number: 351

Exsanguination and Autonomy

Case Presentation: The patient was a 79‐year‐old male Jehovah's Witness who had been newly diagnosed with vasculitis and was near the end of life and requiring blood products. After 2 weeks of daily hemoptysis and [...]

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HM2013 Abstract Number: 352

Salmonella Typhi Abscess Following Liver Biopsy

Case Presentation: A 23‐year‐old man with severe chorea and dysarthria due to Wilson's disease presented 5 days after percutaneous liver biopsy with persistent abdominal pain and fever as high as 104°F. He stopped eating and [...]

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HM2013 Abstract Number: 349

Myxing Up the Differential, an Unusual Case of an Abdominal Mass

Case Presentation: A 25‐year‐old woman presented with 3 weeks of right upper quadrant abdominal pain. She described the pain as a “fullness” or “pulling” sensation. Over the past few days the pain had increased in [...]

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HM2013 Abstract Number: 350

Cryptococcus Gattii: A Spreading Tropical Fungus

Case Presentation: The patient is a 50‐year‐old man with productive cough for 3 months, weight loss, and leg buckling with progressive thigh pain. He has a history of a ground‐level fall from a horse while [...]

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HM2013 Abstract Number: 347

Hereditary Gastric Cancer Presenting As Antiphospholipid Antibody Syndrome with Extensive Venous Thrombosis

Case Presentation: A previously healthy 41‐year‐old man presented to the emergency department (ED) with right‐sided pleuritic chest pain of 1‐week duration. He was diagnosed with right lower lobe pulmonary embolism (PE) on CTA of the [...]

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HM2013 Abstract Number: 348

Ban What Syndrome? — Banwarth Syndrome Due to Lyme Disease

Case Presentation: A 65‐year‐old man presented with a 4‐week history of general malaise, headaches, low‐grade fevers, and bilateral upper‐extremity pain. He denied having episodes of chills, vomiting, or photophobia. He lives in a wooded area [...]

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HM2013 Abstract Number: 345

When There Are No Outpatient Options

Case Presentation: The patient was 69‐year‐old man with an extensive medical history including dementia with delirium, end‐stage renal disease, ischemic heart failure, and a recent subarachnoid hemorrhage. He presented from his dialysis center with enterococcal [...]

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HM2013 Abstract Number: 346

A Rare but Rapidly Reversible Cause of Hyperammonemic Encephalopathy

Case Presentation: A 21‐year‐old man with metastatic fibrolamellar hepatocellular carcinoma (HCC) with recurrent malignant ascites was admitted to the hospital for nausea and vomiting. His disease had continued to progress after 4 cycles of FOLFOX [...]

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HM2013 Abstract Number: 343

What's That Pustule?!? Bringing Mass Spectrometry to the Bedside

Case Presentation: A 66‐year‐old immune‐compromised woman with systemic lupus erythematosus, antiphospholipid antibody syndrome, and adrenal insufficiency was admitted to the hospital due to a 2‐week history of painful skin lesions and associated swelling on her [...]

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HM2013 Abstract Number: 344

Alcohol‐Induced Leukopenia, New Myth for an Old Disease

Case Presentation: A 55‐year‐old man with history of alcohol abuse, presented with 2 days history of shortness of breath, cough, fever, chills, and confusion. He was unconscious on admission and was intubated and placed on [...]

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HM2013 Abstract Number: 341

An 8‐Year Old Child with Acute Onset of Headache and Decreased Level of Consciousness; an Unusual Presentation of Bacterial Endocarditis

Case Presentation: This is an 8‐year‐old female with Marfan's syndrome and mitral valve prolapse who had been experiencing daily fevers for 1 week prior to presentation. On the day of admission she had a sudden [...]

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HM2013 Abstract Number: 342

Not Your Ordinary Rash: A Case of Metastatic Cutaneous Rectal Adenocarcinoma

Case Presentation: A 68‐year‐old woman was initially diagnosed with metastatic rectal adenocarcinoma in 2009. She received chemoradiation at that time with excellent response. 2 years after her initial diagnosis, she developed metastatic recurrence in her [...]

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HM2013 Abstract Number: 339

A Less Than Benign Case of Cholesteatoma

Case Presentation: A 56‐year‐old woman presented to the emergency room with left ear pain with sanguineous drainage for 2 days. She had a history of biopsy‐proven benign left ear mass 1 year prior, but was [...]

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HM2013 Abstract Number: 340

Laryngeal Mass and Pneumomediastinum — an Unusual Case of T‐Cell Lymphoma

Case Presentation: A 22‐year‐old El Salvadoran man presented with 2 months of fevers, night sweats, fatigue, cough with scant hemoptysis, hoarseness and a 60‐pound weight loss. Over the next month, he developed progressive dysphagia, odynophagia, [...]

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HM2013 Abstract Number: 337

New‐Onset Cardiomyopathy in a Patient with Sarcoidosis: A Rare Case of Concomitant Cardiac Sarcoidosis and Amyloidosis

Case Presentation: A 54‐year‐old African American woman with diabetes mellitus, pulmonary sarcoidosis (diagnosed 6 months prior to presentation and maintained on prednisone and hydroxychloroquine), hypertension, and diastolic heart failure presented to the emergency room after [...]

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HM2013 Abstract Number: 244

Diabetic Ketoacidosis Complicated by Pneumomediastinum

Case Presentation: A 29‐year‐old man with type 1 diabetes of 10 years presented with abdominal pain for 2 days. The pain was located in the midepigastrium, was nonradiating, associated with nausea and bilious, nonbloody vomiting. [...]

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HM2013 Abstract Number: 241

Bee Sting–Induced Nephrotic Syndrome

Case Presentation: A 64‐year‐old female patient with a significant medical history of ovarian cancer in remission treated with surgery 20 years ago presented with a 5‐day history of shortness of breath and right‐sided chest pain. [...]

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HM2013 Abstract Number: 242

Rare Etiology of a Common Symptom: Tracheal Obstruction Due to Extranodal Rosai–Dorfman Disease

Case Presentation: A 76‐year‐old woman with hypertension, type 2 diabetes mellitus, and a 20‐pack‐year smoking history presented with complaint of 6 weeks of nonproductive cough. Left breast cancer had been treated 7 years prior with [...]

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HM2013 Abstract Number: 239

Complicated Euglycemic Diabetic Ketoacidosis in Pregnancy

Case Presentation: A 31‐year‐old woman with history of type 1 diabetes mellitus who was 35 weeks' pregnant came to the ER with chief complaints of nausea, vomiting, and severe retrosternal burning sensation for 3 days. [...]

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HM2013 Abstract Number: 240

An Unusual Case of Complete Heart Block

Case Presentation: A 57‐year‐old white man with no significant medical history was brought to the emergency department with complaints of not feeling well for 2 weeks. He also mentioned generalized weakness, vague abdominal discomfort, coffee‐ground [...]

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HM2013 Abstract Number: 237

Well, Doc, My Chest Pain Is All Gone

Case Presentation: A 69‐year‐old man with a history of hypertension presented to an outside hospital emergency department (ED) with nonradiating substernal chest pressure that woke him at 2 am. He had experienced such pain before [...]

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HM2013 Abstract Number: 238

Atypical Hemolytic Uremic Syndrome

Case Presentation: A 60‐year‐old woman presented with acute shortness of breath at rest requiring intubation. She denied any preceding fever, chills, chest pain, or diarrhea. Her medical history included stage IV gallbladder cancer treated with [...]

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HM2013 Abstract Number: 235

Clopidogrel Hypersensitivity Reaction After Placement of a Drug‐Eluting Stent

Case Presentation: A 65‐year‐old white man with a history of coronary artery disease was admitted with acute coronary syndrome. He underwent a percutaneous coronary intervention (PCI) with placement of an everolimus drug‐eluting stent and was [...]

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HM2013 Abstract Number: 236

Unusual Suspects: An Interesting Case of Pancreatitis

Case Presentation: A 44‐year‐old man with schizoaffective disorder, hypertension, diabetes mellitus, and hyperlipidemia presented with epigastric pain associated with vomiting and nausea for 2 hours on day‐9 of psychiatry admission for psychosis. He was on [...]

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HM2013 Abstract Number: 233

The Final Insult: A Case of Acute‐on‐Chronic Budd–‐Chiari Syndrome

Case Presentation: A 61‐year‐old woman was admitted with acute jaundice. She was in her usual state of health until 2 weeks prior to admission, when she developed progressive jaundice, dull right upper quadrant pain, and [...]

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HM2013 Abstract Number: 234

An Unusual Case of Cmv Pneumonitis That Led to the Diagnosis of an Unexpected Immunodeficiency

Case Presentation: A 40‐year‐old female patient with no significant medical history, presented with shortness of breath and chronic cough that was associated with recurrent sinusitis for a year. Physical exam showed mild tachypnea and hypoxia. [...]

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HM2013 Abstract Number: 231

The Tooth Is in the Pudding: Odontogenic Brain Abscess

Case Presentation: A 49‐year‐old man presented with a 2‐month history of confusion, blurry vision, fevers, chills, night sweats. He reported a 30‐pound weight loss over 3 months, history of hypertension and stroke; denied weakness, trauma, [...]

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HM2013 Abstract Number: 232

Triple Threat

Case Presentation: A 42‐year‐old woman with HIV/AIDS (CD4 count, 40 cells/mm3) presented with fever, nausea, and headaches for 1 week. She was febrile at 101.4°F but her physical exam was unremarkable. Initial labs showed leukopenia [...]

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HM2013 Abstract Number: 229

A Blinding Headache

Case Presentation: A 52‐year‐old man with a history of psoriasis presented with a 1‐week of gradually worsening and throbbing headache over both his temples. He found little relief from nonsteroidal anti‐inflammatory drugs, and his headache [...]

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HM2013 Abstract Number: 230

Sella!

Case Presentation: A 56‐year‐old man presented with altered mental status secondary to complex partial seizures. He had a history of neurosarcoidosis diagnosed by imaging. On arrival to the hospital, he was found to be hypotensive, [...]

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HM2013 Abstract Number: 227

Rare Symptomatic Distal Renal Tubular Acidosis in Alcoholic Liver Disease

Case Presentation: A 38‐year‐old man presented with complaints of yellowish discoloration of skin, severe fatigue, polyuria, and polydipsia for 5 months. He had a history of alcoholism for 20 years. He was diagnosed with chronic [...]

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HM2013 Abstract Number: 228

Tension Pneumothorax Complicating Septic Pulmonary Emboli

Case Presentation: A 40‐year‐old woman was referred from the local jail with a tension pneumothorax. She had a long history of intravenous (IV) heroin and cocaine use followed by a 2‐year history of sobriety. She [...]

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HM2013 Abstract Number: 225

A Case of Reversible Osmotic Myelinolysis After Rapid Correction of Hyponatremia

Case Presentation: A 71‐year‐old woman on thiazide treatment for hypertension developed protracted vomiting and diarrhea for several days followed by confusion and lethargy. In the emergency department, serum sodium (SNa) was found to be 107 [...]

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HM2013 Abstract Number: 226

I Can't Breathe Doc … and … !!

Case Presentation: A 77‐year‐old obese white man presented with episodic dyspnea and chest tightness. He had similar symptoms several times in the past 12 months, resulting in multiple ED visits. A detailed review of systems [...]

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HM2013 Abstract Number: 223

The Decubitus Ulcer: A Canary in the Coal Mine?

Case Presentation: A 63‐year‐old man with diabetes complicated by peripheral neuropathy presented with increasing right lower‐extremity weakness and a recent fall 2 days prior to admission. His vital signs and physical exam were unremarkable with [...]

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HM2013 Abstract Number: 224

Abdominal Compartment Syndrome and Ischemic Colon After Milk‐and‐Molasses Enema for Fecal Disimpaction in a Patient with Functional Constipation

Case Presentation: Patient is an 8‐year‐old male with no significant medical history other than a long‐standing history of constipation who presented to a school‐based clinic with abdominal pain and fecal incontinence. He was diagnosed with [...]

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HM2013 Abstract Number: 221

Not Simply Red

Case Presentation: A 38‐year‐old man presented with sudden‐onset fever and a rash on his face and shoulders that rapidly progressed to his trunk, arms, and lower extremities within a few hours. He denied recent illness, [...]

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HM2013 Abstract Number: 222

Flying High

Case Presentation: A 32‐year‐old man presented with 1 day of left‐sided upper abdominal pain. The pain radiated to the left shoulder and was associated with nausea and vomiting. Initially, he complained of pain with taking [...]

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HM2013 Abstract Number: 219

A Curious Case of Progressive Weakness

Case Presentation: A 45‐year‐old man presented with 3 months of symmetrical upper and lower limb weakness, paresthesias, and a 40‐pound weight loss. He had no cranial nerve deficits or visual changes. He had global hyperreflexia [...]

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HM2013 Abstract Number: 220

It's a Cell‐Eat‐Cell Kind of World

Case Presentation: A 42‐year‐old woman presented with 1 week of subjective fevers, chills, and night sweats. Her medical history included HIV/AIDS, and she was not currently on antiretroviral therapy. She was febrile on presentation with [...]

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HM2013 Abstract Number: 217

Dysphonia — Where Is the Pathology?

Case Presentation: An 80‐year‐old white man with a medical history of stroke without residual deficit in 2006 and coronary artery disease presented with complaints of gradual loss of voice over a 6‐month period. It started [...]

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HM2013 Abstract Number: 218

Acute Stammering and Seizure: An Unknown Presentation for Syncope

Case Presentation: A 57‐year‐old man with a history of tonsillar lymphoma and adrenal insufficiency (on home prednisone 10 mg and fludrocortisone) was transferred from an outside hospital for syncope. Patient had been hospitalized 3 times [...]

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HM2013 Abstract Number: 215

A Case of Mistaken Identity: Herpes Encephalitis, I Presume?

Case Presentation: A 73‐year old woman presented with altered mental status after being found minimally responsive. She was awake but diaphoretic, ill appearing and unable to cooperate. Her temperature was 105°F (40.6°C). Her cardiovascular, pulmonary, [...]

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HM2013 Abstract Number: 216

Recurrent Kikuchi's Disease in an African American Man

Case Presentation: A 43‐year‐old African American man presented to the emergency department with a 1‐week history fever up to 104°F and worsening frontal headaches. For 6 months prior to presentation, he had had intermittent episodes [...]

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HM2013 Abstract Number: 213

A Hidden Bleed

Case Presentation: A 77‐year‐old man with laryngeal squamous cell carcinoma presented with shortness of breath and pleuritic chest pain. He was diagnosed with a pulmonary embolism and started on a heparin infusion. Following multiple failed [...]

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HM2013 Abstract Number: 214

A Sinister Synergy: Heparin‐Induced Thrombocytopenia and Bilateral Adrenal Hemorrhage

Case Presentation: A 57‐year‐old woman who had undergone an elective total knee replacement 9 days earlier presented to the ED with 1 day of progressive, diffuse abdominal pain, nausea, and fevers. Her postoperative course had [...]

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HM2013 Abstract Number: 211

You Can Teach an Old Stroke New Tricks

Case Presentation: An 82‐year‐old woman came to the emergency department with pleuritic chest pain, cough, and fever. On arrival, she was found to have aphasia and right‐sided hemiparesis. Her family noted that she was normal [...]

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HM2013 Abstract Number: 212

This Isn't Child's Play: Transient Intussusception in Adults

Case Presentation: A 22‐year‐old man was admitted with intractable nausea, vomiting, and abdominal pain for 7 hours. He was visiting New Orleans and reported consuming 4–6 beers prior to onset. He described the pain as [...]

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HM2013 Abstract Number: 209

Steroid Refractory Drug Reaction: Time to Readdress

Case Presentation: A 58‐year‐old African American man presented to our hospital with confusion, diffuse morbiliform rash, facial edema, fever to 41.1°C, leukocytosis with eosinophilia, acute kidney injury, transaminitis, and elevated creatinine kinase. Extensive evaluation for [...]

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HM2013 Abstract Number: 210

Zonegran? More Like Zonegrain

Case Presentation: A 64‐year‐old man with a history of seizure disorder presented to the hospital with increased seizure activity. No preceding illness was noted. He had been treated with phenytoin and phenobarbital and was adherent [...]

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HM2013 Abstract Number: 207

A Belly Full of Blood!!

Case Presentation: A 73‐year‐old obese white man with a medical history of hypertension, asthma, and diverticulosis was brought to the emergency department for sudden‐onset severe left lower quadrant abdominal pain, nausea, vomiting, and diaphoresis. The [...]

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HM2013 Abstract Number: 208

The Perilous Pearl

Case Presentation: A 41‐year‐old white woman was evaluated in an outpatient clinic 4 hours after her friend observed that she had slurred speech and facial droop for 30–40 seconds that spontaneously resolved. She denied any [...]

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HM2013 Abstract Number: 205

Hypertensive Crisis Causing Acute Myocardial Ischemic Injury After Subcutaneous Injection of Glatiramer Acetate

Case Presentation: A 47‐year‐old white man with a history of multiple sclerosis (MS) presented to the emergency room with complaints of headache, chest discomfort, and cough with frothy bloody secretions approximately 30 minutes after subcutaneous [...]

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HM2013 Abstract Number: 206

A Case of Recurrent Fever

Case Presentation: A 6‐year‐old white male was admitted with decreased intake due to 6 weeks of recurring painful oral ulcers. He endorsed arthralgia and abdominal pain and at the onset had fevers of 102°F–103°F. In [...]

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HM2013 Abstract Number: 203

Good Syndrome

Case Presentation: A 62‐year‐old man was admitted to the hospital for shortness of breath, weaknessb and chills. In addition, he complained of loss of appetite resulting in weight loss. The patient had a history of [...]

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HM2013 Abstract Number: 204

A Rare Case of Relapse of Chronic Inflammatory Demyelinating Polyneuropathy After Influenza Vaccine

Case Presentation: A 78‐year‐old man with a medical history of atrial fibrillation presented with complaints of 5 days of severe generalized weakness and difficulty walking. He also reported difficulty in getting up from a chair [...]

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HM2013 Abstract Number: 201

Lumps and Bumps … and Mumps?

Case Presentation: A 22‐year‐old woman presented with 2 weeks of fevers, nonproductive cough, and a left‐sided neck mass. Her medical history included systemic lupus erythematosus, currently managed by 5 mg of prednisolone daily. She was [...]

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HM2013 Abstract Number: 302

Ninety‐Year‐Old Evaluated by Medical Consult for Postoperative Hypotension

Case Presentation: A 90‐year‐old woman with a medical history significant for upper‐extremity DVT provoked by a central venous catheter and ileostomy history of sepsis secondary to C. difficile colitis was admitted to the hospital for [...]

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HM2013 Abstract Number: 299

Iliacus Hematoma Presenting As Femoral Nerve Palsy

Case Presentation: A 77‐year‐old white woman with a history of pulmonary embolisms on chronic Coumadin therapy and an elective left hip arthroplasty 3.5 weeks prior to admission presented with progressive numbness on the anterior aspect [...]

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HM2013 Abstract Number: 202

Flying Is Not Always Fun!

Case Presentation: A 58‐year‐old man with a medical history significant for hypertension presented with bilateral arm weakness and numbness. The symptoms started when he was flying in a 2‐seated plane at an altitude of 25,000 [...]

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HM2013 Abstract Number: 199

A Surprise from Behind

Case Presentation: A 69‐year‐old woman with a history of pancreatic cancer and degenerative disk disease was admitted for an evaluation of cholestatic liver disease and 70 pound weight loss. On day two of hospitalization, she [...]

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HM2013 Abstract Number: 200

Gone but Not Forgotten

Case Presentation: A 38‐year‐old otherwise healthy Laotian refugee presented with a week of fevers, cough, and hemoptysis. He had initially been treated for pneumonia but soon developed progressive headache, somnolence, and myoclonic jerks. Basic labs [...]

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HM2013 Abstract Number: 197

A “Hole” Lot of Problems

Case Presentation: A 35‐year‐old man from Louisiana presented with 1 day of sharp and constant right lateral chest pain. The patient noted a similar pain in the right upper chest 2 weeks prior that had [...]

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HM2013 Abstract Number: 300

Not Just Another Case of Uti

Case Presentation: A 50‐year‐old woman with Down syndrome mental disability presented with acute confusion and diarrhea. She was hypotensive, tachycardic, and in acute renal failure. Patient was admitted to the ICU for septic shock secondary [...]

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HM2013 Abstract Number: 297

Not Every Granuloma Is Tb

Case Presentation: A 35‐year‐old woman presented with moderate body aches, cough, dyspnea, chills, fever, nausea, and vomiting. Patient had a Groshong catheter in place for total parenteral nutrition because of short bowel syndrome following gastric [...]

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HM2013 Abstract Number: 298

When the Proof Is Not in the Pudding

Case Presentation: A 73‐year‐old man presented with fever, cough, expectoration, and weight loss for 2 months. Chest CT demonstrated a moderately thick‐walled irregular cavitary lesion in the left lung upper lobe, suspicious for abscess versus [...]

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HM2013 Abstract Number: 295

A Rare Case of Paget–Schroetter Syndrome in a Young Healthy Weight Lifter

Case Presentation: A 29‐year‐old heavyweight lifter presented with the complaint of right upper‐extremity swelling and pain for 1 day. There was no personal or family history of venous thromboembolism or malignancy. Physical examination revealed a [...]

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HM2013 Abstract Number: 296

Leser–Trelat Syndrome and Glioblastoma

Case Presentation: A 77‐year‐old African American man with no significant medical history was admitted for progressive memory loss and confusion. A CT without contrast was performed as part of the dementia workup, which showed bilateral [...]

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HM2013 Abstract Number: 293

Recurrent Unexplained Encephalopathy, a Case of Mollaret's Meningitis

Case Presentation: A 57‐year‐old woman with a history of herpes encephalitis and residual right temporal lobe encephalomalacia (diagnosed 9 years prior to our encounter) presented to the emergency department on 2 separate occasions 1 month [...]

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HM2013 Abstract Number: 294

Case of the Chicken or the Egg: Breast Cancer and Lung Cancer — Which One Is the Primary?

Case Presentation: A 73‐year‐old African American man presented with productive cough and shortness of breath for 2½ weeks. He was ex‐smoker with about a 30‐pack‐per‐year history and family history of lung cancer. On presentation, vital [...]

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HM2013 Abstract Number: 291

Acute Kidney Injury Due to Oxalate Nephropathy

Case Presentation: A 52‐year‐old man with a history of obesity with Roux‐en‐Y gastric bypass (RYGB) in 2002, chronic back pain, diabetes, hypertension, and benign prostatic hypertrophy presented with 1 day of alteration in mental status [...]

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HM2013 Abstract Number: 292

Speechless Extubation: A Case Report of Bilateral Hypoglossal Nerve Paralysis After Intubation

Case Presentation: A 63‐year‐old morbidly obese woman with no known medical history presented emergently with worsening shortness of breath. She had a CT scan of the abdomen, which showed free intraperitoneal air. Because of her [...]

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HM2013 Abstract Number: 289

Lung Cavities in the Young and Healthy: Lemierre's Syndrome Can Still Do It

Case Presentation: Lemierre's syndrome is a rare form of thrombophlebitis, usually associated with tonsillitis and peritonsillar abscess, which can harbor anaerobic bacteria (most commonly Fusobacterium necrophorum). Deep to the abscess, the bacteria can grow and [...]

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HM2013 Abstract Number: 290

Bedside Lung Ultrasound: The Hospitalist's New Best Friend

Case Presentation: An 88‐year‐old man with a medical history of atrial fibrillation presented with dyspnea for 1 week. He endorsed bilateral leg edema, orthopnea, and productive cough of pinkish sputum. He denied fevers, chest pain, [...]

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HM2013 Abstract Number: 287

Emphysematous Gastritis Secondary to Adenocarcinoma of the Duodenum

Case Presentation: A 60‐year‐old man with a medical history significant for chronic HCV infection with treatment failure complicated by cirrhosis (Child–Pugh class B) presented to our institution with a 3‐week history of nausea, nonbilious, nonbloody [...]

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HM2013 Abstract Number: 288

An Unusual Cause of Pleuritic Chest Pain

Case Presentation: A 43‐year‐old woman presented with acute pleuritic chest pain and shortness of breath. She had no medical history or medications besides day 6 of 7 of nitrofurantoin for UTI. She had had a [...]

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HM2013 Abstract Number: 285

Hepatitis E Virus: Case Report and Literature Review

Case Presentation: A 48‐year‐old white man with a medical history significant for 30 years of alcohol abuse presented for alcohol detoxification. At admission, he noted 1 week of fevers and fatigue; he had no abdominal [...]

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HM2013 Abstract Number: 286

Coexistence of Takayasu's Arteritis and Rheumatoid Arthritis: An Unusual Cause of Abdominal Pain

Case Presentation: The patient was a 24‐year‐old white woman with a history of rheumatoid arthritis diagnosed 1 year ago. She presented with symptoms of diffuse postprandial abdominal pain, nausea, and generalized fatigue for a few [...]

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HM2013 Abstract Number: 283

Acquired Factor Viii Deficiency: A Rare but Overlooked Bleeding Diathesis

Case Presentation: An 81‐year‐old woman presented with a 5‐day history of worsening left upper‐extremity edema in the absence of trauma. On admission, vitals signs were stable, and physical exam was remarkable for ecchymosis and nonpitting [...]

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HM2013 Abstract Number: 284

Topical Steroids: Not so Quick with That Prescription Pad — It Can Be Too Much of a Good Thing

Case Presentation: A 48‐year‐old man with a 1‐year history of generalized pruritic rash presented with lethargy. His temperature was 99°F, pulse 80, and blood pressure 141/99 mm Hg. Exam revealed a regular heart beat, clear [...]

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HM2013 Abstract Number: 281

Why Can't I Move? A Case of Hypokalemic Paralysis As the Initial Presentation of SjÖgren's Syndrome

Case Presentation: A 51‐year‐old woman presented with worsening bilateral upper‐ and lower‐extremity weakness and difficulty walking for 2 weeks. She denied fevers, back pain, bowel and fecal incontinence, but reported oral and ocular dryness for [...]

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HM2013 Abstract Number: 282

Type B Lactic Acidosis in Chronic Lymphocytic Leukemia

Case Presentation: A 71‐year‐old man with stage IV chronic lymphocytic leukemia (CLL), hypertension, and diabetes mellitus was admitted to the hospital medicine service for the evaluation of 2 weeks of generalized weakness, anorexia, and mild [...]

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HM2013 Abstract Number: 279

When Failure to Meet Diagnostic Criteria Is Not a Diagnostic Failure

Case Presentation: A 7‐year‐old previously healthy male initially presented with neck pain and myalgias. Subsequently he developed a constellation of fever, abdominal pain, and intermittent rash. He received doxycycline for presumed tick‐borne illness with no [...]

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HM2013 Abstract Number: 280

Livin' with Liven (Levamisole‐Induced Vasculopathy Ecchymosis/necrosis)

Case Presentation: A 50‐year‐old woman with recurrent cocaine abuse and chronic hepatitis C presented to the hospital with a 3‐day history of rapidly expanding purpuric lesions on her bilateral cheeks, ears, and right thigh. She [...]

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HM2013 Abstract Number: 277

Oligosecretory Multiple Myeloma Presenting As Intracranial Plasmacytoma

Case Presentation: A 38‐year‐old hypertensive woman presented to the ED due to rapidity of her neurologic symptoms. She reported 3 months of frontal headaches, partially relieved with ibuprofen, a 2‐month history of anosmia, and a [...]

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HM2013 Abstract Number: 278

Autoimmune Polyglandular Syndrome Type Ii: An Unusual Cause of Syncope

Case Presentation: A 33‐year‐old woman presented to the emergency department after a syncopal episode. She endorsed dizziness on standing and palpitations prior to the event. Her review of systems was notable for the following: 2 [...]

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HM2013 Abstract Number: 275

Don't Leave Out Lofgrens

Case Presentation: A 34‐year‐old woman presented to the ED with pain and swelling of the wrists and ankles for 6 days. The patient noted a worsening of symptoms over the course of the week had [...]

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HM2013 Abstract Number: 276

Management of Cutaneous Necrotizing Vasculitis in the Setting of Community‐Acquired Pneumonia

Case Presentation: A 47‐year‐old female smoker presented to the emergency department for right rib pain for 4 days. She had nausea, nonbloody and nonbilious emesis, nonproductive cough, and sore throat. She denied fever, headaches, dizziness, [...]

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HM2013 Abstract Number: 273

Clopidogrel Overdose: A Case Report and Literature Review

Case Presentation: A 54‐year‐old woman with hyperlipidemia and prior transient ischemic attack (TIA) 2 months ago presented to our hospital with vaginal bleeding after an intentional overdose of a study drug of clopidogrel versus placebo. [...]

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HM2013 Abstract Number: 274

Neurenteric Cyst of the Area Postrema — a Case Report

Case Presentation: This 34‐year‐old woman presented with an 8‐month history of frequent emergency department visits related to episodically severe and progressively frequent nausea, vomiting, and abdominal pain. She had no neurological symptoms at the time. [...]

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HM2013 Abstract Number: 271

A Case of Cardiobacterium Hominis Prosthetic Valve Endocarditis

Case Presentation: The patient is a 64‐year‐old white man with coronary artery disease and a remote history of coronary artery bypass graft 17 years ago. Eighteen months prior to admission, he underwent a repeat sternotomy [...]

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HM2013 Abstract Number: 272

Role of Chemotherapy in Sweat Gland Cancer

Case Presentation: A 51‐year‐old man presents to the emergency department with shortness of breath for 2 days. In 2008, 4 years prior to presentation, the patient had a red papular 4‐cm painful mass on the [...]

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HM2013 Abstract Number: 269

Finally a Diagnosis Without a Grave Prognosis

Case Presentation: An 83‐year‐old woman was noted to have gradual cognitive decline over the past year. Because of the need for increasing supervision and assistance with ADLs, she was moved to live with her son. [...]

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HM2013 Abstract Number: 270

A Word Is Worth a Thousand Pictures: Timely Communication to Avoid Delays in Urgent Diagnostic Imaging

Case Presentation: Day 1 — A 41‐year‐old woman presented with 1 week of progressive neck pain and 2 days of fevers and chills. Her medical history included AIDS (CD4 count of 49) and ESRD requiring [...]

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HM2013 Abstract Number: 267

A Rare Case of Pustular Psoriasis and Vancomycin‐Induced Linear Iga Disease Mimicking Ten

Case Presentation: A 77‐year‐old woman with a remote history of mild psoriasis, previously controlled with topical medication, presented with erythema of her left forearm and a scaly rash, worse on her thighs. She had multiple [...]

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HM2013 Abstract Number: 268

Forgotten Cause of Forgetfulness: A Case Report and Literature Review

Case Presentation: A 64‐year‐old man presented with 12 days of altered mental status that began with a severe left‐sided headache and progressed to include expressive aphasia, unfamiliarity in well‐known places, falling, and fecal incontinence. He [...]

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HM2013 Abstract Number: 265

How Low Can You Go? Treating Anemia in the Setting of Hyperleukocytosis

Case Presentation: A 57‐year‐old man with previously untreated Rai stage IV chronic lymphocytic leukemia presented with severe dyspnea on exertion over the last 3 months. He also noted pulsatile tinnitus, lower leg pains with walking, [...]

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HM2013 Abstract Number: 266

When Opportunity Arises

Case Presentation: A 28‐year‐old woman presented with 3 days of fevers. She also noted headache and dyspnea on exertion. She denied cough, chest pain, vision changes, or neurologic deficits. She had grade III oligoastrocytoma status [...]

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HM2013 Abstract Number: 263

Acute Calcific Periarthritis Presenting in a Woman with Hyperthyroidism and Normocalcemia

Case Presentation: A 24‐year‐old woman presented to our emergency department with right fifth‐finger metacarpophalangeal (MCP) pain. She had a history of overt hyperthyroidism and had self‐discontinued her methimazole several years prior to admission, and had [...]

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HM2013 Abstract Number: 264

It's Not Reefer Madness!

Case Presentation: A 25‐year‐old man, diagnosed with systemic lupus erythematous (SLE) 6 months prior and undergoing a workup for LUPUS NEPHRITIS, was brought to the emergency department by his family for weakness and altered mental [...]

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HM2013 Abstract Number: 261

A Split Decision: Unmasking Immunobullous Skin Disease

Case Presentation: This is a 93‐year‐old woman who presented with a 1‐day history of dyspnea and was subsequently found to have pneumonia. Her medical history was significant for diastolic congestive heart failure, atrial fibrillation, and [...]

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HM2013 Abstract Number: 262

Outside‐In or Inside‐Out

Case Presentation: A 45‐year‐old man with history of hepatitis C presented with a 7‐day history of worsening pain in his right arm and chest. His symptoms initially began as a sharp stabbing pain in his [...]

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HM2013 Abstract Number: 259

Acute Ataxia with Negative Neuroimaging: Consider an Uncommon Polyneuropathy

Case Presentation: A 68‐year‐old man with history of remote ischemic stroke, diabetes, and tobacco abuse presented to a community hospital with a complaint of ataxia. He had fallen to the floor after arising from sleep [...]

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HM2013 Abstract Number: 260

Disseminated Coccidimycosis Masquerading As Pott's Disease

Case Presentation: A young African American man with no medical history presented with 4 months of progressive mid–low back pain along with 1 week of right leg and foot pain, numbness, and weakness. He described [...]

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HM2013 Abstract Number: 257

A Blast from the Past Sent Straight to the Heart

Case Presentation: A 45‐year‐old man with no medical history presented with a 3‐week history of progressively worsening chest pain. The pain was sharp, exertional, and worsened by lying flat. He denied fever, chills, or recent [...]

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HM2013 Abstract Number: 258

Hemophagocytic Lymphohistiocytosis: Two Patients with This Increasingly Recognized Secondary Phenomenon

Case Presentation: Patient 1 is a 22‐year‐old man with no medical history who presented with progressively worsening fevers, severe nausea, and nonbloody severe emesis with a diagnosis of infectious mononucleosis. The patient had fevers to [...]

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HM2013 Abstract Number: 255

Diagnose or Die: Look No Further Than the Name

Case Presentation: A 30‐year‐old man with history of HIV and metastatic Kaposi sarcoma presented with 3 days of worsening pain, bilateral swelling, and progressive purplish discoloration of his lower extremities. Initial blood pressure was 95/56 [...]

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HM2013 Abstract Number: 198

Babesiosis in the Absence of Tick Exposure: A Case Report in Queens

Case Presentation: A 61‐year‐old visiting Trinidadian woman with squamous‐cell rectal cancer and hypertension who had received multiple courses of chemotherapy and radiation therapy beginning in May 2012 and was hospitalized in July 2012 at a [...]

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HM2013 Abstract Number: 195

Thrombotic Thrombocytopenic Purpura — It's More Than Just the Pentad

Case Presentation: A 65‐year‐old woman presented with acute right flank pain. A CT scan of her abdomen revealed a 4.7‐cm right renal infarction. The patient was hospitalized for 5 days during which her pain resolved. [...]

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HM2013 Abstract Number: 196

Blood Is Not the Only Option: Managing Life‐Threatening Anemia in a Jehovah's Witness

Case Presentation: A 55‐year‐old Jehovah's Witness with poorly controlled ulcerative colitis on azathioprine and essential thrombocytosis on hydroxyurea was transferred with 4 days of symptomatic anemia, declining blood transfusion. Her hemoglobin (Hgb) was 5.1 g/dL [...]

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HM2013 Abstract Number: 193

Ataxia and Rash in a Patient Undergoing Hepatitis C Treatment

Case Presentation: A 60‐year‐old man with hepatitis C and gout presented to our hospital with rash and ataxia. He was on week 10 of treatment for hepatitis C with peginterferon, ribavirin, and telaprevir. One week [...]

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HM2013 Abstract Number: 194

Use of Electronic Control Device (Taser) Associated with Cardiac Arrest and Severe Anoxic Brain Injury

Case Presentation: A 44‐year‐old man was reported to be wandering naked in the streets of his town and behaving erratically. Police were summoned. He was evasive and combative when officers attempted to apprehend him, leading [...]

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HM2013 Abstract Number: 191

Primary Thoracic Ewing's Sarcoma — a Case Report with Unusual Presentation

Case Presentation: A 33‐year‐old otherwise healthy white man came to our clinic for evaluation of chronic sinus congestion, cough, and occasional chills. On review of symptoms he reported some diminished exercise tolerance over the past [...]

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HM2013 Abstract Number: 192

Bugs, Drugs, or Immune System Flubs — What Causes Limbic Encephalitis? Moreover, What Causes Anti‐N‐Methyl‐D‐Aspartate Receptor Encephalitis?

Case Presentation: A 27‐year‐old woman, initially admitted to the inpatient psychiatry service for psychosis, progressed to catatonia, autonomic dysfunction, and respiratory failure requiring tracheostomy. Her medical history was significant solely for polysubstance abuse including methamphetamines. [...]

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HM2013 Abstract Number: 189

Devil in the Details: A Rare Cancer Masquerading As Common Symptoms

Case Presentation: A 77‐year‐old white man presented to our institution after he was diagnosed with a large right‐sided pleural effusion. His medical history included hypertension, type 2 diabetes mellitus, and urethral stricture. He was initially [...]

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HM2013 Abstract Number: 190

HIV‐Induced Thrombotic Microangiopathy — a Different Approach to Treatment

Case Presentation: A 44‐year‐old African American man with AIDS and noncompliant with highly active antiretroviral therapy (HAART) presented with altered mental status. He also had history of uncontrolled hypertension, pneumocystis jiroveci pneumonia, lichen simplex chronicus, [...]

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HM2013 Abstract Number: 187

Ultrasound for Thoracentesis and Paracentesis: Can You Teach a Hospitalist a New Trick?

Background: Paracentesis and thoracentesis are among the most common procedures performed by hospitalists. Though many hospitalists feel comfortable with these procedures, there are several reasons to use ultrasound for these procedures: (1) the literature supports [...]

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HM2013 Abstract Number: 188

Common Can Be Commonly Missed: Common Variable Immunodeficiency in Hospital Medicine

Case Presentation: D.H. is a 16‐year‐old Hispanic female who presented as a referral from an outside hospital for pancytopenia and splenomegaly. The patient initially presented with abdominal pain to the emergency room. She was admitted [...]

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HM2013 Abstract Number: 185

Academic Detailing to Teach Aging and Geriatrics

Background: Detailing has been employed by the pharmaceutical sales industry to increase physician knowledge about new medications. Work‐hour rules and hectic schedules have challenged residency training programs to develop and utilize efficient and effective teaching [...]

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HM2013 Abstract Number: 186

Academic Hospitalists On‐Boarding Mentor Program Evaluation

Background: Mentoring relationships among physicians in academic medicine have been implemented to facilitate scholarly productivity, faculty development, and retention. Mentorships have been shown to encourage productive activity (e.g., peer‐reviewed publications), drive career advancement (e.g., faculty [...]

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HM2013 Abstract Number: 183

An Evidence‐Based Approach to Curriculum Development in Consultative Medicine

Background: The ability to effectively practice consultative medicine is increasingly important. The increase in medical specialization, as well as an increasing number of providers responsible for patient care, makes this particularly evident in inpatient settings. [...]

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HM2013 Abstract Number: 184

Copd 30‐Day Readmission Reduction Initiative

Background: Chronic obstructive pulmonary disease (COPD) is a major public health problem. The Global Burden of Disease Study has projected that COPD will become the third‐leading cause of death worldwide by 2020. In developed countries, [...]

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HM2013 Abstract Number: 181

Beyond Attestation: Functional Enhancements to a Medication Reconciliation System to Improve Medication Safety at Discharge

Background: Medication discrepancies are a cause of avoidable harm when patients are discharged from the hospital. As such, the Joint Commission has made medication reconciliation at discharge a requirement for hospital accreditation. However, in practice, [...]

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HM2013 Abstract Number: 182

Sudden Unexpected Infant Death Education and Risk Reduction

Background: Sudden infant death syndrome (SIDS) is the death of an infant younger than 1 year of age with the cause of death unknown even after a complete autopsy and investigation. SIDS is the leading [...]

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HM2013 Abstract Number: 179

Implementation of a Piloted Risk Assessment Tool and Electronic Order Set for Venous Thromboembolism Prevention in a Tertiary Children's Hospital

Background: There is a dearth of clinical practice guidelines for the prevention of venous thromboembolism (VTE) in hospitalized pediatric patients. Despite a lower incidence of VTE in the pediatric population as compared with adults, thrombosis [...]

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HM2013 Abstract Number: 180

Using Electronic Chart Documentation to Increase HIV Test Offers and Possible Detection of Disease

Background: HIV remains a public health risk, with a high rate of transmission by people unaware they are infected with the virus. Although in New York State it has become law to offer testing at [...]

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HM2013 Abstract Number: 177

Development of a Hospitalist Committee Focused on Improving Health Care Value

Background: Many policy initiatives, such as Medicare's Value‐Based Purchasing program and the promotion of accountable care organizations, explicitly seek to realign hospitals' financial incentives from a focus on production to one on value (quality divided [...]

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HM2013 Abstract Number: 178

Nebs No More After 24: Improving Use of Appropriate Respiratory Services

Background: Nebulized bronchodilator therapies (“nebs”) are commonly used in the inpatient setting for the treatment of obstructive pulmonary symptoms. Neb administration, however, requires direct respiratory therapist (RT) care, making them a resource‐intensive therapy. Metered dose [...]

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HM2013 Abstract Number: 175

A Unique Hospitalist/pain Management Collaboration to Improve Pain Outcomes

Background: Pain management is complex, and multiple variables may affect pain relief for patients. It is estimated that roughly 40% of hospitalized patients experience moderate to severe pain. Because hospitalists now care for an increasing [...]

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HM2013 Abstract Number: 176

Understanding the Root Cause of Pneumonia Readmissions at an Urban Medical Center

Background: Hospital readmissions continue to pose a challenge for many hospitals across the country. With the implementation of financial penalties for high rates of 30‐day readmissions in October 2012, hospitals stand to forfeit more than [...]

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HM2013 Abstract Number: 173

Impact of a Multidisciplinary Safety Checklist on the Rate of Preventable Hospital Complications and Standardization of Care

Background: Hospitalized patients are at risk for a number of preventable complications. Utilization of indwelling urinary catheters (IUCs) and central venous catheters (CVCs) can increase the risk of infection while provision of venous thromboembolism (VTE) [...]

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HM2013 Abstract Number: 174

Making Pain Visible and Actionable: The Live View Reporting Tool

Background: Pain management is a key quality indicator in hospital satisfaction surveys throughout the United States. Inadequate pain management contributes to longer inpatient length of stay, medical complications, inadequate healing, and dissatisfaction with the hospital [...]

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HM2013 Abstract Number: 171

Presumed Versus Confirmed Full Code

Background: Many problems exist regarding inpatient code status: advance directives are rarely completed in outpatient and inpatient settings, patients' preferences regarding code status are often not elicited, physicians do not provide adequate information to allow [...]

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HM2013 Abstract Number: 172

An Effective Strategy for Enhancing Clinical Documentation

Background: Documentation in the medical chart is important to ensure that severity of patient illness and case complexity is accurately reflected. Ambiguous language and inconsistencies between provider notes can lead to inaccurate coding, resulting in [...]

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HM2013 Abstract Number: 169

Oppe/pi‐Cme: Alphabet Soup You Have to Try!

Background: The field of medicine is continuously evolving. Hospital medicine is in the forefront of transforming care delivery. To continuously improve practice, hospitalists need to participate in accredited continuing medical education (CME). Accredited CME is [...]

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HM2013 Abstract Number: 170

Improving Appropriateness of Physical Therapy Consultation Through Education and Interdisciplinary Collaboration

Background: Physical and occupational therapy (PT/OT) services are a limited resource in the inpatient setting. PT/OT consults ordered by resident physicians on patients who do not need them take time and resources away from patients [...]

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HM2013 Abstract Number: 167

Implementation of a Computerized Copd Inpatient Pathway and Transition Pathway

Background: Chronic obstructive pulmonary disease (COPD) exacerbations occur in a significant proportion of hospitalizations but are often treated with substandard care. This may include inappropriate use of medications during and after hospitalization and failing to [...]

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HM2013 Abstract Number: 168

Teaching Essential Skills: Training Medical Students in Quality Improvement, Procedures, and Transitions of Care

Background: Medical school educators are charged with providing students the tools needed to succeed as physicians. Trainees begin residency with a knowledge base shaped by individual experiences and with an awareness of both strengths and [...]

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HM2013 Abstract Number: 165

Enhancing the Preoperative Medical Assessment Process

Background: Adverse outcomes in surgery account for up to $25 billion expenditure annually. This is despite spending >$30 billion annually on preop testing. Although algorithms and checklists have improved outcomes in a pocketful of areas [...]

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HM2013 Abstract Number: 166

Morbidity and Mortality Conference for Modern Medicine: Moving to the Sharp End

Background: Training in quality improvement (QI) is an essential part of residency and medical practice. Critical to this is accepting that human infallibility is impossible, and we need to shift the culture of medicine from [...]

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HM2013 Abstract Number: 163

Getting Hip to Vitamin D: A Hospitalist Project for Improving Assessment of and Treatment for Vitamin D Deficiency in Elderly Patients Undergoing Hip Fracture Surgery

Background: Vitamin D deficiency is common in elderly patients with low‐trauma hip fractures, and major practice guidelines recommend screening for deficiency in this population. Our hospitalist group directly cares for all patients with acute hip [...]

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HM2013 Abstract Number: 164

A Collaborative Inpatient Education Initiative to Reduce Hospital Readmissions

Background: Our facility's 30‐day hospital readmission rate is 18%, which is higher than the accepted rate of 13%. Research shows that interventions emphasizing education on disease self‐management and symptom awareness significantly reduces readmissions. Purpose: Our [...]

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HM2013 Abstract Number: 161

A New Foundation for Clinical Leadership — Teaching Residents Health Systems Operations

Background: Although educational programs for health care trainees increasingly emphasize quality improvement and patient safety, a substantial gap exists between teaching and meaningful change. Because of ACGME mandates, residents and fellows in the United States [...]

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HM2013 Abstract Number: 162

The Night Float System and Implications on Patient Safety: Minimizing Overnight Medical Mistakes by Adopting Institution‐Specific Educational Programs

Background: In light of the new ACGME intern duty‐hour restrictions, many internal medicine residency programs have turned to an intern night‐float system. This system intrinsically brings with it a number of patient safety issues related [...]

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HM2013 Abstract Number: 159

Stress Ulcer Prophylaxis: Pilot Project to Reduce Inappropriate Use in the Intensive Care Unit

Background: Stress ulcer prophylaxis (SUP) is overused in the intensive care setting. Acid suppression therapy has been associated with multiple adverse effects including increased risk of nosocomial pneumonia and Clostridium difficile colitis. Reduction in the [...]

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HM2013 Abstract Number: 160

Using a Facilitated Check‐In Rounds to Identify Diagnostic Errors and Assess Resource Utilization

Background: The diagnostic process can be difficult but is an important aspect of the work for most physicians. Although there has been much cognitive research into defining type I and type II thinking, this process [...]

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HM2013 Abstract Number: 157

Standard for Pager‐Based Communication Improves Satisfaction and Efficiency for Hospitalists and Nurses

Background: On the nonteaching service at a large metropolitan teaching hospital, hospitalists were frustrated by inefficient pager‐based communication from nurses frequently consisting of “call back number only” pages in which no other information was communicated [...]

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HM2013 Abstract Number: 158

Implementation of Hospital‐Based Clinical Performance Metrics Teaching Sessions for Medicine Residents on Duke General Medicine

Background: Medicine residents have limited exposure to some of the common topics in quality improvement and clinical performance. One identified need in their education was promoting knowledge of how inpatient clinical performance is measured. Purpose: [...]

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HM2013 Abstract Number: 155

Implementing Hospital‐Wide Unit‐Based Assignment and Bedside Rounds to Improve Care

Background: At this 328‐bed hospital there were 8 hospitalists rounding on up to 9 units per day. This prevented efficient and effective communication with nurses, patients, and families. Physicians spent more than 30 minutes of [...]

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HM2013 Abstract Number: 156

An Organized Patient Blood Management Program Contributes to Reduction in Transfusion of Hospitalized Patients

Background: Donor blood transfusion has been a frequently used treatment modality for a wide variety of clinical situations in hospitalized patients for decades. Despite it being one of the most commonly performed medical procedures, with [...]

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HM2013 Abstract Number: 153

Appropriate Rbc Transfusions in the Intensive Care Setting: A Quality Improvement Initiative

Background: Transfusion practices vary worldwide given the diverse clinical situations necessitating transfusions. More than 1.32 million packed red blood cell (pRBC) units are transfused annually in the United States. Given the infectious and noninfectious risks [...]

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HM2013 Abstract Number: 154

Take a Seat: An Innovation to Encourage Seated Dialogue on Physician Rounds

Background: Patient satisfaction has been linked to improved compliance with medication instructions and physician recommendations, as well as enhanced clinical outcomes. Previous studies have shown that when physicians sit, patients perceive they spend 40% longer [...]

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HM2013 Abstract Number: 151

Postdischarge Clinics: Attitudes and Experiences of Hospitalists

Background: Hospitalist‐run postdischarge clinics (PDCs), clinics created to care for recently discharged patients, hold promise for improving access to care and reducing errors during transitions in care. However, these clinics require hospitalists to extend the [...]

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HM2013 Abstract Number: 152

Who Gets the Next Admission? An Innovation to Create a Systematic Process for Team Assignment While Improving Patient Handoffs

Background: With recent duty‐hour restrictions for internal medicine residencies, hospitals are increasingly hiring hospitalists to meet the demand of higher patient volumes not on the teaching services. This creates an interesting dilemma about how newly [...]

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HM2013 Abstract Number: 149

A Va Hospitalist‐Run Postdischarge Clinic: Patient Outcomes and Lessons Learned

Background: Readmission to the hospital shortly after discharge is common and costly. Reducing preventable hospital readmissions would improve health care quality and reduce costs. New models for providing care during the crucial first few weeks [...]

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HM2013 Abstract Number: 150

Feasibility and Efficacy of a Specialized Pilot Training Program to Enhance Inpatient Communication Skills of Hospitalists

Background: With the advent of value‐based purchasing (VBP), the importance of high‐quality communication skills among hospitalists is receiving greater scrutiny. Purpose: To describe a hospitalist training program using a behavioral bundle (AIDET) to improve patient [...]

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HM2013 Abstract Number: 147

Use of a Multidisciplinary Team Approach to Help Patients Transition Home Safely

Background: A significant amount of information crucial to patients' recovery is given at the time of hospital discharge. Studies have shown that patients have difficulty remembering all the instructions given during their hospital stay. Much [...]

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HM2013 Abstract Number: 148

Impact of Language Discordance on Patient Satisfaction of Physician Care in the Inpatient Setting

Background: Patient satisfaction has attracted increasing attention as a surrogate indicator for quality of care and as a component of the new physician compensation structure. Interpersonal patient–physician relationships, a component of patient satisfaction, may be [...]

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HM2013 Abstract Number: 145

The Development of Best Practices for Writing Discharge Summaries in an Ehr

Background: Optimizing transitions of care (TOCs) has become a clear focus of national health care goals. The discharge (DC) summary is arguably the most important document in the TOC for a hospitalized patient. Ideally, it [...]

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HM2013 Abstract Number: 146

Reducing Copd Readmissions: Building Successful Transitions of Care to Skilled Nurse Facilities (Snfs) and Visiting Nurse Associations (Vnas)

Background: The reported 30‐day rehospitalization rate of 22.6% for patients with chronic obstructive pulmonary disease (COPD) ranks third in most frequent causes of hospital readmissions. Beginning on October 1, 2015, Medicare reimbursement will be reduced [...]

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HM2013 Abstract Number: 143

Transitions of Care from the Hospitalist to the “Snfist”: A Campaign to Improve Communication and Reduce Readmissions

Background: Patients discharged to a skilled nursing facility (SNF) are at significantly higher risk of readmission within 30 days. For hospitalists at the Cleveland Clinic, the rate in 2012 to date is 25.8%. The physician [...]

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HM2013 Abstract Number: 144

Development of Best‐Practice Guidelines for Improving the Quality of Provider Documentation in an Electronic Health Record

Background: Although there are a number of advantages to documenting in an electronic health record (EHR), such as legibility and accessibility, providers nationally have observed that aspects of the quality of provider documentation decline after [...]

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HM2013 Abstract Number: 141

Development and Application of Information Technology Solutions to Improve the Quality and Availability of Discharge Summaries

Background: The discharge summary functions as the most common form of communication between hospitalists and outpatient physicians when hospitalized patients are discharged. Unfortunately, discharge summaries frequently lack important information and are not made available to [...]

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HM2013 Abstract Number: 142

Ipads for Hospitalized Patients: The Inpatient Technology Outreach Unifying Communication and Health (In‐Touch) Pilot Project

Background: For many patients, hospitalization involves substantial inactive time between provider visits, tests, and treatments. This time could be used to engage patients in discharge preparation by (1) learning about their health conditions and (2) [...]

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HM2013 Abstract Number: 139

Integrating Transitions of Care Into Development of Acos: The Role of Hospitalists in a Statewide Multisite Collaborative

Background: As hospitals work to reduce avoidable hospital readmission rates, health care delivery systems more broadly have been working to develop efficient, effective health care delivery models under the rubric of accountable care organizations (ACOs). [...]

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HM2013 Abstract Number: 140

“Updated”: Using a Sign‐Out Audit Tool to Address Milestones and Entrustable Professional Activities in Patient Handoffs

Background: ACGME Milestones and Entrustable Professional Activities (EPA) have emerged as benchmarks for the professional development of house staff. Residents must demonstrate expertise in these patient care activities in order to progress in training, and [...]

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HM2013 Abstract Number: 137

Discharge Before Noon Challenge to Improve Medicine Service Throughput

Background: Late‐afternoon discharges create admission bottlenecks in the ED. Long ED length of stay (LOS) is a major dissatisfier for patients. In addition, patients who arrive on the floor after 1 pm have a 0.6 [...]

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HM2013 Abstract Number: 138

Using a Modified Coleman Model to Decrease 30‐Day Readmissions on a Telemetry Unit

Background: Transition from an acute care setting to a skilled nursing facility (SNF) or home is ripe with opportunities for poor communication. Changes in medications, lack of understanding about disease processes, and inadequate discharge teaching [...]

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HM2013 Abstract Number: 135

Facilitating Condolence Card Use on an Inpatient Medicine Service

Background: The age‐old practice of writing a doctor's letter of condolence provides a way for physicians to share the grief of losing their patients while communicating the impact of a therapeutic doctor–patient relationship. Studies show [...]

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HM2013 Abstract Number: 136

The Transitions‐of‐Care Ambulatory Block: A Novel Approach to Transition Education

Background: Care transitions occur between providers on a single team, between teams on a service, and between services. They also occur between inpatient and ambulatory providers. As this discontinuity introduces potential for error, care transitions [...]

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HM2013 Abstract Number: 133

Universal Opt‐Out HIV Screening in “Medical” Versus “Surgical” Inpatients

Background: An estimated 1 in 5 HIV‐positive Americans is unaware of their HIV status. Experts warn that this subgroup notably contributes in propagating the U.S. HIV epidemic. Universal opt‐out screening may mitigate this problem but [...]

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HM2013 Abstract Number: 134

Patient Handoffs in Undergraduate Medical Education

Background: Since the landmark IOM report “To err is human” was published in 2000, national focus has been on patient safety and preventing medical errors. Miscommunication during patient care handoffs is a particular area of [...]

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HM2013 Abstract Number: 131

Is Heart Score Offer a Better Tool for Ruling Out Acs in the Ed?

Background: There are several scoring models used for risk stratification of patients presenting with chest pain. The HEART score is a tool recently developed in a European cohort of patients. It combines 5 elements: history, [...]

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HM2013 Abstract Number: 132

Bacterial Contamination of Health Care Worker Uniforms: A Randomized, Controlled Trial of Antimicrobial Scrubs

Background: Health care worker (HCW) uniforms become contaminated with bacteria during normal use, and this may contribute to hospital‐acquired infections. Antimicrobial uniforms are currently marketed as a means of reducing this contamination. Our objective was [...]

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HM2013 Abstract Number: 129

Changes in Inpatient Staffing Following Implementation of New Residency Work‐Hour Restrictions

Background: In July 2011, the Accreditation Council for Graduate Medical Education (ACGME) mandated new residency work‐hour restrictions. These changes limited the maximum hours of continuous clinical responsibilities from 30 to 16 hours for interns, 24 [...]

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HM2013 Abstract Number: 130

Internal Medicine Rounding Practices at Academic Medical Centers

Background: The Accreditation Council for Graduate Medical Education (ACGME) has established the requirement for residency programs to assess trainees' competencies in 6 “core” domains (patient care, medical knowledge, practice‐based learning, interpersonal skills, professionalism, and systems‐based [...]

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HM2013 Abstract Number: 127

A Multicenter Study of Physician Knowledge of Patient Fall Risk

Background: Falls are the leading cause of injury death among adults 65 or older. Physician knowledge of fall risk factors is crucial to reducing falls. Interventions targeting fall risk factors can reduce fall rates by [...]

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HM2013 Abstract Number: 128

Development of the Tool to Assess Inpatient Satisfaction with Care from Hospitalists (Taisch)

Background: Service excellence in the U.S. hospitals, as measured by patient satisfaction scores, is receiving more attention, with the results being reported publicly and affecting reimbursement rates. Ideally, accurate feedback could be given to individual [...]

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HM2013 Abstract Number: 125

Determining Interrater Reliability of the “4T” Pretest Clinical Scoring System for Heparin‐Induced Thrombocytopenia

Background: Heparin‐induced thrombocytopenia (HIT) is a clinicopathologic process that is the end result of antibodies directed at platelet factor 4–heparin complexes. The clinical findings can be subtle or dramatic, and serologic confirmation is problematic. Current [...]

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HM2013 Abstract Number: 126

Value of Clinical Judgment in Detection of Clinical Deterioration: A Prospective Blinded Validation of the Patient Acuity Rating Score in Comparison with the Modified Early‐Warning Score

Background: Failure and delay in identifying clinical deterioration in hospitalized ward patients can result in adverse outcomes. Although many hospitals have instituted rapid response teams to quickly treat and triage unstable patients, early and reliable [...]

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HM2013 Abstract Number: 123

Differences in Work Priorities Do Not Explain Gender Gap in Hospitalist Compensation

Background: Pay disparities by gender are pervasive and have also been demonstrated in the hospital medicine physician workforce. The earnings gap has been attributed to multiple factors including the differences in work‐related priorities of women [...]

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HM2013 Abstract Number: 124

Hospitalist Morale Assessment: A Multisite Multiyear Analysis

Background: Recruiting hospitalists is expensive, and turnover remains a challenge. Monitoring morale may help leaders maintain it within their groups, thereby improving retention. No published scale measures hospitalist morale, and based on our prior work, [...]

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HM2013 Abstract Number: 121

Efficacy and Perceived Utility of a Postgraduate Physician Assistant Hospitalist Training Program

Background: The role of physician assistants (PAs) within the field of hospital medicine has experienced unparalleled growth this past decade. In efforts to provide specialized training for PAs entering hospital medicine, we designed and presented [...]

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HM2013 Abstract Number: 122

Variation in Practice Patterns Among Physicians in the Acute Management of Atrial Fibrillation

Background: Atrial fibrillation (AF), the most common arrhythmia encountered in clinical practice, is managed by a variety of specialists. Current guidelines differ in their recommendations and may not adequately address management in the acute setting, [...]

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HM2013 Abstract Number: 119

Night Staffing of Pediatric Teaching Services and Pediatric Hospitalist Night Responsibilities

Background: Recent changes in resident work hours have placed an increased emphasis on attending service and supervision of residents, especially at night. There are little data about how non–critical care pediatric inpatient teaching services are [...]

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HM2013 Abstract Number: 120

Antibiotic Discordance Between Emergency Physicians and Hospitalists for Children Admitted with Respiratory Illness

Background: Acute respiratory illness is the most common reason for hospitalization in children. Antibiotics are recommended for hospitalized children with community‐acquired pneumonia despite an inability to distinguish bacterial from the more common viral etiologies. Chest [...]

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HM2013 Abstract Number: 117

Chronic Opioid Therapy in Hospitalized Patients: Common but Not Immutable

Background: Chronic opioid therapy has grown more prevalent over the last 2 decades, as have concerns about effectiveness and adverse events. Although a robust literature is emerging regarding outpatient management of pain conditions and chronic [...]

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HM2013 Abstract Number: 118

A Successful Alternative for Fourth‐Year Internal Medicine Externships

Background: Medical school class size is increasing per the Association of American Medical Colleges (AAMC) recommendations. Therefore, the number of students participating in the internal medicine third‐year clerkships and fourth‐year externships is increasing as the [...]

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HM2013 Abstract Number: 115

Hospitalist Experiences, Practice, Opinions, and Knowledge Related to Peripherally Inserted Central Catheters: A Michigan Survey

Background: Peripherally inserted central catheters (PICCs) are commonly inserted/ordered by hospitalists for venous access, long‐term therapies, and infusion of total parenteral nutrition, Despite these salient roles, little is known about PICC use in hospitalized patients. [...]

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HM2013 Abstract Number: 116

MRSA Nasal Screening Is Useful in Predicting Etiology of Ventilator‐Associated Pneumonia

Background: Reduction of the spread of nosocomial and community‐acquired methicillin‐resistant Staphylococcus aureus (MRSA) has become a health priority for hospitals and public health officials because of the increasing rate of MRSA infections and the difficulty [...]

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HM2013 Abstract Number: 113

Evaluation of Charlson Comorbidity Index As a Predictor of Adverse Outcomes in Patients Admitted with Community‐Acquired Pneumonia

Background: Patients diagnosed with community‐acquired pneumonia (CAP) are commonly risk‐stratified using either the validated CURB‐65 criteria or the Pneumonia Severity Index (PSI), both of which primarily use acute clinical findings to predict mortality. The role [...]

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HM2013 Abstract Number: 114

Implements to Current Coumadin Protocol in Acute Hospital Setting

Background: Coumadin anticoagulation is used in many indications: atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism, and DVT prophylaxis in patients undergoing orthopedic surgery. In our institution, the international normalized ratio (INR) is checked daily [...]

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HM2013 Abstract Number: 111

Comparison of Hcahps Patient Satisfaction Scores for Specialty and General Medical Hospital: Confounding Effect of Survey Response Rate

Background: Because of the low survey response rate of the Hospital Consumer Assessment of Healthcare Provider and Systems (HCAHPS) patient satisfaction survey, currently administered by more than 4500 hospitals, patient satisfaction scores (PSSs) may not [...]

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HM2013 Abstract Number: 112

Impact of a Web‐Based Discharge Ordering Module on the Quality of Medication Reconciliation

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 among hospitalized and recently discharged patients. In November 2011, [...]

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HM2013 Abstract Number: 109

Impact of an Electronic Automated Nurse‐Driven Vaccine Protocol on Inpatient Flu and Pneumococcal Vaccination in an Academic Health System

Background: To comply with new inpatient immunization measures introduced by the Centers for Medicare and Medicaid Services (CMS) effective January 1, 2012, our health system implemented a nurse‐driven vaccine protocol using native functionality in our [...]

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HM2013 Abstract Number: 110

Association Between a Hospital's Quality Performance for In‐Hospital Cardiac Arrest and Common Medical Conditions

Background: Public reporting on hospital quality has been widely adopted for a few medical conditions. Broadening the scope of these efforts to include cardiac arrest is now being considered. Given growing evidence that hospital organization [...]

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HM2013 Abstract Number: 107

Changes in Patient Satisfaction Associated with Hospital Building Renovation: Experience with a New Clinical Building

Background: Hospitals are among the most expensive and complex facilities to build and renovate. Patient‐ and family‐focused design is one of the key aspects of planning these constructions. There is an increasing trend toward designing [...]

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HM2013 Abstract Number: 108

Optimizing Inpatient Anticoagulation and Management of Venous Thromboembolism: A Hospitalist–Pharmacist Initiative

Background: Venous thromboembolism (VTE) is a common inpatient condition, managed with high‐risk anticoagulants. VTE management is often suboptimal. Inpatient anticoagulation teams improve anticoagulation processes and outcomes, but many centers (including ours) lack this resource. Diverse [...]

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HM2013 Abstract Number: 105

Early Result from Use of an Implantable Loop Recorder for Detection of Atrial Fibrillation in Patients with Cryptogenic Stroke

Background: Paroxysmal atrial fibrillation (AF) is an important risk factor for thromboembolic complications. We hypothesized that using an implantable loop recorder (ILR) may help for identification of occult AF in patients with cryptogenic stroke. Methods: [...]

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HM2013 Abstract Number: 106

Assessment of the Knowledge Base of Pediatric Hospitalist Sedation Providers

Background: Although procedural sedation has been proposed as a core competency for pediatric hospitalists (PHs), little sedation training is given during pediatric residency. Most PHs are trained on the job and may have received only [...]

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HM2013 Abstract Number: 103

Upper Extremity Deep Vein Thrombosis: A Marker of Severity of Illness in Hospitalized Patients?

Background: Upper‐extremity (UE) deep vein thrombosis (DVT) is increasingly diagnosed in hospitalized patients. High morbidity and mortality rates associated with UEDVT have been reported, suggesting that UEDVT may be a marker of severe illness. The [...]

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HM2013 Abstract Number: 104

Impact of Weekly Feedback on Number of Laboratory Tests Ordering in Internal Medicine Residency

Background: There are various reasons why physicians order laboratory tests. In teaching institutions and academic centers, residents often order many unnecessary tests for patients. Earlier studies have shown that in many cases test‐ordering behavior lacks [...]

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HM2013 Abstract Number: 101

Improving Bed Management by Utilizing Early Interdisciplinary Discharge Planning

Background: Last‐minute discharge planning and thereby lack of coordination in the discharge process can lead to inefficiencies and bed management constraints during this vital transition point of patient care. Our study was designed to assess [...]

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HM2013 Abstract Number: 102

Tablet‐Based Cardiac Arrest Documentation: A Pilot Study

Background: Documentation of in‐hospital cardiac arrest commonly consists of a paper transcript of the interventions provided during a resuscitation. However, this method of documentation is notoriously unreliable, often lacking the accuracy that is necessary for [...]

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HM2013 Abstract Number: 99

Abdominal Wall Varices: Mysterious Culprits Revealed?

Background: Our previous research has confirmed that bleeding from paracenteses is unrelated to coagulation parameters or the presence of blood‐thinning/antiplatelet medications. However, despite this and the routine use of ultrasound, we have consistently witnessed a [...]

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HM2013 Abstract Number: 100

Too Much of a Good Thing: The Prevalence and Cost of Duplicate Pneumococcal Immunizations

Background: Pneumococcal disease is a potentially fatal illness that can manifest as pneumonia, meningitis, or sepsis. The Advisory Committee on Immunization Practices (ACIP) has made recommendations for 23‐valent pneumococcal polysaccharide vaccine (PPSV23) the prevention of [...]

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HM2013 Abstract Number: 97

Timing of Postdischarge Venous Thromboembolic Events and Effect of Prophylaxis on Hospitalized Medical Patients

Background: Hospitalized patients are known to be at increased risk for venous thromboembolism (VTE). The timing of postdischarge VTE events and the effect of pharmacologic prophylaxis exposure during hospitalization on such events are not well [...]

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HM2013 Abstract Number: 98

Peripheral Iv Access Using Ultrasound Guidance (Pivus): A Path Forward

Background: Ultrasound guidance is an invaluable technique for obtaining vascular access. The Agency for Healthcare Research and Quality (AHRQ) determined that this is required for patient safety during all central line placements. The need for [...]

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HM2013 Abstract Number: 95

Is Heparin‐Induced Thrombocytopenia Overdiagnosed in a Community Hospital?

Background: Heparin‐induced‐thrombocytopenia (HIT) is a life‐threatening immunologic reaction that develops as a result of the formation of platelet‐activating antibodies that recognize platelet factor 4 and heparin complexes (PF4/heparin). Subsequent thrombocytopenia and thrombus formation can lead [...]

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HM2013 Abstract Number: 96

An Underappreciated Ethical Problem: Delays in Death Certificate Completion

Background: Death certificates are legal documents that permit families to finalize a multitude of end‐of‐life tasks. Physicians play a key role in generating these documents, in partnership with hospital staff, funeral directors, and state health [...]

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HM2013 Abstract Number: 93

Effect of Vapocoolant Spray on Pain from Venipuncture in Adults: A Randomized, Blinded, Placebo‐Controlled Trial

Background: Painful diagnostic or therapeutic procedures are commonly performed in the emergency department (ED). Previous investigations indicate that practitioners frequently do not provide adequate anesthesia for painful medical procedures. Patients indicate they would like to [...]

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HM2013 Abstract Number: 94

Vaccination Rates in Chronic Kidney Disease Patients — Missing the Target!

Background: According to the National Kidney Foundation, 14 million Americans suffer from chronic kidney disease (CKD). Infectious diseases are the second most common cause of death in patients with CKD, and vaccination reduces the mortality [...]

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HM2013 Abstract Number: 91

Risk of Venous Thromboembolism Associated with Peripherally Inserted Central Catheters: A Systematic Review and Meta‐Analysis

Background: Peripherally inserted central catheters (PICCs) are associated with an increased risk of venous thromboembolism (VTE). However, the precise incidence and magnitude of this risk relative to other central venous catheters (CVCs) is unknown. We [...]

By | 2013-05-16T01:00:02+00:00 May 16th, 2013|Uncategorized|Comments Off on Risk of Venous Thromboembolism Associated with Peripherally Inserted Central Catheters: A Systematic Review and Meta‐Analysis

HM2013 Abstract Number: 92

When and How Does Picc‐Related DVT Occur? An Epidemiological Study

Background: Despite widespread use of peripherally inserted central catheters (PICCs), about 1 in 20 patients who receive these devices will develop PICC‐related deep vein thrombosis (DVT). Preventing this complication is an important goal for hospitalists. [...]

By | 2013-05-16T01:00:02+00:00 May 16th, 2013|Uncategorized|Comments Off on When and How Does Picc‐Related DVT Occur? An Epidemiological Study

HM2013 Abstract Number: 89

Impact of an Electronic Pharmacy Alert System on the Incidence of Inappropriate Medication Dosing for Patients with Kidney Disease

Background: Most drugs and active metabolites are eliminated through the kidneys and, if not carefully adjusted for the renal clearance, may have adverse effects. The purpose of the research study was to evaluate the impact [...]

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HM2013 Abstract Number: 90

Hand Hygiene Patterns on a Medicine Teaching Service

Background: Clinicians have struggled to achieve consistent levels of appropriate hand hygiene (HH) in the inpatient setting. The behavior of influential members of the team is known to affect HH practices of others, but the [...]

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HM2013 Abstract Number: 87

Hospitalist Versus Resident Readmissions

Background: Hospitalists are increasingly being engaged in the teaching and training of medical residents. One question commonly raised is whether inpatient teaching services deliver the same quality of care as nonteaching hospitalist services. This study [...]

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HM2013 Abstract Number: 88

The Invasive Procedure Team: Improving Patient Care and Resident Education

Background: A specialized team to perform nonemergent invasive procedures is desired within hospitals Hospitalists are the ideal candidates to meet such demands. Because of the recent de‐emphasis by ABIM on proving manual proficiency of bedside [...]

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HM2013 Abstract Number: 85

Utilization of Tight Glycemic Protocols for Patients Admitted to the General Medicine Floors

Background: Diabetes mellitus type II, one of the most prevalent diseases amongst the U.S. population, is associated with significant comorbidities. Patients with uncontrolled diabetes are more prone to develop complications and have higher rates of [...]

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HM2013 Abstract Number: 86

Night Vision: Resident and Hospitalist Perceptions of Night‐Shift Education

Background: In response to the 2003 ACGME guidelines restricting resident duty hours and the 2008 Institute of Medicine report recommending increased attending‐level supervision of house staff, many residency programs substituted hospitalist‐supervised night‐float rotations for traditional [...]

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HM2013 Abstract Number: 83

Comparative Analysis of Vital Sign Ranges in the Pediatric Early‐Warning System

Background: The Pediatric Early Warning System (PEWS) is an established tool that aids in the identification of hospitalized patients at risk for clinical deterioration. Many pediatric institutions have adopted the PEWS as a patient safety [...]

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HM2013 Abstract Number: 84

Blind Spot: Assessing and Correcting Vision Among Hospitalized Patients

Background: The prevalence of poor vision among hospitalized patients has not been well characterized. Hospitalized patients who lack appropriate vision correction may be at risk for vision‐related hazards, thus leading to worse patient outcomes. For [...]

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HM2013 Abstract Number: 81

Effects of Contact Precautions on Patient Satisfaction: A Prospective Cohort Study

Background: Contact precautions decrease health care worker–patient contact and may affect patient satisfaction. Contact precautions have been reported to result in fewer health care worker visits and an increase in adverse events. Our objective was [...]

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HM2013 Abstract Number: 82

Do Inpatient Cardiology Consults Reduce 30‐Day Readmissions for Acute Heart Failure Exacerbation?

Background: Congestive heart failure (CHF) remains the most common reason for admission in U.S. hospitals. Admissions for CHF account for approximately 80% of total cost for heart failure care. The Center for Medicare and Medicaid [...]

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HM2013 Abstract Number: 79

New Take on an Old Story: Revisiting the Heparin Nomogram

Background: Continuous infusions of unfractionated heparin (UFH) are still commonly used in the initial treatment of venous thromboembolism (VTE). As a result of UFH's high‐risk profile and common usage, weight‐based UFH nomograms were developed more [...]

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HM2013 Abstract Number: 80

Resident Perceptions of the Educational and Clinical Benefit of a Rapid Response Team at an Academic Medical Center

Background: Medical training has become increasingly interprofessional with greater emphasis placed on residents working alongside nonphysician providers. Rapid response teams (RRTs) are often led by nurses and thus provide an opportunity to examine the clinical [...]

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HM2013 Abstract Number: 77

Computed Tomography Pulmonary Angiography (Ctpa) to Evaluate for Pulmonary Embolism in Postoperative Orthopedic Patients

Background: Hospitalists are increasingly participating in the care of orthopedic patients who are known to be at high risk for pulmonary embolism (PE). In September 2010, a hospitalist medicine consult service was started for orthopedic [...]

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HM2013 Abstract Number: 78

Attending Use of the Electronic Health Record and Implications for House‐Staff Supervision: Preliminary Results from a Mixed‐Methods Study

Background: With current health information technology, the electronic health record (EHR) is accessible to review clinical information from remote locations. Although patterns of remote EHR access by residents have been described, little information exists regarding [...]

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HM2013 Abstract Number: 75

Are All Vital Signs “Vital”? A Retrospective Study of Nighttime Vital Sign Frequency and Risk of Clinical Deterioration

Background: Sleep disruptions are prevalent among ward patients and are associated with a number of negative health outcomes, including elevated blood pressures and delirium. Overnight vital signs are an especially bothersome disruptor and can deplete [...]

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HM2013 Abstract Number: 76

Improving Handoffs to Post–Acute Care Providers: Implementation of a Checklist‐Guided Telephone Call

Background: Handoffs between care providers present opportunities for communication errors that can adversely affect patient care. Inadequate handoffs have been associated with problems with assessment and diagnosis, medication errors, and decreased patient satisfaction in acute [...]

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HM2013 Abstract Number: 73

Perceptions of Nurse Practitioner and Physician Assistant Interview Candidates Regarding the Incorporation of Simulated Medical Scenarios Into the Hiring Process for Hospital‐Based Positions

Background: Hospital practices have increasingly utilized nurse practitioners (NPs) and physician assistants (PAs) to supplement provider support. However, standard interview formats have historically lacked the sensitivity to distinguish candidates with the unique aptitude for the [...]

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HM2013 Abstract Number: 74

Sepsis Screening — Is It Effective?

Background: Early intervention has been shown to change outcomes in patients with sepsis. Patients on general medical units often develop and suffer complications from sepsis, but it is unclear if we identify these patients soon [...]

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HM2013 Abstract Number: 71

A Simple Educational Intervention Can Improve Documentation of Comorbidities to Impact Hospital Quality Measures

Background: The ratio of expected to observed length of stay (LOS), cost of stay (COS), and mortality are critical benchmarks for measuring hospital performance in quality of care, safety, and value. Without full documentation of [...]

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HM2013 Abstract Number: 72

A Pilot to Improve Identification, Treatment, and Prevention of Delirium in a Hospital Medicine/orthopedic Surgical Comanagement Patient Population

Background: Delirium is a problem that can be dangerous for patients and costly for hospitals. Despite its high prevalence, the identification and treatment can often be delayed because of its ability to mimic other illnesses. [...]

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HM2013 Abstract Number: 527

Code Sepsis: Rapid Identification and Treatment of Severe Sepsis in Floor Patients

Background: Sepsis is an increasingly frequent problem among hospitalized patients that results in longer lengths of stay and higher mortality. Sepsis is more common among elderly patients and the incidence is expected to rise with [...]

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HM2013 Abstract Number: 70

Who's My Doc

Background: Hospitalized patients have trouble identifying doctors on their primary inpatient team. Patients report a lack of understanding among the different roles of interns, residents, and attendings. Studies report improved satisfaction of patients who could [...]

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HM2013 Abstract Number: 526

The Glycemic Control Widget: A Visual Cue to Promote Use of an Evidence‐Based Order Set for Effective Glycemic Control in the Hospital

Background: Hyperglycemia and diabetes are common, affecting up to 30% of hospitalized adults in the United States. These conditions carry significant morbidity and mortality at a cost of $174 billion annually. Treatment in the hospital [...]

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HM2013 Abstract Number: 68

Procedural Credentialing in General Internal Medicine: A Survey of Division Chiefs

Background: Invasive bedside procedures are associated with high complication rates — 15% for central venous lines (CVLs), 20% for thoracenteses, and 6% for paracenteses. The American Board of Internal Medicine, while requiring that “the internist [...]

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HM2013 Abstract Number: 69

A Survey of Academic Hospitalists' Quality Improvement Activities

Background: Effective quality‐improvement (QI) collaborations among physicians, nurses, and managers have been shown to improve health care outcomes. Thus, participation in QI activities is considered a core competency for practicing hospital medicine. Despite this, physician [...]

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HM2013 Abstract Number: 66

A Limited Intervention to Improve the Quality of Physician Handoffs by Service Type in an Academic Medical Center

Background: Between 44,000 and 98,000 patients die as the result of medical errors annually. Suboptimal communication is the root cause of most sentinel events in hospitalized patients. Implementation of resident duty hours has resulted in [...]

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HM2013 Abstract Number: 67

Comparison of Palliative Care Consultation Services in California Hospitals Between 2007 and 2011

Background: Palliative care can improve outcomes and quality of life for people with serious illness and is a critical aspect of care for hospitalized patients. Despite calls for more palliative care consultation services (PCCS), little [...]

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HM2013 Abstract Number: 65

Off‐Label Use of Ondansetron in Hospitalized Medical Patients: Prevalence, Patterns, and Predictors

Background: Hospitalists frequently prescribe ondansetron for nausea and vomiting. However, the Food and Drug Administration (FDA) has approved this agent only for prophylaxis of nausea and emesis related to chemotherapy or radiation therapy or for [...]

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HM2013 Abstract Number: 525

Internet Use for Postdischarge Health Care Tasks Among Readmitted Patients: Preliminary Results from the Homerun Transitions of Care Study

Background: Lack of communication and coordination of care after discharge are important factors in hospital readmission. Interventions such as postdischarge phone calls or home visits can improve care transitions, but these approaches are very resource [...]

By | 2013-05-16T01:00:02+00:00 May 16th, 2013|Uncategorized|Comments Off on Internet Use for Postdischarge Health Care Tasks Among Readmitted Patients: Preliminary Results from the Homerun Transitions of Care Study

HM2013 Abstract Number: 58

Post–Cardiac Arrest Care: Do Physicians Resuscitate Younger Patients More Aggressively?

Background: It is very common for physicians to adopt aggressive treatment strategies when dealing with younger patient populations. This usually leads to more use of resources and often results in better outcomes. Thus, we sought [...]

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HM2013 Abstract Number: 523

Mentored Implementation of Project Boost — Outcomes of a Statewide Initiative

Background: Reducing readmissions increasingly captures the attention of hospitals, yet little data exist supporting effective hospital strategies. Project BOOST (Better Outcomes by Optimizing Safe Transitions) is a patient‐centered multicomponent intervention created to enhance the hospital [...]

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HM2013 Abstract Number: 524

Unexplained Geographic Variation in Opioid Utilization in Hospitalized U.S. Medical Patients

Background: Recent literature has drawn attention to the high and increasing rates of opioid prescribing and overdose‐related deaths in the United States. These studies have focused on community‐based and emergency department prescribing, leaving prescribing practices [...]

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HM2013 Abstract Number: 57

Inpatient Workup of Incidental Findings in Patients Admitted for Chest Pain: Is It the Patient or the Provider?

Background: With the advent of high‐resolution cross‐sectional imaging, incidental findings (IFs) have become an increasingly common occurrence. Though workup guidance is available for a few IFs (such as a pulmonary nodule), there are no guidelines [...]

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HM2013 Abstract Number: 55

Hospital‐Acquired Venous Thromboembolism: Incidence and Preventability in a Cohort of Academic Hospitals

Background: Hospital‐acquired venous thromboembolism (HA‐VTE) is a morbid, often fatal, and — in cases of pulmonary embolism (PE) or lower‐extremity deep venous thrombosis (LE DVT) — pharmacologically potentially preventable condition. Because the Centers for Medicare [...]

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HM2013 Abstract Number: 64

Impact of Variations in Care on Pediatric Appendicitis

Background: Appendicitis is the most common surgical condition of childhood. Although guidelines exist for diagnostic imaging, there is lack of consensus about pre‐ and postoperative medical management. Our objective was to examine the effects of [...]

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HM2013 Abstract Number: 56

Incidental Findings in Patients with Chest Pain: When to Expect the Unexpected?

Background: With the increasing use of diagnostic imaging modalities, incidental findings (IFs) are a common occurrence in hospitalized patients. They present a unique challenge to hospitalists treating patients admitted for chest pain because of the [...]

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HM2013 Abstract Number: 53

Does the Initiation of a Hospital‐Wide Rapid Response Team Decrease the Incidence of Codes and Improve Both Survival and Survival to Discharge?

Background: Rapid response teams (RRTs) are a recent occurrence. There has been exponential growth in the number of RRTs in the United States and internationally. Discussion has ensued regarding their merit. The purpose of RRTs [...]

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HM2013 Abstract Number: 50

Impact of Clostridium Difficile Infection on Medicare Beneficiary Health Care Utilization and Outcomes

Background: Clostridium difficile infection (CDI) primarily occurs in elderly adults and contributes to excess patient mortality, readmissions, and hospital and postdischarge costs. Two‐thirds of CDI hospitalizations are for patients with CDI as a secondary diagnosis [...]

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HM2013 Abstract Number: 54

Operational Aspects of a Rapid Response Team at a Large, Urban, Academic Tertiary‐Care Referral Institution in the United States

Background: Rapid response teams (RRTs) are a relatively new and growing trend in the United States and throughout the world. The operational characteristics have not been well defined. This has implications regarding staffing, equipment, supplies, [...]

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HM2013 Abstract Number: 51

Patient Experiences After Hospitalizations for Elective Surgery

Background: A recent focus on reducing rehospitalizations is motivated by the mandate to improve medical and surgical hospital care quality, and internists are increasingly involved in improving the care of surgical patients. However, little is [...]

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HM2013 Abstract Number: 52

Receptivity to Weight Management Interventions Among Hospitalized Obese Patients: An Untapped Opportunity

Background: Obesity is a major contributor to morbidity and decreased life expectancy. Hospitalized obese patients rarely receive guidance from hospitalists on obesity management. Previous research found that obese patients welcome inpatient counsel to address weight [...]

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HM2013 Abstract Number: 49

Effect of Geographic Structured Interdisciplinary Rounding on Hospitalist and Medicine Resident Efficiency in a Large Academic Medical Center

Background: Structured interdisciplinary rounding (SIDR), also known as multidisciplinary rounding, has been shown to improve collaboration between allied medical providers. It may have additional positive effects on patient safety, hospital efficiency, and patient and provider [...]

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HM2013 Abstract Number: 48

Evaluation of Aha Recommendations for Cardiac Monitoring in a Noncritical Setting

Background: Cardiac monitoring is often overutilized. The 2004 American Heart Association (AHA) practice standards categorized indications for electrocardiographic monitoring in hospitalized patients based on the potential therapeutic benefit. This study sought to evaluate whether the [...]

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HM2013 Abstract Number: 47

Effect of Comorbidities on Clinical Outcomes in Patients with Low‐Risk Curb‐65

Background: The CURB‐65 score is widely used to risk‐stratify patients with community‐acquired pneumonia (CAP). When the score is less than 3, the patient is considered to have a low mortality risk, and current recommendations suggest [...]

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HM2013 Abstract Number: 45

Does Early Ed Ct Scanning of Nonsevere First Episodes of Acute Pancreatitis Ever Change Management?

Background: The American Gastroenterology Association (AGE) states that 2 of 3 features must be present in order to diagnose acute pancreatitis (AP): (1) characteristic abdominal pain, (2) serum amylase and or lipase activity 3 times [...]

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HM2013 Abstract Number: 46

Clinical Predictors of Adverse Outcomes in Severe Sepsis Patients with Intermediate Lactate Level

Background: Determining what clinical variables are associated with adverse outcomes in severe sepsis with an intermediate lactate level (2–4 mM) may assist clinicians to better triage and manage these patients who immediately may not need [...]

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HM2013 Abstract Number: 43

Functional Status, Nephrology Admission, and Acute Kidney Injury Determine Hospitalization Survival in Nonagenerian Inpatients

Background: With the advance of medicine and aging society, elderly inpatients occupy a greater proportion of admission. However, few studies deal with this issue in the literature. We investigated the clinical determinants of hospitalization duration [...]

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HM2013 Abstract Number: 44

How Do Internal Medicine Residents Spend Their Time? A Time–Motion Study

Background: Work‐hour restrictions are intended to improve resident education and patient care. This study quantifies the time interns and residents spend on direct patient care, indirect patient care, computer tasks, and education. Methods: This is [...]

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HM2013 Abstract Number: 521

Yield and Diagnostic Value of Stress Myocardial Perfusion Imaging in Patients with Syncope

Background: ACC/AHA Appropriate Use Criteria recommend performing stress myocardial perfusion imaging (MPI) for intermediate‐ to high‐risk patients presenting with syncope (level A7), but not for low‐risk patients (level I3). However, there are limited data to [...]

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HM2013 Abstract Number: 522

Adoption of the Hospitalist Model by Primary Care Providers: An Analysis of Medicare Beneficiaries in Texas

Background: How and why primary care providers (PCPs) adopt the hospitalist model is not well defined. We sought to characterize the patterns by which PCPs transition from personally caring for their hospitalized patients to referring [...]

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HM2013 Abstract Number: 520

Angiotensin Axis Blockade, Hypotension, and Acute Kidney Injury in Elective Major Orthopedic Surgery

Background: Recommendations regarding administering or withholding angiotensin axis blockade (AAB) prior to orthopedic surgery are not clearly defined in the current literature. Patients presenting for surgery with AAB with either angiotensin‐converting enzyme inhibitors (ACEIs) or [...]

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HM2013 Abstract Number: 42

Predictors of Adverse Event in Postpericardiotomy Syndrome

Background: Postpericardiotomy syndrome (PPS) is relatively common complication following cardiac surgery. Criteria for the diagnosis of PPS has been suggested in previous studies. It occurs few days to several weeks following cardiac surgery. Patients who [...]

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HM2013 Abstract Number: 38

Evaluation of a Hospitalist Medicine Consult Service for Total Joint Arthroplasty Patients

Background: Internists play an increasingly important role in the medical management of orthopedic surgery cases. A randomized controlled trial of patients undergoing total hip and knee replacement found that those who were comanaged by internal [...]

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HM2013 Abstract Number: 13

Status of Advance Directive and Goals‐of‐Care Discussions in a University‐Affiliated Community Hospital

Background: The New York State Palliative Care Information Act, passed in 2011, mandates that physicians offer terminally ill patients information and counseling on palliative care and end‐of‐life options. The Allen Hospital of New York Presbyterian [...]

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HM2013 Abstract Number: 41

Clinical Outcomes Comparison Between Patients Admitted to Teams with and Without Standardized Handoff of Care

Background: The transition of care between providers constitutes a vulnerable point in the care of a hospitalized patient. Poor‐quality or inadequate handoffs have been identified as a nidus for adverse clinical events. As shift restrictions [...]

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HM2013 Abstract Number: 39

Self‐Assessed Discharge Readiness and Readmission

Background: Press–Ganey survey data suggest that low self‐assessment of discharge preparedness is associated with hospital readmission. However, Press–Ganey data are collected after hospitalization, limiting the ability to respond to concerns. The intent of this project [...]

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HM2013 Abstract Number: 40

Can Obesity Counseling During Hospitalization with Postdischarge Phone Follow‐Up Lead to Weight Loss 6 Months Following Discharge?

Background: The multiple comorbidities associated with obesity often to lead to or contribute to hospitalization. Hospitalization itself represents a teachable moment during which behavioral interventions have been successful. This study sought to determine whether inpatient [...]

By | 2013-05-16T01:00:02+00:00 May 16th, 2013|Uncategorized|Comments Off on Can Obesity Counseling During Hospitalization with Postdischarge Phone Follow‐Up Lead to Weight Loss 6 Months Following Discharge?

HM2013 Abstract Number: 9

Postdischarge Phone Calls and Improved Patients' Perceptions After Hospital Discharge

Background: The Institute of Medicine (IOM) has highlighted the importance of patient‐centered care (PCC) to health care quality. We hypothesized that patients cared for by residents exposed to a curriculum that teaches elements of PCC [...]

By | 2013-05-16T01:00:02+00:00 May 16th, 2013|Uncategorized|Comments Off on Postdischarge Phone Calls and Improved Patients' Perceptions After Hospital Discharge

HM2013 Abstract Number: 37

Breast Cancer Screening Preferences Among Hospitalized Women

Background: Despite their proven benefit, mammographic screening rates continue to be low among women of lower socioeconomic status and who are ethnic minorities. Efforts to increase early detection in these groups of women have been [...]

By | 2013-05-16T01:00:02+00:00 May 16th, 2013|Uncategorized