Case Presentation: A 57 year-old woman without significant past medical history presented with fever, malaise, diffuse painful lymphadenopathy, and palpitations. Patient developed palpitations 4 weeks ago after receiving a second dose of the Pfizer-BioNTech COVID-19 vaccine. She later developed painful cervical lymphadenopathy and was treated with metoprolol, levofloxacin, and prednisone with minimal improvement. On admission, [...]

Case Presentation: A 22-year-old man with Asperger syndrome presented with five days of fever and acute confusion after an episode of pharyngitis. Vital signs were significant for T 39.3°C, HR 120/min, BP 93/57 mmHg, and RR 22/min with O2 sat 94% on 4L. Physical exam was remarkable for thick oral secretions, tenderness to palpation of [...]

Case Presentation: This is a 60 year old woman with systolic heart failure, and giant left atrium (atriomegaly) resulting from past history of rheumatic heart disease, presenting to the emergency department with clinical picture consistent with pneumonia and subsequent shock. Bronchoscopy done and found total left main stem bronchus obstruction by the left atriomegaly. Shock [...]

Case Presentation: We present a case of 71 year old male with a history of advanced non-small cell lung cancer with metastasis to the brain, recurrent deep venous thrombosis on anticoagulation, and prostatomegaly who was initially admitted for dyspnea and subsequently diagnosed with community acquired pneumonia. His chest x-ray on admission also showed heavy burden [...]

Case Presentation: 75-year-old female with atrial fibrillation, ESRD on HD, HFrEF, cognitive decline, a history of multiple hypoglycemic episodes, and previous alcohol use disorder presented with unresponsiveness and hypoglycemia (serum glucose = 42mg/dL). Her past medical history was also notable for recent Staph aureus bacteremia from an infected left AV fistula and an infection of [...]

Case Presentation: 50-year-old female with HTN and hyperlipidemia was brought to the ED after being found unconscious for an unknown duration. She was last seen well 12-hours prior to presentation. On exam, she was disoriented and somnolent but arousable to repeated stimulation. Vital signs were remarkable for tachycardia (P = 120 bpm) and hypertension (BP [...]

Background: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected certain racial and ethnic minority groups, many of whom may not speak english as a primary language. Patients with Limited English proficiency (LEP) have previously been shown to have worse outcomes in the hospital, including higher odds of mortality from sepsis. We investigated the association [...]

Background: The COVID-19 pandemic required physicians to care for a new disease with uncertain and evolving characteristics while also adhering to physical and social distancing practices, and under conditions of extreme duress – all factors likely to lead to missed or delayed diagnoses among patients admitted ‘under investigation’ for COVID-19. Methods: We carried out a [...]

Background: Transthoracic echocardiogram (TTE) is a frequently used cardiovascular imaging test for hospitalized patients especially those with chronic heart failure. Over the past two decades, TTE orders increased at a rate of about 5-8% per year. A large component of this is repeat TTE orders, defined as orders done within one year of a prior [...]

Background: Literature on the timing of inpatient laboratory test collection is limited. Most studies suggest that physicians and patients are satisfied with morning collection [1], more specifically, intermittent late morning lab collection to decrease sleep disruption [2,3]. Evening labs put increasing demands on healthcare providers given limited resources available outside standard work hours. We sought [...]