Case Presentation: Our patient is a 51-year-old male with PMHx of tobacco abuse who presented to the emergency room (ER) with left flank pain for 1 month. He was involved in a motor vehicle collision while driving his motorcycle four weeks ago. He initially presented to an urgent care for pain where he was found [...]

Case Presentation: INTRODUCTION: Disseminated gonococcal infection presents as either purulent monoarticular arthritis or as tenosynovitis, migratory polyarthralgia and vesiculopustular rash in young sexually active adults. We present an unusual case of disseminated gonococcal infection presenting as petechial rash, tenosynovitis and polyarthralgia with hypocomplementemia in a middle woman.CASE PRESENTATION: 46 years old woman medical history of [...]

Case Presentation: A 43-year-old woman presented to the emergency department for sudden-onset of right calf pain, dyspnea, and coughing of blood-tinged sputum, along with worsening of right-sided, dull, heavy, pleuritic chest pain which had otherwise been present for three weeks. She was diagnosed with  systemic lupus erythematosus four days prior to presentation. On physical exam, pulse rate was 114/min [...]

Case Presentation: A 76 y.o. female with history of chronic diastolic heart failure and poorly controlled polycythemia vera (PV) on 500 mg of hydroxyurea daily presented with 2 days of progressive difficulty breathing, sialorrhea and uncontrolled movements of the face and mouth. Due to general malaise, she stopped taking her furosemide and hydroxyurea 2 days [...]

Background: Zinc is an essential trace mineral in the human body and is thought to be one of the most common micronutrients to be deficient. Zinc is needed for proper metabolism and immune system function. Zinc is a co factor in over 100 enzymatic reactions and is used for protein and DNA synthesis, cell division, [...]

Background: Lumbar punctures are an important diagnostic and therapeutic tool for internists. While rates of major complications are low, success rates in the literature are widely variable and dependent on patient body habitus, patient positioning, operator experience, and use of ultrasound guidance.1 Many trainees report discomfort with their skill in performing and supervising bedside procedures, [...]

Background: Multiple studies support the association between systematic implementation of Patient Blood Management (PBM) programs and improved patient outcomes, reduced RBC utilization, and decreased healthcare costs. In 2019, Sentara Healthcare launched a system-wide PBM program aimed at decreasing avoidable transfusions by 24% over 3 yrs. Several care collaboratives, including the Society of Hospital Medicine (SHM), [...]

Background: Over-utilization of telemetry can lead to reduced bed availability in telemetry units, which is a crucial bottleneck in hospital throughput. To address this, in our hospital a new orderset embedded in the EMR (Electronic Medical Record) was created. The orderset brought several changes to the workflow. Before, providers can admit patients to the telemetry [...]

Background: Telemetry overuse contributes to excess healthcare costs, unnecessary workup of incidentalomas, and alarm fatigue. To curb overuse, guidelines such as the 2017 AHA/ACC continuous ECG monitoring practice standards have outlined appropriate telemetry use standards. The aim of this study was to perform a rapid “plan-do-study-act” (PDSA) cycle and assess whether a nursing (RN)-driven checklist [...]

Background: Telemedicine has been increasingly relied upon to deliver health care remotely. During the COVID-19 pandemic, telemedicine has been essential to conserving PPE and minimizing potential exposures. Though more frequently used in outpatient settings, telephone and video visits are now also being used to connect hospitalized patients with members of their inpatient care team. Data [...]