Case Presentation: A 59 year old male with history of End Stage Renal Disease (ESRD) on Hemodialysis, Cerebrovascular disease and Hypertension presents to emergency department (ED) with single episode of bloody emesis and hemoptysis without associated abdominal pain or melena. On exam he was afebrile, hypertensive without tachycardia. His mucous membranes were dry, sclera non-icteric, [...]

Case Presentation: A 43-year-old male with anxiety and chronic back pain presented to the emergency department with altered mental status. He was found by family exhibiting incoherent vocalizations and agitated behavior, despite acting normally the previous day. Vitals revealed a fever of 100.5 F and heart rate of 127 BPM. On exam, he was diaphoretic, [...]

Case Presentation: A 33-year-old previously healthy man presented with fever, diffuse joint pain, muscle pain, and weakness after a recent gastrointestinal illness. Musculoskeletal exam revealed generalized muscle weakness and asymmetric synovitis involving large and small joints. Initial differential diagnosis included reactive arthritis given his recent diarrhea, though his presentation prompted concern for sepsis due to [...]

Case Presentation: A 59-year-old male with a past medical history of hypertension and cocaine use disorder presented to the emergency department for altered mental status (AMS) and weight loss. For two months he had been having progressively more frequent episodes of left facial grimacing with sudden flexion of the left arm. Additional symptoms included progressive [...]

Case Presentation: A 62-year-old male with no significant past medical history presented with a two-month history of diffuse rash, generalized weakness, fever, weight loss, progressive dyspnea and recurrent bronchitis and pneumonia unresponsive to outpatient antibiotics. On admission, he was febrile (102.9 F), hypoxic, tachycardic and hypotensive. On physical exam, he appeared ill with bibasilar crackles, [...]

Case Presentation: A healthy 15-year-old male developed cough, nasal congestion, and abdominal pain. After several days, he presented to the hospital with worsening pain and emesis. He was febrile to 100.4 degrees Fahrenheit, with a heart rate of 121 beats per minute and a respiratory rate of 27 breaths per minute. He appeared pale and [...]

Case Presentation: A 7-year-old female presented with 3 days of bilateral knee pain and 1 day of left wrist pain and swelling. Knee pain resolved 1 day prior to presentation at which point left wrist symptoms started. No fevers, recent illnesses, or history of trauma. History notable for Acute Myeloid Leukemia (AML) diagnosed at 4 [...]

Case Presentation: A 17-year-old girl presented with one month of progressive cough and exertional dyspnea. She denied fever, chest pain, or hemoptysis. Vitals were normal for age. Growth review showed recent weight loss from the 38th to 15th percentile with stable height at the 5th percentile. Pulmonary exam revealed faint bilateral crackles but was otherwise [...]

Case Presentation: A previously healthy 16-year-old male presented with six days of headache and abdominal pain followed by three days of fever, myalgias, stiff muscles, nausea, anorexia, and fatigue. He denied exertional activity, trauma, substance use, or recent illness. ED diagnostic evaluation revealed leukopenia (1.96 ×10³/µL), CD4 count 155/µL, thrombocytopenia (121 ×10³/µL), LDH 1210 U/L, [...]

Background: Staffing shortages can impact a rural hospital’s viability. Nighttime coverage is particularly difficult given limited resources, low patient volumes and high provider costs. A tele-hospitalist coverage model split between multiple sites is one solution to minimize these challenges. After successfully creating a daytime tele-hospitalist program to support two rural hospitals, our group at a [...]