Case Presentation: A 62-year-old male with a history of paroxysmal atrial fibrillation presented with hypotension and 2 week history of chest pain after an ablation with pulmonary vein isolation. Transthoracic echocardiography demonstrated a pericardial effusion. Pericardial fluid sampling revealed an elevated leukocyte count of 130,000 cells per cubic millimeter and culture grew rare strep mitis/oralis [...]

Case Presentation: A 70-year-old woman visiting from India with history of hypothyroidism and adrenal insufficiency presented with four days of profuse diarrhea and fever. She was admitted for sepsis secondary to Rotavirus gastroenteritis with initial sodium level 132 (135-145 mmol/L). On day 2 of hospitalization, sepsis resolved with isotonic fluids and stress dose steroids, but [...]

Case Presentation: A previously healthy 21-year-old man presented to the emergency department with a three-day history of rash, fever, and fatigue. The rash first appeared on his trunk and spread to his arms and hands on the first day of illness. Over the next two days, he developed worsening fevers and fatigue, and was sleeping [...]

Case Presentation: A 43-year-old male with roux-en-y gastric bypass fourteen years ago with complications and multiple adhesions, hiatal hernia associated with nausea and vomiting, and subsequent small bowel resection last year, started to experience cognitive changes and short-term memory loss. He has also experienced problems with balance, generalized weakness, and unintentional 60-pound weight loss. His [...]

Case Presentation: A 37-year-old-male with no significant past medical history who presents to the hospital with 2 months of progressive exertional dyspnea, palpitations and scrotal pain. He has also noticed some leg swelling and has a nonproductive cough. For the past 6 months, he has had ongoing diarrhea and unintentional weight loss of about 20 [...]

Background: Sleep disruptions for routine care, such as vital sign assessments, are common during hospitalization and are associated with negative health outcomes and patient satisfaction. While higher risk patients may benefit from increased monitoring at night, the tradeoff is less obvious for lower risk patients. We hypothesized that assigning overnight vital sign assessment based on [...]

Background: Somatic Symptom and Related Disorders (SSRD) is an umbrella term for a wide variety of disorders commonly encountered in the inpatient pediatric setting, including conversion disorder, amplified pain syndrome, and psychogenic non-epileptiform seizures. These patients can be high utilizers of medical resources. The hospitalist is often charged with ruling out a medical diagnosis and [...]

Background: Point-of-care ultrasound (POCUS) of the inferior vena cava (IVC) can help to noninvasively predict the effectiveness of treatment for volume-sensitive conditions, such as acute heart failure and shock. Recently POCUS-IVC has also been used to iteratively tailor fluid treatment to patient-specific targets. In real-world clinical settings, such iterative assessments are necessarily obtained by multiple [...]

Background: COPD is associated with high morbidity and mortality. It is the third-ranked cause of death in the United States, killing more than 120,000 individuals each year. As a consequence of its high prevalence and chronic nature, COPD causes high resource utilization with frequent clinician office visits, hospitalizations due to acute exacerbations, and need for [...]

Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]