Background: Problem Definition: Inadequate Advance Care Planning conversations and documentation remain a persistent gap in healthcare delivery. Admitting patients to the inpatient service without explicitly exploring the ‘goals of care’ and ‘code status’ results in stressful moments for the patients, their families, and providers if the condition deteriorates and may result in providing care that [...]

Background: The physical exam for heart failure can be limited by poor reproducibility, lack of specificity, provider inexperience, or patient habitus. To estimate the JVP or HJR requires identifying the internal jugular vein (IJV). Finding the IJV can be limited by those factors but the addition of ultrasound can improve its identification. Ultrasound can therefore [...]

Background: The personal statement (PS) is a crucial factor in a residency program’s evaluation of applicants and has traditionally been helpful in understanding applicants’ journeys in medicine, values, and written communication skills. Now, with accessible large language models (i.e. ChatGPT) designed for language composition, there is interest in how these models may be utilized by [...]

Background: The STAT priority is understood across the medical community to communicate a medical emergency however misuse of the STAT priority is also widespread1. Previously reported studies have shown that inappropriately ordered STAT radiology images could have a negative impact on patient care2. At our institution, qualitative surveys found that the STAT priority was used [...]

Case Presentation: A 91-year-old male with a known history of benign prostatic hyperplasia (BPH), diastolic heart failure, pulmonary embolism, hypertension, and previous extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli) urinary tract infection (UTI) presented with encephalopathy. He was not tachypneic nor tachycardic, but his bicarbonate was low at less than 8, and his lactic acid [...]

Case Presentation: A 71 year old female with past medical history of DM2, HTN, and CKD presented with weakness and body aches, progressing to inability to ambulate. Home medications included insulin, valsartan, and rosuvastatin. She was found to have a creatinine of 7.99 mg/dL from a baseline of 2 mg/dL. She was also found to [...]

Case Presentation: An 85-year-old female presented to the ED with a chief concern of altered mental status from her previous baseline cognitive status a few hours prior. The patient’s medical history was significant for dementia, type 2 diabetes mellitus, and hypothyroidism. Initial exam revealed a confused but cooperative patient, A&Ox2 (self and time), discoloration of [...]

Case Presentation: A 71-year-old female patient with a medical history of coronary artery disease (CAD), hypertension (HTN), and mixed hyperlipidemia presented to our medical facility, reporting chest pain. She underwent a left heart catheterization, revealing significant stenosis in the proximal right coronary artery (RCA), which was successfully treated with percutaneous transluminal coronary angioplasty (PTCA) and [...]

Case Presentation: A 72 y/o African American male with PMHx of HTN, IDDM, CAD, ESLD 2/2 Hepatitis C in remission with portal hypertension and hepatocellular carcinoma s/p radioembolization presented after a fall at home. He had generalized weakness for 3 weeks with worsening over last 3 days. His ROS significant for diarrhea from lactulose and [...]

Case Presentation: A 63-year-old female with a past medical history of hypertension, atrial fibrillation, type 2 diabetes, multiple strokes with residual left sided deficit, and chronic kidney disease, who presented with altered mental status (AMS) after losing consciousness for 20 minutes during which family noticed left sided facial droop and dysarthria. The patient denied chest [...]