Background: The direct oral anticoagulants (DOACs) apixaban and rivaroxaban are increasingly prescribed due to convenient oral formulation without the need for routine laboratory monitoring and are now commonly regarded as first line anticoagulants in most cases of venous thromboembolism (VTE). However, the optimal choice of subsequent anticoagulant in instances of first line DOAC failure is [...]

Background: Venous excess ultrasound score (VExUS) is an emerging point-of-care volume assessment tool that utilizes inferior vena cava diameter and doppler waveforms within the hepatic, portal, and renal veins to predict venous congestion. High VExUS grades have previously been validated against elevated filling pressures during right heart catheterization in patients with steady-state fluid balance; however, [...]

Background: Venous thromboembolism (VTE) is a leading cause of preventable in-hospital mortality and a primary focus of quality improvement/patient safety efforts. VTE prophylaxis reduces the incidence of in-hospital VTE, but nonadministration rates—primarily attributed to patient refusal—often reach 10-15%. Notably, nonadministration of VTE prophylaxis may correlate with higher incidence of hospital acquired VTE. Prior studies showed [...]

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 [...]

Case Presentation: Case 1: A 38-year-old woman with no past medical history presented to the hospital with four days of fatigue, myalgias, and productive cough. On admission, she was febrile to 103 F, had a heart rate of 130 with ECG showing sinus tachycardia, saturating 95% on two liters of nasal cannula oxygen. Initial workup [...]

Case Presentation: A 63-year-old male with end-stage renal disease, on hemodialysis via left arteriovenous fistula for over 10 years, presented with progressively worsening left fifth-digit infection and severe hand pain over the last month. Additional history includes peripheral vascular disease resulting in bilateral above-the-knee amputations and recent right fourth-digit amputation. He was seen outpatient by [...]

Case Presentation: We report here a case of high output heart failure (HOHF), a rare but potential complication of Arteriovenous fistula (AVF) in a post-renal transplant patient.A 60-year-old male with end-stage renal disease and subsequent renal transplant 3 months ago presented with exertional dyspnea, worsening anasarca, and weight gain of 20 pounds. The patient also [...]

Case Presentation: A 52-year-old male with hypertension, sleep apnea, and polycythemia presented to an outside hospital for abdominal bloating and pain with emesis for 2 weeks. Labs showed WBC up to 26k/µl, AST of 166, ALT of 155, and total bilirubin of 2.8 mg/dl with normal range lipase and lactate. Initial CT abdomen pelvis (CTAP) [...]

Case Presentation: A 26-year-old female with PMH migraines presented to the ED with a 3-day history of headaches unlike her migraine headache. The headache was located in the occipital region, pressure-like, not alleviated by acetaminophen, and was associated with blurred vision, left ear throbbing, and neck pain. She also reported recent head trauma. She denied [...]

Case Presentation: A 55-year-old patient with history of Crohn s disease complicated by small bowel obstruction s/p resection and ileocolonic anastomosis, and transition to Upadacitinib from infliximab, a month prior to the admission, presented with a three-day duration of worsening abdominal pain, non-bloody diarrhea, and intermittent fevers. Vital signs notable for temperature of 102.2F and [...]