Background: Mechanically ventilated patients are often administered analgesic medications such as dexmedetomidine (DEX) and lorazepam (LZP) to reduce pain and anxiety. Studies have suggested that benzodiazepines may increase the risk of developing acute brain dysfunction, mechanical ventilation time, and length of stay (LOS) (Pandharipande PP, et al. JAMA 2007). Although Clinical Practice Guidelines recommend use [...]

Background: Sepsis is a leading cause of death among hospitalized patients. Early detection of sepsis has the potential to reduce mortality by facilitating timely evidence-based interventions. Past studies have used electronic health records (EHR) to trigger alerts at the onset of sepsis, or to predict general clinical deterioration. In this study we describe the impact [...]

Background: U.S. healthcare costs are rising due to the increase in polypharmacy, which is a potential risk factor for hospital readmission.1 In a cohort study of 5,507 patients with ≥10 discharge medications, more than 25% of them were readmitted.1 At one of the largest public county hospitals in the U.S., readmission rates for patients with high-volume home [...]

Case Presentation: A 90-year-old man with a history of left upper lobe pulmonary nodule on prior imaging presented with dark tarry stools, fatigue and syncope. He had not had an EGD or colonoscopy done in about 10 yrs. Five months prior to this presentation, a 2.4 cm left upper lobe pulmonary nodule suspicious for neoplasm [...]

Case Presentation:       A 33 year-old Hispanic male without significant history presented with an unremitting fever for 5 days, associated with myalgais, fatigue, night sweats, and a rash. Upon admission, he was tachycardic, hypotensive and febrile at 103F. Physical exam revealed a diffuse non-blanching, maculo-papular rash, sparing the face, palms and soles. Labs [...]

Case Presentation: A 65-year-old woman with hepatitis C-induced liver cirrhosis status-post liver transplantation, coronary artery disease and gout, presents with one week of progressive fatigue, weakness, and severe pain in her right leg and left shoulder. She was on atorvastatin for cardiac disease and had recently started Ledipasvir/Sofosbuvir for hepatitis C two months prior. She [...]

Case Presentation:  A 32-year-old man with human immunodeficiency virus (HIV) presented with a painful and swollen right ankle. The patient had been well until 6 weeks ago when he developed a sprain followed by worsening pain and swelling of his ankle. His CD4+ T-lymphocyte count was 169 cells/mm3 with a viral load of 3770 copies/mL. [...]

Case Presentation: An 18 year male presented to the ED with complaints of 48 hours of chest pain radiating towards the neck associated with a sensation of fullness of the upper chest.  He began a vigorous bench pressing regimen about two weeks prior to admission (PTA) with last session 5 days PTA. History is remarkable [...]

Case Presentation: A 66 year-old woman with Waldenstrom macroglobulinemia (WM), hypertension, and hyperlipidemia presented with acute altered mental status. She had been diagnosed with WM by bone marrow biopsy and was treated with rituximab, then maintained on thalidomide until 2 months prior to presentation. Her mother had suffered from multiple myeloma. Vital signs were normal. [...]