Background: The relation of a patient’s age to survival in cardiac arrest is often discussed at the bedside when clinicians, patients, and families are faced with the question of whether CPR is medically appropriate for elderly individuals. Few studies are available to help guide this conversation. This study sought to evaluate in-hospital cardiac arrest (IHCA) […]

Background: Mitochondrial disease (MD) refers to a group of clinically heterogeneous disorders that result from dysfunctional oxidative phosphorylation and subsequent cellular incapability to meet energy demands. Mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), myoclonus, epilepsy, ataxia with ragged red fibers (MERRFs), chronic progressive ophthalmoplegia, Kearns–Sayre syndrome, and sensory ataxia neuropathy dysarthria ophthalmoplegia are among […]

Background: Overuse of non-ICU continuous adult cardiac (telemetry) monitoring is a well-documented problem that can lead to increase hospital cost, alarm desensitization, nursing time loss, and patient discomfort 1,2. Previous studies assessing reduction of inappropriate telemetry use have employed a combination of electronic health record (EHR) order, nursing protocol changes, intensive educational, and/or feedback initiatives […]

Background: In order to reduce overuse, many hospitals have conducted studies and implemented protocols with the goal of reducing non-indicated telemetry monitoring. A common tool that institutions utilize for these changes are the clinical decision support systems (CDSS). In this report, we will present the telemetry protocol utilized by our hospital and review its effects […]

Background: Telemetry over utilization increases wasted spending, increases alarm fatigue, and creates patient safety risks. Despite the presence of American Heart Association (AHA) practice guidelines, patients are often placed on telemetry for inappropriate reasons at the discretion of the medical provider and are monitored for longer than anticipated. The goal of this quality improvement project […]

Background: Hospital based providers are often tasked with leading cardiopulmonary arrest resuscitations known as code blues. This responsibility can be stress provoking and poorly executed without appropriate training resulting in poor patient outcomes. At our academic medical center, internal medicine residents on their inpatient hospital based rotations are responsible for this assignment. The process of […]

Case Presentation: Our patient was a 70-year-old male with a past medical history of HTN, HLD, COPD, and CAD status-post CABG. He originally presented with hypotension, new onset weakness, dyspnea, orthopnea and bilateral lower extremity pitting edema. As part of his work-up, a CT scan of the abdomen and pelvis was ordered, which revealed an […]

Case Presentation: This is a 49 year old female, with no significant medical history, who started having intermittent fevers, night sweats, and fatigue 11 months prior. She reported a temperature of 100.4°F with cough and rhinorrhea, diagnosed as bronchitis with an elevated CRP of 40 mg/L. She reported some improvement with azithromycin but continued to […]

Case Presentation: A 39-year-old male with a history of primary refractory T-cell lymphoblastic leukemia/lymphoma (T-ALL) complicated by superior vena cava (SVC) syndrome, and Guillain Barre Syndrome secondary to chemotherapy presented with worsening right-sided pleuritic chest pain. He denied dyspnea or difficulty during exertion. On exam, blood pressure was 106/74 mmHg, heart rate was 123 bpm […]

Case Presentation: Patient presented to the ED in June 2019 with 6 month history of progressive proximal bilateral upper and lower extremity weakness, swallowing difficulty and 100 lbs. weight loss over 3 months. Exam was significant for decreased strength of bilateral hip flexors, knee flexors and knee extensors with intact reflexes. Labs were significant for […]