Background: Coumadin anticoagulation is used in many indications: atrial fibrillation, deep vein thrombosis (DVT), pulmonary embolism, and DVT prophylaxis in patients undergoing orthopedic surgery. In our institution, the international normalized ratio (INR) is checked daily until discharge once patients are started on Coumadin. We propose this practice poses undue hardship to patients from daily blood […]

Background: Acute pancreatitis (AP) is one of the most common causes of hospitalization in the United States. Intravenous hydration with normal saline (NS) is the most commonly used fluid for resuscitation. Recent studies have shown better outcomes with the use of more pH balanced fluid-like ringer’s lactate and Plasmalyte (PL). We conducted a retrospective cohort […]

Case Presentation: A 67‐year‐old man with no known past medical history presented to Beth Israel Medical Center with a one week history of right leg pain and thigh swelling. He denied any recent trauma, IV drug use or recent travel within the past three months. Physical examination revealed erythema, warmth, increased right thigh swelling and […]

Case Presentation: A 20-year-old male with past history of asthma presented initially with bloody diarrhea and subjective fever of one day’s duration. Upon evaluation vital signs revealed temperature of 103 F, and tachycardia. On physical examination there was generalized abdominal tenderness with normal bowel sounds. Thrombocytopenia was present with platelet count of 46 k/ul. Antibiotics […]

Case Presentation: An 80 year-old female presented to the emergency room with shortness of breath and melena. She was afebrile, with blood pressure of 121/70 and heart rate 93. Labs showed hemoglobin of 5.2 g/dL with normal INR and platelet count. She underwent an upper endoscopy revealing a 2 mm clean-based duodenal ulcer. As this […]

Case Presentation: A 76‐year‐old man with a past medical history of hypertension and dyslipidemia presented with sudden onset confusion and expressive aphasia. Subsequently, he developed shaking and weakness of the right side of the body. Patient started having generalized tonic clonic seizures eight months ago. Family also noticed a recent decline in memory. Physical examination […]

Case Presentation: A 60‐year‐old male with a history of type 2 diabetes mellitus and hypertension presented with nausea, vomiting, malaise and bilateral lower extremity weakness. He was found to have tubercular osteomyelitis with spinal cord compression at the level of T1‐T2 and underwent a T1‐ T3 laminectomy, decompression of the spinal cord and C4 to […]

Case Presentation: A 65-year-old man with a past medical history of gout and chronic pancreatitis complicated by pseudocyst presented with bilateral lower leg swelling, erythema, and pain for few weeks. The rash was also associated with bilateral lower extremity nodules that would spontaneously open and discharge white material. He was seen and treated in the […]

Case Presentation: This is a case of a 22 year old female with history of systemic lupus erythematosus (SLE) complicated by lupus nephritis class III/IV, immune thrombocytopenia, coombs positive anemia, discoid lupus & seizures, who presented to the ED with a 2 week history of feeling “unwell” and a 1 week history of epigastric pain […]

Case Presentation: A 90 year old woman presented with weakness for one month. Atorvastatin 80mg was newly prescribed for a myocardial infarction. On exam proximal muscle strength on all extremities was 3/5. Creatine phosphokinase (CPK) was 4,515U/L with a normal creatinine. The statin was discontinued and intravenous hydration was given. One week later, CPK rose […]