Background: Detailing has been employed by the pharmaceutical sales industry to increase physician knowledge about new medications. Work‐hour rules and hectic schedules have challenged residency training programs to develop and utilize efficient and effective teaching methods. Academic detailing has been successful in the realm of continuing medical education. Purpose: We chose to employ academic detailing […]

Background: Peripherally inserted central catheters (PICCs) are frequently used to deliver intravenous (IV) antibiotic therapy. Infectious disease (ID) physicians are often consulted prior to PICC placement, but whether their engagement influences PICC appropriateness and complications is not known. Methods: Using data from the Michigan Hospital Medicine Safety Consortium on PICCs placed in hospitalized medical patients […]

Case Presentation: A 57‐year‐old woman who had undergone an elective total knee replacement 9 days earlier presented to the ED with 1 day of progressive, diffuse abdominal pain, nausea, and fevers. Her postoperative course had been notable only for a supratherapeutic INR of 6.2 in the setting of routine DVT prophylaxis with warfarin, for which […]

Background: Until the advent of novel oral anticoagulants (NOACs), Warfarin was the only oral agent available for the treatment of deep venous thrombosis (DVT) and Pulmonary embolism (PE). Bridging with parenteral anticoagulation until warfarin reaches a full therapeutic level often results in prolonged hospitalization. Rivaroxaban, Dabigatran, Apixaban, Edoxaban were approved by the FDA for DVT […]

Background: Deep Vein Thrombosis (DVT) is a pathology characterized by the formation of a blood clot inside the venous system. It comprises either distal vein thrombosis, but also proximal vein thrombosis (i.e. Femoral, Popliteal and Iliacal veins), which leads to a significant increase in complications of the disease, such as pulmonary thromboembolism (PE) and even […]

Case Presentation: Lemierre's syndrome is a rare form of thrombophlebitis, usually associated with tonsillitis and peritonsillar abscess, which can harbor anaerobic bacteria (most commonly Fusobacterium necrophorum). Deep to the abscess, the bacteria can grow and pass into an adjacent internal jugular vein, causing septicemia and septic emboli. A 19‐year‐old female presented to the ED with […]

Case Presentation: This is the case of a 68-year-old Hispanic woman with a history of hypertension, non-insulin dependent diabetes mellitus and dyslipidemia who presented to the ED with AMS for 1 day. Collateral history from the patient’s daughter revealed that the patient had been having chronic constipation for some time with intermittent episodes of diarrhea. […]

Case Presentation: A 56-year-old-male with hypertension, diabetes mellitus, chronic kidney disease (CKD) stage 3 presented with a 6-month history of intermittent lower extremity swelling and a 3-week history of scrotal and abdominal swelling. 9 months prior, he was noted to have worsening renal function and nephrotic range proteinuria (13g) prompting two renal biopsies which demonstrated […]

A case of wegner with C-ANCA, anti GBM+ with preserved kidney  function in a 22 year old Case Presentation: 22 years old male, Jehovah’s witness  with no past medical history. He was in a normal state of health before presentation to the emergency department for 3  days of fever,shortness of breath,cough and mild hemoptysis. He […]

Case Presentation: A 64-year-old Middle-Eastern man with a history of rheumatic heart disease status post mechanical mitral Starr-Edwards ball-in-cage valve (in 1968), atrial flutter on coumadin and prior ischemic stroke with residual blindness presented with 4 days of “bloody” urine. Physical exam was significant for scleral icterus, an unchanged holosystolic murmur, and the observation of […]