Background: Painful diagnostic or therapeutic procedures are commonly performed in the emergency department (ED). Previous investigations indicate that practitioners frequently do not provide adequate anesthesia for painful medical procedures. Patients indicate they would like to receive local anesthesia prior to a painful procedure, but often it is not offered. Topical anesthetics have been recommended as […]

Background: Staffing of inpatient medicine services with Advanced Practice Providers (APPs), including physician assistants and nurse practitioners, is becoming increasingly common at academic medical centers across the United States. The various roles filled by APPs have not been well-described in the literature. The purpose of this study is to better characterize how APPs are utilized […]

Case Presentation: A 78‐year‐old man with a medical history of atrial fibrillation presented with complaints of 5 days of severe generalized weakness and difficulty walking. He also reported difficulty in getting up from a chair and difficulty while lifting his arm. On further questioning, he also reported taking an influenza vaccine shot a few days […]

Background: Risk assessment for venous thromboembolism (VTE) is a part of every hospital admission. The workflow of who completes the assessment varies between hospitals, but often it is carried out by trainees. VTE risk assessment is further complicated by the variety of methods to identify those patients who are appropriate for chemoprophylaxis, mechanical prophylaxis, or […]

Case Presentation: A 23‐year‐old man with severe chorea and dysarthria due to Wilson's disease presented 5 days after percutaneous liver biopsy with persistent abdominal pain and fever as high as 104°F. He stopped eating and drinking and was unable to walk or speak as usual. Constipation and decreased urine output were noted. CT scan of […]

Background: More than 30 million children and adolescents participate in organized sports in the United States every year. Participation has numerous benefits including improved physical fitness and better school performance, however, it is not without risk. According to the Centers for Disease Control and Prevention, children sustain more than 3.1 million sports and recreation-related injuries […]

Case Presentation: HUS is a life‐threatening disease that causes microangiopathic hemolysis, thrombocytopenia, kidney failure, stroke, myocardial infarction, and death. Typical or enteropathic HUS (eHUS) occurs after a gastrointestinal infection (usually Escherichia coli O157:H7) and is treated with supportive care and sometimes plasmapheresis. An atypical form of HUS (aHUS) is due to genetic mutations that lead […]

Background: Hospital Medicine (HM) continues to be a rapidly evolving field. Within our own institution, 15-20% of our graduates in the Internal Medicine Residency Program have pursued careers in HM in recent years. Purpose: The goal of this project is to provide residents with better preparation for careers in HM by implementing a HM Pathway. […]

Case Presentation: A 29 year old female with past medical history significant for hyperemesis gravidarum requiring total parenteral nutrition (TPN) presented to the Emergency Department (ED) with chest pain. She had been having intermittent chest pain for the last 3-4 years, which she had always attributed to the scar from her infusion port. An infusion […]

Case Presentation: An 87-year-old male with a history of atrial fibrillation, a myeloproliferative disorder, and recently diagnosed cirrhosis presented with shortness of breath. He reported three weeks of progressive shortness of breath and weight gain, and on the night prior to admission, he developed fevers and chills. In the ED, he was febrile to 101.6 […]