Background: The COVID-19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. Our study aimed to identify the major changes in inpatient pediatric healthcare delivery and potential learnings from these changes. Methods: We conducted semi-structured interviews for this qualitative study. We purposefully sampled hospitals [...]

Background: Internal medicine and hospital medicine providers are under pressure to move patients quickly through the hospital and decrease length of stay. Providers spend most of their clinical time seeing patients, documenting or coordinating care and have minimal time to disrupt workflow to perform common bedside procedures such as paracentesis, lumbar punctures, central lines, arthrocentesis [...]

Case Presentation: A 62 year old incarcerated male presented to an outside hospital for a near syncopal event. He reported increased general fatigue, dyspnea with exertion, edema of bilateral legs, weight gain of 20 pounds, and orthopnea over the prior two months without any other associated symptoms. His past medical history included diabetes mellitus type [...]

Case Presentation: We present a case of a 20-year old male with past medical history of polysubstance abuse and major depressive disorder who was found unresponsive by his roommate in the morning after black tar heroin use. Roommate injected Narcan without effect and called EMS. Roommate reported both the patient and himself were chronic heroin [...]

Case Presentation: Mr. O is a 28 year old Navy cadet with no significant past medical history who presented to the Emergency Department with three days of malaise, nausea, polyuria, and polydipsia in the setting of recent steroids for a new rash. On presentation, Mr. O’s glucose returned at 624 mg/dL, pH was 7.28 and [...]

Case Presentation: A 55-year-old Hispanic male with PMH of hypertension presented to the emergency department (ED) with a 2-week history of flu-like symptoms including malaise, fever and chills, anorexia, dry cough and night sweats. In the ED he was found to be lethargic, short of breath, and had abdominal distention accompanied by urinary and bowel [...]

Case Presentation: A 29-year-old otherwise healthy man presented to the emergency room with five weeks of progressively worsening pruritus and fatigue. The patient denied recent ingestion of herbal supplements, and reported lifetime abstinence from alcohol use. Physical exam revealed jaundice and scleral icterus. No ascites or hepatomegaly were noted on initial exam. Admission labs revealed [...]

Case Presentation: The presence of abnormal liver function tests has a broad list of differential diagnoses and is commonly seen in patients with medication side-effects. Hepatotoxicity is associated with many checkpoint inhibitor immunotherapeutics and requires immediate initiation of steroids; however, it is important to consider alternate etiologies for transaminitis. We present a case of a [...]

Case Presentation: A 61-year-old female with a history of non-alcoholic steatohepatitis (NASH) cirrhosis complicated by hepatocellular carcinoma (HCC), who underwent a liver transplant 2 months prior, presented to an outpatient clinic complaining of several days of fatigue, headache, nausea, vomiting, abdominal pain and confusion. Her headaches were new since the transplant. She denied any fevers, [...]

Case Presentation: A 70 year male presented to the emergency department with complaints of worsening fatigue, abdominal distension, abdominal pain, dyspnea, and increased lower extremity edema. He had been diagnosed with pancreatic cancer 3 months ago and recently started on chemotherapy. An abdominal CT scan revealed massive ascites and multiple liver abscesses essentially replacing the [...]