Case Presentation: A 70 year old man presented with four days of epigastric pain, nausea, vomiting and abdominal distension. He reported 50lbs of weight loss due to decrease in appetite over two months. He denied any hematemesis or melena. Physical exam was unremarkable except for diminished bowel sounds and positive stool guaiac test. CT scan [...]

Case Presentation: A 77 year old male with history of diabetes mellitus, systolic heart failure and morbid obesity who presented with multiple episodes of falls occurring over a 2 week period. The patient reported bilateral weakness and pain in the lower extremities, in addition to sensation of paresthesias and numbness. He reported a progressive loss [...]

Background: Over the past 50 years, observation status patients have been cared for in a variety of settings: in the emergency department, on inpatient floors, and in dedicated observation units. At our medical center, inpatient teams have traditionally cared for observation patients on medical wards. Patients were often unaware of their admission status until they [...]

Background: POCUS is increasingly being used across medical specialties, and adds value to diagnostic accuracy for numerous pathologies and levels of acuity. Emergency Medicine providers were early adapters, providing examples of how POCUS increases patient satisfaction and diagnostic clarity (1, 2). Internal Medicine and Family Medicine have been slower to adopt this technology; however, general [...]

Background: Academic Medical Centers (AMC) have utilized teams comprised of an attending, resident, interns and medical students to care for hospitalized patients. ACGME work restrictions have reduced the capacity of teaching services. Consequently, most AMCs now rely on direct care Hospital Medicine Services (HMS). Non-clinical tasks (making appointments, faxing for records), traditionally performed by teaching [...]

Case Presentation: A 69-year-old male with history of iron deficiency anemia, recurrent venous thromboembolism on apixaban, splenomegaly, ulcerative colitis who presented to emergency department due to exertional shortness of breath. 6 weeks prior to admission, the dose of azathioprine was increased from 50mg daily to 100mg daily due to suboptimal 6-thioguanine nucleotide (6-TGN) level. 1 [...]

Case Presentation: A 94-year-old man with no significant past medical history presented to the Emergency Department with a two week history of progressively worsening constipation accompanied by nausea, vomiting, and abdominal pain. He denied any hematochezia, melena, change in stool caliber or unintentional weight loss. He had never undergone a colonoscopy. He had tried stool [...]

Background: Point-of-care ultrasound (POCUS) has expanded in popularity and practice amongst hospitalists, critical care physicians, and is a standard part of the emergency medicine curriculum for a multitude of reasons: increased diagnostic accuracy and speed, cost reduction, and reduced radiation exposure. Internal medicine (IM) residents are exposed to the practice of using POCUS at all [...]

Background: The use of maintenance fluids (MF, continuous intravenous fluid (IVF)) to prevent dehydration is common, yet highly variable in practice. Unnecessary MF can cause patient harm including fluid overload, sleep disruption (associated alarms), and increase falls risks. In 2017, Hurricane Maria destroyed Puerto Rican facilities that were critical in producing IVF, exacerbating an existing [...]

Background: SIBR originated from a multi-pronged initiative to improve value and outcomes for our patients. On the Oncology floor where the complexity of care is high and patients have several consultants involved in their care, it is very easy to have fragmentation of care and lose the patient’s trust. Our objective was to engage the [...]