Background: In 2014, the ACC/AHA released guidelines regarding indications for preoperative transthoracic echocardiogram (pre-op TTE) in patients undergoing noncardiac surgery. Studies indicate that the ordering of pre-op TTE in noncardiac surgery is not consistent with the ACC/AHA guidelines. Some studies suggest the pre-op TTE have a significant impact on management, while others have demonstrated low cardiac [...]

Case Presentation: A 44 year old woman with a history of Roux-En-Y gastric bypass (RYGB), hypothyroidism, and morbid obesity, presented with one day of confusion and somnolence. In the emergency department, she was unresponsive to voice with an initial Glasgow Coma Score of 9. Her temperature was 94 F, pulse 94 beats per minute, blood [...]

Case Presentation: We present a case of a 68-year-old female with a history of CKD IV and chronic iron deficiency anemia who was admitted for symptoms of generalized weakness and found to be in hypovolemic shock from a suspected GI bleed. The hospital course was complicated by a left MCA stroke. During the initial workup, [...]

Case Presentation: We present a case of acquired hemophilia A (AHA) in an elderly patient with longstanding rheumatoid arthritis (RA). An 85-year-old woman was transferred from an outside hospital for further evaluation of spontaneous soft tissue hematomas. She reported numerous enlarged bruises, spontaneously appearing on her upper and lower extremities over the last 2 months. [...]

Case Presentation: Microangiopathic hemolytic anemia (MAHA) refers to mechanical hemolytic anemia characterized by schistocytes on peripheral smear (PS). It is seen in various conditions such as thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS), disseminated intravascular coagulation (DIC), infections and immune disorders. Rarely, it can occur in malignant tumors as a paraneoplastic syndrome. We describe [...]

Case Presentation: A 27 year old previous healthy male presented to the Emergency Department with 4 days of progressive fatigue and scleral icterus. These symptoms were preceded by 2 days of a nonproductive cough. Upon presentation, the patient’s labs were notable for an indirect hyperbilirubinemia of 5.9 mg/dL. Complete blood count revealed a macrocytic anemia [...]

Background: Inpatient telemetry monitoring is a limited resource. The value of telemetry monitoring in hospitalized patients with high risk for cardiac arrhythmia is high. However, telemetry monitoring is often ordered for inpatients at low risk for cardiac arrhythmia. The SHM’s Choosing Wisely campaign recommended avoiding continuous telemetry monitoring in non-ICU patients without a protocol. Ordering [...]

Case Presentation: A 93-year-old female with a history of stroke, hypertension, moderate aortic stenosis (AS) and peripheral vascular disease presented with four days of right lower extremity pain. She had recently been seen in vascular clinic for difficulty walking and associated pain, which was attributed to chronic venous insufficiency. In the emergency department, examination revealed [...]

Case Presentation: An 8-year-old HIV-negative boy presented to a hospital in Malawi in septic shock secondary to typhoid fever with ileocecal perforation. He underwent repair and peritoneal washout without bowel resection. He was treated with ceftriaxone, metronidazole and supportive care. Initial labs were notable for hemoglobin of 10g/dl, platelets of 22/dL, and WBC 2.8/dL. Two [...]