Background: It is known that more people die during the nighttime compared to daytime in the community setting. Many health care providers are required to care for patients in a critical condition which includes around the time of death, and which may be at night. However, there have been few studies with respect to the [...]

Background: Hospitalized COIVD-19 patients are complex and heterogenous with regards to socio-demographics and comorbidities and many patients are at heightened risk for adverse clinical outcome. Early risk stratification enables clinical decision making for appropriateness and timeliness of interventions. Since the pandemic began, more than 100 models to forecast prognosis for hospitalized patients with COVID 19 [...]

Background: Clinicians encounter sudden death among aortic stenosis (AS) patients especially after they become symptomatic. Mortality is 50% at 1 year and 70 to 80% at 2 years without aortic valve replacement. However, there have been few studies that investigate the predictor for short-term sudden cardiac arrest in patients with severe AS. We investigated the [...]

Background: Drug overdose deaths involving opioids are on the rise in the setting of the current opioid epidemic in the United States (US).1 In 2017 there were ~46.6 drug overdose deaths a day in the US involving prescription opioids.1 Naloxone is a proven and effective opioid antagonist that is FDA approved for use in the [...]

Background: The “July effect” is a perceived increased risk of medical errors that occurs when US medical graduates begin residencies. There is substantial variability in results across studies of the “July effect” on patients who are admitted for heart attacks. Furthermore, studies that do show statistically significant increase in mortality at the start of residency [...]

Case Presentation: A 30-year-old previously healthy man presented with one week of fatigue, malaise, and confusion, complaining of dull neck pain. In the ED he became acutely agitated and combative, eventually requiring sedation and intubation for altered mental status. Initial vitals were normal, with BP 130/85 and HR 66, but then patient developed a fever [...]

Case Presentation: A 35-year-old black male presented to the emergency department (ED) with acute onset diffuse abdominal pain, along with nausea and vomiting. Review of systems was positive for polyuria and polydipsia. The examination was unremarkable apart from a sizeable fungating lesion of the left lower extremity by the ankle measuring 12 x 8 cm. [...]

Case Presentation: A 32 year old female presented with 2 month history of acute onset pressure-like chest pain occurring after yelling at her children and radiating to the back. The symptoms recurred and become progressive while doing house chores. The pain was relieved by rest. Family history was positive for premature coronary artery disease, dyslipidemia [...]

Case Presentation: A 23 year-old man with no prior medical history presented with witnessed syncope.  Patient was playing basketball when he suddenly collapsed, initially unresponsive, regaining consciousness after minutes.  No seizure activity was observed.  VS were BP 116/71, HR 55, RR 16, O2sat 100% RA.  ECG showed sinus bradycardia with right axis deviation.  Physical exam [...]

Case Presentation: A 56 y/o African American male with a history of paroxysmal atrial fibrillation presented with “pounding” chest pain after being assaulted. On presentation, the patient was afebrile and normotensive but significantly tachycardic (heart rate 140). Physical exam revealed an irregular rhythm with a s3 gallop and a 2/6 systolic murmur in the left [...]