Case Presentation: A 35-year-old female presented to the emergency department after an episode of syncope. She takes methadone (180 mg/day) for opioid dependency. She had a recent relapse and returned to illicit drug use after a period of sobriety. Vital signs were notable for tachycardia, blood pressure and respiratory rate were normal. On physical exam [...]

Case Presentation: A 34 year old male with a medical history of polysubstance abuse and hypothyroidism presented from subacute rehab after a combined thoracolumbar and sacral fixation surgery with worsening generalized weakness. The patient described deconditioning with increased difficulty standing despite 3-4 hours of daily physical therapy. Other acute symptoms included insomnia and mood swings. [...]

Background: Patients with opioid use disorder (OUD) are frequently hospitalized, however up to 25% of these encounters end in patient directed discharge (PDD), leading to interruptions in care, increased mortality, and higher hospital readmission rates.1-4 Receipt of medications for opioid use disorder (MOUD) has been shown to decrease odds of PDD.5 However, to date, less [...]

Background: Gastric Point-of-Care Ultrasound (POCUS), has been validated for perioperative pulmonary aspiration risk reduction, but data on medical inpatients is lacking (1). Inpatients often have multiple risk factors for delayed gastric emptying, but may need urgent surgery or procedures. According to the American Society of Anesthesiologists (ASA), a fasting period of 2, 6, and 8 [...]

Case Presentation: A 57-year-old male with past medical history of alcohol-induced chronic pancreatitis complicated by chronic pain, opioid use disorder (OUD) on methadone, and depression on sertraline presented to the emergency department with dizziness, dyspnea, and nausea. About six months prior to admission, he had been transitioned from buprenorphine to methadone for better pain control. [...]

Case Presentation: A 66-year-old male with ESRD on dialysis, hepatitis C, hypertension, and opioid use disorder (OUD) on 135 mg of methadone presented with bilateral leg ulcerations and complex pain syndrome that was complicated by recurrent hypoglycemia. His initial blood glucose of 35 was thought to be due to poor insulin clearance with ESRD. He [...]

Case Presentation: A 44-year-old female with severe opioid use disorder (OUD) was admitted after a benzodiazepine withdrawal seizure. Her history was significant for methadone 165 mg daily dosing, anxiety managed with daily unprescribed benzodiazepines, and alcohol use disorder in remission. She had a prolonged QT interval, with a notable episode 18 months prior, when she [...]