Background: Assessing severity of illness using available electronic medical record (EMR) data on admission and predicting inpatient mortality is very challenging. Lacking standardized practices around end of life issues, hospitalists use their clinical judgment in making these crucial decisions. Prolonged discussions may be needed in medically complex patients to direct an optimal plan of care [...]

Background: Noninvasive ventilation (NIV) is frequently used to treat patients admitted with acute respiratory failure in both the intensive care and progressive care settings. While often perceived to be safer than invasive mechanical ventilation, many pitfalls and technical difficulties can arise when this modality is used in a setting that is less monitored than the [...]

Background: Advanced Practice Professionals, APPs (Nurse Practitioners and Physician Assistants) often practice in variable, undefined capacities in teaching hospitals. APP roles are parallel to teaching faculty led teams, and function to accommodate clinical overflow and adjust to attending specific workflows. This impacts role satisfaction, professional advancement, and creates retention challenges. APPs’ inability to fit in [...]

Case Presentation: A 70 year old female with metastatic melanoma presented to the emergency department with fatigue and lethargy for one month. She had recently completed 6 cycles of Nivolumab and Ipilimumab and was currently receiving Nivolumab monotherapy. Over the past month, she had worsening fatigue associated with nausea and decreased appetite. Lab work one [...]

Case Presentation: A 66-year-old man with a history of stage IIId melanoma, who received 6 cycles of Nivolumab, presented with anorexia and persistent large-volume diarrhea. Initial workup included a non-elevated white blood cell count of 6.9 k/mm3 and a creatinine of 1.6 mg/dL from baseline creatinine of 0.8 mg/dL. CT imaging of the abdomen showed [...]

Case Presentation: A 67 year old Caucasian male with history of squamous cell carcinoma of the lower lobe of the left lung was admitted to the hospital after his pre-chemotherapy laboratory work at his oncologist showed elevated liver enzymes (AST 162, ALT 141), elevated CK (2856), CK-MB (104) and elevated troponin (0.83). The patient had [...]

Case Presentation: The patient is a 38-year-old Caucasian female who was diagnosed with Stage IIIb malignant melanoma. The excision of the left scapular lesion and axillary dissection was performed. Baseline 18F-FDG PET scan showed no evidence of metastatic disease. After the 5th cycle of Nivolumab treatment, the patient developed 38 ºC fever and grade 2 [...]

Case Presentation: A 66 year old female with a past medical history significant for metastatic melanoma undergoing immunotherapy with ipilimumab (treatment start date three weeks prior) and nivolumab, poorly controlled T2DM, abnormal liver function tests, and hyperlipidemia who initially presented to an urgent care, presents to the emergency department with double vision and difficulty swallowing. [...]

Case Presentation: A 77 year old man with stage IIIC mucosal melanoma, hypothyroidism, HTN and COPD presents from an outside hospital with two months of rapidly progressive altered mental status. He was diagnosed with melanoma of the oral palate, left parotid gland and neck one year ago, and underwent two cycles of ipilimumab (ipi) and [...]

Case Presentation: Patient is an 82-year-old male with a past medical history of primary epithelial mesothelioma secondary to asbestos exposure while on active duty in the Navy. Patient was initially treated with neoadjuvant chemotherapy with carboplatin pemetrexed for 4 cycles followed by pleurectomy and talc pleurodesis. Patient had recurrent disease after surgery and was started [...]