Background: Acute heart failure (AHF) exacerbations are a leading cause of hospitalization in the United States. Despite the frequency of AHF hospitalizations, there are inadequate data or practice guidelines on how quickly diuresis should be achieved. Methods: We conducted a pooled cohort study using data from three acute heart failure trials (DOSE, ROSE, and ATHENA-HF). [...]

Background: Acute heart failure (AHF) exacerbations are a leading cause of hospitalization in the United States. Despite the frequency of AHF hospitalizations, there are inadequate data or practice guidelines on how quickly diuresis should be achieved. Methods: We conducted a pooled cohort study using data from three acute heart failure trials (DOSE, ROSE, and ATHENA-HF). [...]

Background: Respiratory failure is the most common organ failure syndrome in US hospitals (1). Hospitalists strive to detect the earliest signs of respiratory instability. Measurement of respiratory vital signs (like respiratory rate & oximetry) is a necessary aspect of risk stratification, but it is not sufficient. In one study, 46% of hospitalized patients had no [...]

Case Presentation: This patient was a 32 year old male with one week of fevers, coughing, and shortness of breath. On examination, the patient was tachycardic with an oxygen saturation of 85%. He had increased work of breathing with accessory muscle use, but no crackles or wheezing. Complete blood count showed leukocytosis. CT angiogram showed [...]

Case Presentation: A 26-year-old woman presented following accidental ingestion and aspiration of lighter fluid during a fire-breathing performance. She noted difficulty breathing, significant oral pain, and a burning sensation in her throat and chest.Initial vitals were notable for tachycardia to 110s, tachypnea to mid-20s, and oxygen saturation of 100% on non-rebreather mask. She appeared anxious [...]

Case Presentation: A 65-year-old female with history of 70 pack years smoking, chronic hip pain, GERD, COPD presented to the ED with a 6 months complaints of diffuse pruritic skin rash associated with progressive facial swelling, fatigue and muscle weakness. She had been seen multiple times in the Dermatology clinic and punch biopsy revealed perifollicular [...]

Case Presentation: A 19 year old female with history of marijuana use presented with subacute, progressive shortness of breath. Productive cough began two weeks prior to presentation. She was diagnosed with atypical pneumonia and received azithromycin from her outpatient provider. After two days without improvement in symptoms, she presented to a nearby hospital with acutely [...]

Case Presentation: Previously healthy, never-smoker, COVID vaccinated, 45yo male with a history of hypertension presented to urgent care for one month history of shortness of breath on exertion, mild cough, and some weight loss. At urgent care, oxygen saturation was found to be 77% on room air and was transferred to Bronson Hospital for further [...]

Background: An important duty of every hospitalist is to detect the earliest signs of imminent clinical deterioration. Breathing motion patterns can convey early warnings of respiratory instability (1). Normal breathing appears regular, effortless, well-coordinated and comfortable (2). In patients at high risk of respiratory deterioration, breathing appears labored (3). Well-established signs of labored breathing include: [...]

Case Presentation: A 41-year-old healthy male presented to emergency department with cough and shortness of breath. Shortness of breath and cough was gradually progressive over one week, worsening with exertion. Cough is dry with no known aggravating factor. He denied fever or wheezing. No history of active or passive cigarette smoking, sick contact, recent travel, [...]