Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]

Background: Affecting approximately 5.9% of the US population, alcohol use disorder (AUD) has been established as a prevalent disease in this country (1). Through repeated hospital admissions for alcohol use disorder (including alcohol withdrawal syndromes), hospital costs have steadily risen to recent estimates of 7.6 billion dollars in 2017 (2). Without the establishment of outpatient [...]

Background: There were nearly 33,000 admissions to Department of Veterans Affairs hospitals for alcohol withdrawal syndrome (AWS) in fiscal year 2017. Symptom-triggered management is the standard of care and, when employed effectively, the number of medication doses during admission is a good proxy for clinical severity of withdrawal. Several evidence-based algorithms for outpatient management of [...]

Background: Affecting approximately 5.9% of the US population, alcohol use disorder (AUD) has been established as a prevalent disease in this country (1). Through repeated hospital admissions for alcohol use disorder (including alcohol withdrawal syndromes), hospital costs have steadily risen to recent estimates of 7.6 billion dollars in 2017 (2). Without the establishment of outpatient [...]

Case Presentation: A 47-year-old male with history of hypertension presented to urgent care with one day of vomiting and bloody diarrhea. Onset of symptoms occurred 30 minutes after consuming raw juice he made at home from a lauki bottle gourd. At urgent care he was pale, ill-appearing, and hypotensive with a blood pressure of 80/36 [...]

Case Presentation: A 38-year-old Caucasian male with no significant prior medical history presented with an acute CVA based on the presence of fatigue, blurry vision, ataxia, headache, and numbness. His MRI showed “multiple small foci of high DWI/ADC signal” in the bilateral cerebral and cerebellar hemispheres consistent with small acute infarcts. Unremarkable CTA brain/neck, ECHO, [...]

Case Presentation: An 89-year-old man with coronary artery disease, hypertension, and osteoarthritis presented with acute-onset severe posterior neck pain, with no viral prodrome. The patient reported experiencing generalized weakness and associated headache, but denied any fevers, chills, cough, myalgia, joint pain, ulcers or rashes. Additionally, he did not report any photophobia, phonophobia, changes in vision, [...]

Case Presentation: A 23-year-old man with cystic fibrosis presented to the Emergency Department with a two-day history of gradual, persistent, right sided abdominal pain associated with dark, tarry stools. He was afebrile with unremarkable vital signs. Exam was notable for generalized abdominal tenderness most noticeable in the right lower quadrant and a normal rectal exam. [...]

Case Presentation: An 80-year-old man presented to the hospital with recurrent falls and generalized weakness over six months. Past medical history was notable for dementia, hypertension, and peripheral polyneuropathy. This was his fifth admission for weakness and falls with elevated CPK concerning for rhabdomyolysis, previously treated with intravenous fluids, physical and occupational therapy, and discharged [...]

Case Presentation: An 86-year-old man with a history of stroke on apixaban and metastatic renal cell carcinoma on ipilimumab/nivolumab presented to our emergency room with lightheadedness. Transthoracic echocardiogram (TTE) for stroke evaluation performed 3 years prior revealed a patent foramen ovale (PFO). Vital signs were significant for hypoxemia to 85% on room air requiring high-flow [...]