Shows
Hospital Medicine UnpluggedAtrial Flutter for Hospitalists: Master the ECG, Anticoagulation, Critical Distinction from Atrial Fibrillation, and the Ablation AdvantageIn this episode of Hospital Medicine Unplugged, we sprint through atrial flutter—spot the sawtooth, choose the fastest safe path to sinus, and keep strokes off the table.
We open with the do-firsts: confirm the rhythm and triage the “why.” Grab a 12-lead ECG—regular narrow tachycardia with classic sawtooth F-waves (atrial ~240–300 bpm, often 2:1 AV → ~150 bpm). Don’t confuse variable conduction with AF. Put the patient on telemetry; replete K/Mg (K ≥4, Mg ≥2). Hunt triggers (infection, hypoxia, decomp HF, stimulants, post-op). Get an echo to size up structure/valves; plan TEE if cardioversion and duration ≥48 h or unknown.
Acut...
2025-10-1931 minHospital Medicine UnpluggedAtrial Fibrillation Management in Hospitalized Patients: Early Rhythm Control, Ablation, and the 48-Hour Anticoagulation RuleIn this episode of Hospital Medicine Unplugged, we blitz inpatient atrial fibrillation (AF)—fix the trigger, pick rate vs rhythm, and prevent stroke—so you can move fast and safely.
We open with the do-firsts: vitals + hemodynamics, bedside ECG, labs (electrolytes, Mg, CBC, TSH when relevant), pulse oximetry/ABG, and a deliberate hunt for reversible triggers—infection, hypoxia, electrolyte derangements, volume shifts, ACS/PE, surgery, alcohol/withdrawal, stimulants. Treat the cause; the rhythm often follows.
Unstable? (hypotension, shock, ischemia, pulmonary edema) → immediate synchronized DCCV. While prepping: oxygen, gentle fluids/pressors as needed, avoid AV-nodal blockers if WPW s...
2025-10-1938 minHospital Medicine UnpluggedHepatorenal Syndrome (HRS-AKI) in Hospitalized Patients: Navigating the Razor-Thin Margin of Survival in Cirrhosis—New Guidelines, Albumin, and the Transplant BridgeIn this episode of Hospital Medicine Unplugged, we sprint through hepatorenal syndrome–AKI (HRS-AKI)—exclude look-alikes fast, start albumin + vasoconstrictor early, watch the lungs, and loop in transplant.
We open with the do-firsts: clinical diagnosis by exclusion—rule out hypovolemia, nephrotoxins, structural kidney disease. Pull diuretics/ACEi/NSAIDs, check UA/sediment (should be bland), kidney US (should look normal), and hunt triggers (SBP, GI bleed, overdiuresis). Albumin challenge (≈1 g/kg/day, max 100 g for 24–48 h): no renal improvement → HRS-AKI. Urine biomarkers (e.g., NGAL) may help ATN vs HRS but aren’t ready for routine.
Call AKI early...
2025-10-1930 minHospital Medicine UnpluggedCardiorenal Syndrome in the Hospitalized Patient: Targeting Venous Congestion and Pseudo-AKI with the VeXUS ProtocolIn this episode of Hospital Medicine Unplugged, we blitz cardiorenal syndrome (CRS)—define fast, subtype smart, decongest early, protect kidneys, and tighten the cardio–nephro handshake.
We start with the frame: CRS = bidirectional heart–kidney dysfunction where trouble in one organ triggers or worsens the other. Know the five plays: Type 1 (acute cardiorenal), Type 2 (chronic cardiorenal), Type 3 (acute renocardiac), Type 4 (chronic renocardiac), Type 5 (secondary/systemic). Classification isn’t trivia—it drives workup and therapy.
Pathophys in one breath: venous congestion > low forward flow; RAAS/SNS surge, vasopressin, inflammation & endothelial dysfunction; sodium avidity → diuretic resistance. CKD stacks the d...
2025-10-1942 minHospital Medicine UnpluggedMallory-Weiss Tears in Hospitalized Patients: Identifying the High-Stakes Bleeders and Mastering Mechanical HemostasisIn this episode of Hospital Medicine Unplugged, we cut through the Mallory-Weiss tear—spot it fast, stop the bleed, stabilize smart, and endoscope right.
We open with the why and who: a longitudinal mucosal laceration at the gastroesophageal junction, triggered by vomiting, retching, or sudden pressure surges. Alcohol, reflux esophagitis, hiatal hernia, NSAIDs, coagulopathy, and liver disease stack the odds. It’s uncommon but not benign—~7.5/100,000 hospitalized patients, with a small but high-risk subset landing in the ICU.
Presentation pearls: classic sequence—retching then hematemesis—appears in 120 mg/dL in liver disease.
• Airway protection if vomiting...
2025-10-1726 minHospital Medicine UnpluggedInpatient Management of Portal Hypertension: Decompensation and the Preemptive TIPS Revolution in Hospitalized PatientsIn this episode of Hospital Medicine Unplugged, we tackle portal hypertension in hospitalized cirrhosis—find it fast, control bleeding, dry the belly, clear the brain, and pick the right patients for TIPS and transplant.
We open with the diagnosis play: suspect it in cirrhosis with splenomegaly/ascites/varices. Gold standard is HVPG; CSPH = ≥10 mmHg. In real life, lean on liver stiffness + platelets for risk (rule-in ≥25 kPa or rule-out
2025-10-1726 minHospital Medicine UnpluggedAcute Upper GI Bleeding (UGIB) in Hospitalized Patients: Mastering the Critical First Hours of Hematemesis Management for HospitalistsIn this episode of Hospital Medicine Unplugged, we blitz acute peptic ulcer bleeding—risk fast, resuscitate right, scope within 24 hours, secure hemostasis, run high-dose PPIs, and crush recurrence.
We open with the do-firsts: airway/breathing/circulation, 2 large-bore IVs, orthostatics, urine output, type & cross, and labs (CBC, BMP, INR/LFTs). Risk-stratify with Glasgow–Blatchford (GBS)—≤1 may go outpatient; everyone else is inpatient/urgent care.
Resuscitation that matters: balanced crystalloids, permissive targets while bleeding, and a restrictive transfusion strategy (Hb
2025-10-1631 minHospital Medicine UnpluggedPeptic Ulcer Bleeding in the Hospitalized Patient: From Emergency Resuscitation to the 72-Hour PPI Mandate and Anticoagulation Balancing ActIn this episode of Hospital Medicine Unplugged, we take on acute peptic ulcer bleeding (PUB)—triage fast, stabilize smart, scope early, seal the vessel, and lock in acid suppression + secondary prevention.
We start at the door with risk stratification: use the Glasgow–Blatchford Score (GBS)—≤1 means very-low risk and potential outpatient management; everyone else gets admitted and prepped for urgent endoscopy. Pull CBC, chemistries, INR, type & cross.
Resuscitation that helps, not harms: large-bore IVs, balanced crystalloids, and a restrictive transfusion strategy—transfuse at Hgb
2025-10-1640 minHospital Medicine UnpluggedDiverticulitis in Hospitalized Patients: The New Evidence on Antibiotics, Abscess Drainage, and Who Needs Surgery
In this episode of Hospital Medicine Unplugged, we blitz acute diverticulitis—spot it early, stage it right, treat what matters, and prevent the encore.
We open with the why: ~200,000 US admissions/year and >$6.3B in costs. Risk stacks with age >65, obesity, NSAIDs/steroids/opioids, HTN/DM2, connective-tissue disease, and genetics. Patients roll in with LLQ pain, fever, leukocytosis, N/V.
Do-firsts in the ED/ward: IV access, analgesia (acetaminophen first; minimize opioids; avoid routine NSAIDs), antiemetics, IV fluids, and labs (CBC, BMP, UA, CRP). CT A/P with IV contrast is the diagnostic gold standard—~99–100% sensit...
2025-10-1633 minHospital Medicine UnpluggedAcute Variceal Bleeding in the Hospitalized Patient: The Critical 3-Step Protocol, Restrictive Resuscitation, and Why Early TIPS is a Game Changer for High-Risk PatientsIn this episode of Hospital Medicine Unplugged, we dive into acute variceal bleeding—a high-stakes emergency in cirrhotic patients where seconds count and outcomes hinge on rapid, coordinated care.
We start with the crash course in recognition and stabilization: ICU-level monitoring, two large-bore IVs, and cautious transfusion—targeting a hemoglobin around 7 g/dL to avoid portal pressure spikes and rebleeding. Protect the airway early; intubate if hematemesis or encephalopathy loom.
Pharmacologic therapy doesn’t wait for endoscopy. Hit fast with octreotide (50 μg bolus → 50 μg/h infusion) or terlipressin/somatostatin if available, and start ceftriaxone 1 g IV daily t...
2025-10-1626 minHospital Medicine UnpluggedPrinzmetal's Angina for the Hospitalist: The Supply-Side Crisis—Diagnosis, Monitoring, and Why Beta Blockers Are DeadlyIn this episode of Hospital Medicine Unplugged, we tackle Prinzmetal’s (variant) angina—catch the transient ST changes, prove the spasm, stop the vasoconstriction, and prevent malignant arrhythmias.
We open with the do-firsts: targeted history (rest pain, night/early-AM clustering, hyperventilation/cold/drug triggers), ECG during pain (repeat until you catch it), high-sensitivity troponin, and continuous ST-segment/telemetry because events are brief and dangerous.
Call the diagnosis when you have the triad: nitrate-responsive rest angina, transient ischemic ECG changes (ST↑ ≥0.1 mV, ST↓, or new negative U waves in ≥2 leads), and documented coronary spasm (>90% transient constriction) spontaneousl...
2025-10-1527 minHospital Medicine UnpluggedManagement of TB in the Hospitalized Patient: Molecular Speed, Isolation Rules, and Tailored Drug Strategies for HospitalistsIn this episode of Hospital Medicine Unplugged, we tackle hospital-focused TB—isolate fast, diagnose accurately, treat immediately, and coordinate with public health.
We open with the do-firsts: airborne isolation (negative pressure + N95s), notify public health, obtain CXR and 2–3 sputums for AFB smear/culture, and run first-line NAAT (Xpert MTB/RIF or Ultra) to both confirm TB and detect rifampin resistance within hours. If no sputum: induce or test extrapulmonary samples; in HIV or the critically ill, add urine LAM and site-specific molecular testing.
Isolation shortcuts that are safe: maintain airborne precautions until effective therapy + clin...
2025-10-1532 minHospital Medicine UnpluggedLife Over Limb: Decoding the High-Stakes Decision for Lower Extremity Amputation in the Hospitalized PatientIn this episode of Hospital Medicine Unplugged, we cut through hospital-focused amputation decisions—prioritize life over limb, align with patient goals, and plan for function from day one.
We open with the do-firsts: stabilize sepsis and perfusion, control infection with source control, tighten inpatient glucose, and stage limb threat (WIfI, GLASS). Loop in vascular, ortho/plastics, ID, endocrine, rehab, palliative, and social/behavioral health—decisions are team sport.
Call amputation when absolute indications hit: uncontrolled sepsis, nonviable extremity, or metabolic derailment from necrosis. Relative cues: failed revascularization, intractable pain, nonfunctional limb, or nonambulatory baseline where salv...
2025-10-1522 minHospital Medicine UnpluggedContrast-Induced Nephropathy in Hospitalized Patients: KDIGO Guidelines, Dual Mechanism Injury, and Essential Prevention ProtocolsIn this episode of Hospital Medicine Unplugged, we unpack contrast-induced nephropathy (CIN)—spot the risks, flood the kidneys (not the lungs), cut the contrast, and prevent a hospital-acquired AKI before it starts.
We open with the do-firsts: identify high-risk inpatients—those with CKD (especially eGFR
2025-10-1429 minHospital Medicine UnpluggedHungry Bone Syndrome: Decoding the Post-Surgery Mineral Debt, Risk Stratification, and Aggressive Management Protocols in Hospitalized PatientsIn this episode of Hospital Medicine Unplugged, we dive into hungry bone syndrome (HBS)—spot it early, replace hard, monitor relentlessly, and shorten the stay.
We open with the do-firsts: check calcium, phosphate, magnesium, ALP, and PTH q6–12h in the first 48–72 hours post-op; screen symptoms (paresthesias, cramps, tetany) and get an ECG for QTc if calcium is low. In dialysis patients, sync labs with the dialysis schedule.
Call the diagnosis when you see rapid, profound, and prolonged hypocalcemia (often Ca ≤7.5 mg/dL for >4 days) plus hypophosphatemia and hypomagnesemia after a sharp PTH drop (post-parathyroidectomy or thyro...
2025-10-1426 minHospital Medicine UnpluggedEmpyema Management in the Hospitalized Patient: Conquering the 47% Mortality Risk in Hospital-Acquired Pleural InfectionsIn this episode of Hospital Medicine Unplugged, we take on pleural empyema in the hospital—recognize fast, drain early, cover smart, escalate on time—because delays and resistant bugs kill.
We set the stage: hospital-acquired empyema hits harder than community-acquired (~47% vs ~17% mortality), driven by MRSA and Pseudomonas/Gram-negatives, poly-microbial mixes, and sicker hosts. Translation: broader empiric antibiotics, earlier drainage, lower threshold for surgery.
Diagnosis you can’t miss: persistent fever, pleuritic pain, failure to improve on pneumonia therapy, and a new/large effusion. Ultrasound first (bedside, maps loculations, guides the tap), contrast CT to define split...
2025-10-1333 minHospital Medicine UnpluggedThe Hospitalist's Guide to Dysphagia: Stroke, ICU, and the Stepwise Guide to Diagnosis and Management in Hospital MedicineIn this episode of Hospital Medicine Unplugged, we tackle hospital-acquired dysphagia—spot it early, screen systematically, intervene fast—to cut pneumonia, malnutrition, and mortality.
We start with the big drivers: critical illness, intubation/mechanical ventilation, tracheostomy, prolonged stay, and neuro disease (esp. acute stroke). In the ICU, post-extubation dysphagia (PED) hits ~12–26%—higher after emergency admits, severe illness, and long ventilation or RRT. Mechanisms stack up: airway trauma, impaired sensorium, neuromuscular/ICU-acquired weakness. On the wards, stroke leads the pack (up to 78%), and older adults/dementia carry heavy risk and consequences.
Why it matters: aspiration pneumonia, malnutri...
2025-10-1334 minHospital Medicine UnpluggedGuillain-Barré Syndrome (GBS): The Hospitalist's Guide to Early Recognition, Prognosis, and Choosing IVIg vs. Plasma ExchangeIn this episode of Hospital Medicine Unplugged, we blitz Guillain–Barré Syndrome (GBS)—recognize early, monitor relentlessly, start immunotherapy on time, prevent complications.
We open with the do-firsts in the hospital: admit all suspected GBS; check vital capacity (VC) & negative inspiratory force (NIF) at baseline and serially; continuous telemetry & BP for dysautonomia; early swallow screen to prevent aspiration. Move moderate–severe weakness or bulbar signs to a monitored/ICU setting.
Diagnosis is clinical-first, tests support: rapidly progressive, symmetric weakness with areflexia/hyporeflexia; look for albuminocytologic dissociation on CSF and use NCS to subtype (AIDP vs axonal...
2025-10-1330 minHospital Medicine UnpluggedWernicke-Korsakoff in the Hospitalized Patient: Why the Preventable Brain Disease is Still Critically Underdiagnosed and Demanding 500mg IV ThiamineIn this episode of Hospital Medicine Unplugged, we discuss Wernicke–Korsakoff syndrome—spot it early, slam thiamine, stop the slide to irreversible amnesia.
We open with the do-firsts: high clinical suspicion in anyone with alcohol use disorder, malnutrition, bariatric surgery, cancer, hyperemesis, or refeeding. Don’t chase labs; give thiamine now—before glucose—and correct magnesium to make the thiamine work.
Clinical diagnosis that doesn’t miss: the classic triad (confusion, ophthalmoplegia, ataxia) is rare. Use Caine criteria (≥2/4: dietary deficiency, oculomotor signs, cerebellar dysfunction, altered mental state/memory). Do not delay for MRI or thiamine levels; imagin...
2025-10-1227 minHospital Medicine UnpluggedType 1 vs. Type 2 NSTEMI: The Critical Distinction Hospitalists Must Master for Life-Saving CareIn this episode of Hospital Medicine Unplugged, we untangle type 1 vs type 2 NSTEMI—different mechanisms, different playbooks, different outcomes—and why hospital factors often tip the scales for type 2.
We set the stage fast:
• Type 1 NSTEMI = atherothrombosis—plaque rupture/erosion → thrombus. Classic chest pain, ischemic ECG, higher use of angiography/PCI, and evidence-based cardioprotective therapy (aspirin + P2Y12, anticoagulation, high-intensity statin, beta-blocker). Protocols are tight and fast.
• Type 2 NSTEMI = supply–demand mismatch—no acute coronary thrombosis. Precipitants are hospital triggers: sepsis, anemia, hypoxia, tachyarrhythmia, perioperative stress, hemodynamic instability. Patients are older, multimorbid, with atypical symptoms and non-specific...
2025-10-1231 minHospital Medicine UnpluggedWhy We Must STOP Routine Inpatient Thrombophilia Testing for Acute VTE: ASH Guidelines, False Positives, and the Harm of Mislabeling in the Hospitalized PatientIn this episode of Hospital Medicine Unplugged, we demystify inpatient thrombophilia workups—why not to test now, who (rarely) to test later, and how to time it so results actually matter.
We start with the do-firsts: treat the clot (full-intensity anticoagulation), document provoking factors, and plan follow-up. Thrombophilia status does not change acute management.
Why routine inpatient testing is discouraged:
• Low clinical yield in the hospital; results rarely alter immediate care.
• Distorted labs during acute thrombosis/illness or on anticoagulants → false positives/negatives (protein C/S, antithrombin, antiphospholipid tests).
• Cost + harm: overdiagnosis, unnecessar...
2025-10-1229 minHospital Medicine UnpluggedHemodialysis vs. Peritoneal Dialysis: Understanding the Differences Between HD versus PD for Optimal Patient OutcomesIn this episode of Hospital Medicine Unplugged, we put hospital dialysis on the clock—HD for speed and control, PD for stability and flexibility—and show you how to choose fast and safely at the bedside.
We open with what hospitals actually do: HD is the default—3x weekly with AVF/AVG/catheter, machines, trained staff, and water systems—because it rapidly clears solute and removes fluid, perfect for hyperK, acidosis, toxins, and crashing volume overload. PD is used less (infrastructure/training barriers) but can be started urgently at the bedside, shines in hemodynamic instability, and needs no antic...
2025-10-1137 minHospital Medicine UnpluggedCPAP vs. BiPAP in the Hospitalized Patient: The Hospitalist's Guide on When to Ventilate and When to OxygenateIn this episode of Hospital Medicine Unplugged, we pit CPAP vs BPAP—who’s first-line, who’s for the exceptions, and how to choose fast at the bedside.
We open with the big picture: CPAP remains first-line for uncomplicated OSA—it’s effective, more cost-effective, and no clear superiority of BPAP for routine outcomes or adherence in general OSA. BPAP shines when ventilation needs a boost or when CPAP isn’t tolerated.
How we call it (efficacy & outcomes):
• Both reduce AHI, sleepiness, and improve quality of life.
• No clinically meaningful outcome gap between CPAP and BPAP fo...
2025-10-1133 minHospital Medicine UnpluggedEvidence-Based Wound Care for the Hospitalist: TIME Framework, Debridement, and Why Your Wounds Get StuckIn this episode of Hospital Medicine Unplugged, we get hands-on with evidence-based wound care—assess precisely, prevent infection, match the dressing to the wound, and escalate smartly for the tough ones.
We start with the do-firsts: identify wound type (SSI, pressure injury, DFU, traumatic), map size/depth/exudate, scan for infection signs, and hunt barriers (ischemia, diabetes, edema, malnutrition, meds, pressure). Document with photos and a consistent ruler; add ABI/pulses for leg ulcers. Classification guides action (CDC/NHSN class, SSI depth; Wagner/UT/WIfI for DFU).
Cleanse like you mean it: tap water or no...
2025-10-1129 minHospital Medicine UnpluggedInpatient Dialysis in the Hospitalized Patient: Mastering Urgent AKI Management, AEIOU Criteria, and Safe Prescription SecretsIn this episode of Hospital Medicine Unplugged, we cut straight into heparin-induced thrombocytopenia (HIT)—the paradoxical clotting disorder that flips heparin from anticoagulant to prothrombotic trigger. Fast recognition and decisive action save lives here.
The first move: stop all heparin—IV, subQ, flushes, even coated catheters—and immediately start a therapeutic-dose, non-heparin anticoagulant. Never “hold and watch.” This isn’t a bleeding problem; it’s a thrombin storm.
Diagnosis is clinical plus confirmatory. Use the 4Ts score to judge pretest probability:
Low → HIT unlikely, continue heparin.
Intermediate/high → stop heparin, order PF4–heparin ELISA...
2025-10-1139 minHospital Medicine UnpluggedPheochromocytoma and Paraganglioma Crisis Management: The Essential Step-by-Step Guide for HospitalistsIn this episode of Hospital Medicine Unplugged, we sprint through pheochromocytoma—confirm biochemically, block before you cut, resect definitively, and guard the perioperative hemodynamics.
We open with the do-firsts: biochemical confirmation (plasma-free or 24-h urine fractionated metanephrines/normetanephrines; >3× ULN is highly suggestive), then localize with adrenal-protocol CT or MRI. Reserve functional imaging (MIBG, SSTR/FDG PET) for suspected multifocal/metastatic disease. Genetic counseling/testing for all patients—heritability is high and changes management.
Pre-op preparation—build the alpha-first backbone:
• Alpha-blockade for 7–14 days (phenoxybenzamine or selective α1: doxazosin/terazosin) titrated to low-normal BP.
• Aggressive volume repletion + hi...
2025-10-1125 minHospital Medicine UnpluggedHIT or HITT? Mastering Heparin-Induced Thrombocytopenia Diagnosis, The 4Ts Score, and Therapeutic Management Pitfalls in Hospitalized PatientsIn this episode of Hospital Medicine Unplugged, we sprint through heparin-induced thrombocytopenia (HIT)—recognize early, stop heparin immediately, and start full-dose non-heparin anticoagulation to prevent limb- and life-threatening thrombosis.
We open with the do-firsts: discontinue ALL heparin (including flushes, heparin-coated lines) and start a therapeutic-dose alternative—not prophylactic dosing—because HIT is prothrombotic even without visible clots.
Call the probability before the proof: use the 4Ts score (thrombocytopenia, timing, thrombosis/skin lesions, other causes). Low score → HIT unlikely (keep heparin, monitor). Intermediate/high → stop heparin, start non-heparin anticoagulant, send labs. Confirm with PF4/heparin IgG immunoassa...
2025-10-1131 minHospital Medicine UnpluggedThe Great Vitamin D Paradox: Targeting Severe Deficiency and Rethinking the Magic Number 30 in Hospital Medicine
In this episode of Hospital Medicine Unplugged, we spotlight vitamin D deficiency in hospitalized patients—who’s at risk, how to diagnose, and when (and how) to treat.
We start with definitions that matter: deficiency =
2025-10-1132 minHospital Medicine UnpluggedSmall Bowel Obstruction in the Hospitalized Patient: The 72-Hour Rule, Strangling Signs, and When to Call the SurgeonIn this episode of Hospital Medicine Unplugged, we run the playbook for small bowel obstruction (SBO)—triage fast, resuscitate early, image smart, don’t miss strangulation, and know when to operate.
We open with the do-firsts: IV access + balanced crystalloids, labs (CBC, electrolytes, creatinine, lactate), strict NPO, NG tube for decompression when vomiting/distended, and analgesia/antiemetics. Broad antibiotics if fever, leukocytosis, peritonitis, or suspected perforation.
Diagnosis & imaging: CT abdomen/pelvis with IV contrast is the gold standard—confirms SBO, finds the transition point, and flags closed-loop or ischemia (reduced wall enhancement, mesenteric edema, free fluid...
2025-10-1036 minHospital Medicine UnpluggedTakotsubo Cardiomyopathy Crisis: Decoding the Catecholamine Storm, LVOTO Risk, and Critical Acute Management in the Hospitalized PatientIn this episode of Hospital Medicine Unplugged, we tackle Takotsubo cardiomyopathy (TTC)—spot the mimic fast, stabilize without harming LVOTO, prevent thromboembolism, and plan recovery.
We open with the do-firsts: treat like ACS until proven otherwise—ECG, troponin, CXR, labs; urgent coronary angiography to exclude obstruction. Then confirm with imaging: TTE for pattern (apical ballooning most common), complications (LVOTO, MR, RV involvement, LV thrombus). Add CMR if the picture is hazy (edema, typically no LGE) or recovery lags.
Diagnosis in one breath: transient LV wall-motion abnormality beyond a single vascular territory + no obstructive CAD + new ECG...
2025-10-1029 minHospital Medicine UnpluggedCerebral Venous Sinus Thrombosis in the Hospitalized Patient: The Hospitalist's Roadmap to Diagnosis, Anticoagulation (Even with Bleeding), and Long-Term OutcomesIn this episode of Hospital Medicine Unplugged, we sprint through cerebral venous sinus thrombosis (CVST)—diagnose fast, anticoagulate early (even with ICH), escalate wisely, and individualize duration.
We open with the do-firsts: therapeutic heparin now—LMWH preferred for predictable dosing and lower HIT risk; UFH is fine if procedures are likely or renal function is tenuous. Anticoagulate even when intracranial hemorrhage is present unless there’s a specific contraindication (e.g., massive hematoma with expansion risk, HIT/VITT). Get MRI/MRV (or CTV when MRI’s a no-go) to confirm site/burden and look for venous infarction/hemorrha...
2025-10-1035 minHospital Medicine UnpluggedHematuria in the Hospitalized Patient: Master the Evidence-Based Approach to Risk, Workup, and The Anticoagulation TrapIn this episode of Hospital Medicine Unplugged, we sprint through hematuria in the hospital—classify fast, stabilize what’s dangerous, risk-stratify smartly, and image with purpose.
We open with the do-firsts: confirm gross vs. microscopic (≥3 RBC/HPF) on a proper urinalysis; repeat if contamination or a transient cause is likely. Don’t blame anticoagulation—it can unmask disease, not explain it away. Take a tight history (infection, stones, trauma/instrumentation, menstruation, exercise, meds, malignancy risks) and exam (vitals, bladder distention, CVA tenderness, external sources).
Red flags that change the room: clot retention/obstruction, hemodynamic instability, sepsis, AK...
2025-10-1032 minHospital Medicine UnpluggedAscending Cholangitis Emergency in Hospitalized Patients: The Core Triad Roadmap to Biliary Decompression and Why Every Hour CountsIn this episode of Hospital Medicine Unplugged, we cut through ascending cholangitis—recognize fast, resuscitate early, hit bugs hard, drain the duct.
We open with the do-firsts: aggressive IV fluids, hemodynamic stabilization, early broad-spectrum antibiotics, and urgent source control planning. Loop in GI/advanced endoscopy, interventional radiology, surgery, and ICU from the start.
How to call it—diagnosis without delay: fever, RUQ pain, jaundice (Charcot’s triad) when present, plus labs of infection + cholestasis and imaging (US first; CT or MRCP if equivocal) showing ductal dilation/obstruction. Remember: the triad is insensitive—don’t wait for all th...
2025-10-0940 minHospital Medicine UnpluggedAcute Mesenteric Ischemia in the Hospitalized Patient: The Abdominal Stroke Protocol—Early Anticoagulation, CTA, and Why You Can't Wait for LabsIn this episode of Hospital Medicine Unplugged, we race through acute mesenteric ischemia (AMI)—recognize early, image fast, revascularize now, salvage bowel.
We open with the do-firsts: high-flow crystalloids, bowel rest + NG decompression, broad-spectrum antibiotics, and therapeutic anticoagulation (arterial/venous causes) unless contraindicated. Loop in surgery, vascular, interventional radiology, and ICU immediately.
Diagnosis that doesn’t dawdle:
• Classic clue: severe abdominal pain out of proportion to exam; normal lactate/WBC do not exclude AMI.
• Imaging: triphasic CT angiography is the gold standard—call it for sudden pain, high-risk hosts (AFib, atherosclerosis, shock, vasopressors, hypercoagu...
2025-10-0934 minHospital Medicine UnpluggedSyncope Simplified: An Evidence-Based Hospitalist's Guide to Risk Stratification and Management (ACC/AHA/HRS Guidelines)In this episode of Hospital Medicine Unplugged, we sprint through syncope—recognize the dangerous few, spare the benign many, and let the ECG lead the way.
We open with the do-firsts: define it right—transient LOC from global cerebral hypoperfusion with rapid, spontaneous recovery. Sort into the big three: cardiac, reflex/neurally mediated, and orthostatic. Cardiac etiologies drive morbidity/mortality—find them fast.
Initial evaluation that actually moves the needle: history (context, prodrome, exertion/supine, palpitations, meds), focused exam with orthostatic BPs, and a 12-lead ECG. These three steps often make the diagnosis and set the ri...
2025-10-0923 minHospital Medicine UnpluggedRight Ventricular Crisis Management: Inpatient Pulmonary Hypertension, Hemodynamics, and the Failing Right Ventricle in the Hospitalized PatientIn this episode of Hospital Medicine Unplugged, we sprint through pulmonary hypertension (PH)—confirm the hemodynamics, protect the right ventricle, keep PAH therapy on, and don’t confuse Group 1 with the rest.
We open with the do-firsts: classify and hunt triggers. PH is mPAP >20 mm Hg; PAH (Group 1) adds PAWP ≤15 mm Hg and PVR ≥3 WU. Identify precipitants fast—infection, arrhythmia, volume shifts, med nonadherence—and correct them early. RV function drives outcomes.
Diagnostic snap: TTE for RV size/function and left-sided clues; ECG/CXR; targeted CT; V/Q scan for CTEPH; labs incl NT-proBNP. Right heart cath...
2025-10-0931 minHospital Medicine UnpluggedCatastrophic Clotting and the Triple Threat: Diagnosing and Managing Antiphospholipid Syndrome (APS) in the Hospitalized PatientIn this episode of Hospital Medicine Unplugged, we sprint through antiphospholipid syndrome (APS)—spot it early, anticoag fast, prevent recurrence, never miss CAPS.
We open with the do-firsts: assess for acute thrombosis (venous/arterial/microvascular), pregnancy history, triggers (infection, surgery, anticoagulant interruption), and extra-criteria clues (thrombocytopenia, livedo, valvular disease, neuro). Send aPL panel—LAC, aCL, anti-β2GPI—knowing diagnosis requires ≥1 clinical event + persistent antibody positivity ≥12 weeks. Flag high-risk phenotypes: triple-positive and coexisting SLE.
Call the diagnosis when the clinical picture (thrombosis and/or pregnancy morbidity) pairs with persistent aPL. Support with imaging (US/CTPA/brain MRI), TTE f...
2025-10-0842 minHospital Medicine UnpluggedCyclic Vomiting Syndrome in the Hospitalized Patient: Master the Acute Inpatient Protocol, Dextrose, and Opioid-Sparing Pain ControlIn this episode of Hospital Medicine Unplugged, we tackle cyclic vomiting syndrome (CVS) in the inpatient world—abort fast, hydrate smart, calm the gut–brain axis, and plan the relapse-proof discharge.
We open with the do-firsts: confirm the stereotyped episodes + symptom-free intervals (Rome IV vibe), rule out red flags (intracranial, obstruction, metabolic), grab labs (electrolytes, glucose, renal, LFTs, lipase) and start dextrose-containing IV fluids early. Keep the room dark, quiet, low-stimulus—sensory brakes matter.
Abortive therapy—hit hard, hit early (even mid-emesis): most adults need ≥2 agents.
• Triptan + antiemetic core: sumatriptan (NS 20 mg or SC 6 mg) + ondans...
2025-10-0730 minHospital Medicine UnpluggedAppendicitis Revolution: Risk Stratification, Antibiotics-First, and the End of Automatic Surgery in Hospitalized PatientsIn this episode of Hospital Medicine Unplugged, we cut through appendicitis—risk-stratify early, choose surgery vs. antibiotics deliberately, and match therapy to CT and patient factors.
We open with the do-firsts: focused history/exam, labs (CBC, CRP), pregnancy test when relevant, urinalysis, and CT A/P (gold standard in adults) to confirm and stage—high-risk CT flags include appendicolith, mass effect/phlegmon, or diameter ≥13 mm. Layer in frailty and peri-op risk tools (e.g., NSQIP) to personalize decisions in older/comorbid patients.
Call the stage to steer care:
• Uncomplicated = inflamed appendix without perforation/abscess/phlegmon...
2025-10-0725 minHospital Medicine UnpluggedHypophosphatemia in the Hospitalized Patient: Mastering Hypophosphatemia Risk, Mechanisms, and Repletion Protocols in High-Acuity PatientsIn this episode of Hospital Medicine Unplugged, we sprint through hypophosphatemia—spot it early, fix the shift, replenish smart, protect the diaphragm and heart.
We open with the essentials: phosphate
2025-10-0728 minHospital Medicine UnpluggedHyperviscosity in the Hospitalized Patient: The Critical Bedside Diagnosis and Acute Management of Hyperviscosity SyndromeIn this episode of Hospital Medicine Unplugged, we blitz hyperviscosity syndrome (HVS)—recognize fast, de-sludge the blood, protect the brain/retina, fix the cause.
We open with the big picture: HVS = impaired microcirculation from thick blood, most often paraproteins (IgM/IgG/IgA), cellular overload (erythrocytosis/leukocytosis), or cryoproteins. Classic triad: mucosal bleeding, visual changes, neurologic symptoms—but treat the patient, not the viscosity number.
Do-firsts at the bedside: focused neuro/ocular exam, fundoscopy (dilated/tortuous veins, hemorrhages), bleeding check. Draw CBC + smear (rouleaux? blasts?), quantitative Igs, SPEP/IFE, serum viscosity/WBV, CMP/LDH/uric acid. Add...
2025-10-0730 minHospital Medicine UnpluggedHip Fracture Management of the Hospitalized Patient: The 48-Hour Imperative and Evidence-Based Management of Geriatric Hip FracturesIn this episode of Hospital Medicine Unplugged, we rapid-fire hip fracture care—spot it early, operate within 24–48 hours, mobilize fast, prevent complications, and lock in secondary prevention.
We open with the do-firsts: anterior groin pain, inability to bear weight, shortened/external rotation. Get AP pelvis + cross-table lateral; if films are normal but suspicion stays high, MRI (occult fracture catcher)—CT is reasonable if faster/available.
Triage & team: orthopedics + hospitalist/geriatric co-management from the ED. Stabilize meds/fluids/electrolytes, correct anemia, manage cardiac issues without needless delays. Multimodal analgesia (scheduled acetaminophen ± cautious NSAID, femoral/fascia-iliaca block) to cut...
2025-10-0724 minHospital Medicine UnpluggedDIC for the Hospitalist: Sepsis, Trauma, and the Critical Balancing Act of Clotting and BleedingIn this episode of Hospital Medicine Unplugged, we cut through DIC—systemic coagulation activation that causes microvascular thrombosis + consumptive bleeding—and show how to diagnose fast, treat the trigger, and tailor hemostatic support without fueling harm.
We open with the core phenotypes: SIC (sepsis) → early microthrombosis/organ dysfunction with modest bleeding; TIC (trauma) → early bleeding that later flips prothrombotic. Always anchor to context (sepsis, trauma, malignancy, obstetrics).
Recognition & labs you can’t skip:
• Think DIC with new bleeding, ischemia, or organ failure in a compatible illness.
• ISTH DIC score (platelets, PT, fibrinogen, D-dimer) for overt DIC...
2025-10-0634 minHospital Medicine UnpluggedFebrile Neutropenia in the Hospitalized Patient: The Critical Golden Hour, Risk Triage, and Antibiotic Stewardship for the HospitalistIn this episode of Hospital Medicine Unplugged, we sprint through febrile neutropenia (FN)—antibiotics within 1 hour, risk-stratify smartly, de-escalate responsibly, and don’t miss invasive fungi.
We open with the do-firsts: rapid triage + focused exam (subtle signs count), two sets of blood cultures (peripheral + each central-line lumen), CBC with differential, renal/hepatic panels, early chest imaging if any respiratory hint, and targeted swabs/cultures per symptoms & season. Start empiric therapy before workup is complete.
Why FN is dangerous: risk climbs with ANC 4–7 days of fever with ongoing neutropenia: add empiric/pre-emptive antifungal—think mold-active azoles or echin...
2025-10-0625 minHospital Medicine UnpluggedMeningitis Pearls in the Hospitalized Patient: Zero-Delay Antibiotics and the 4 Pillars of Evidence-Based ManagementIn this episode of Hospital Medicine Unplugged, we blitz through bacterial meningitis—recognize fast, give antibiotics now, add steroids early, and never delay care for tests.
We open with the do-firsts: minutes matter. Draw blood cultures → start empiric IV antibiotics immediately (don’t wait for CT/LP) → add dexamethasone before or with the first dose (stop if Listeria). Rapid risk screen for CT-before-LP: altered mental status, focal deficits, papilledema, immunocompromise, known CNS disease, or new-onset seizures. If none, LP now.
Call the diagnosis with CSF that screams bacteria: WBC >2,000/µL with neutrophil predominance, protein >2.2 g/L, glucos...
2025-10-0236 minHospital Medicine UnpluggedAcute Hypercalcemia Crisis in the Hospitalized Patient: Evidence-Based Management, Triage, and The Denosumab vs. Bisphosphonate DilemmaIn this episode of Hospital Medicine Unplugged, we sprint through hypercalcemia—recognize fast, rehydrate hard, block bone resorption, and fix the cause.
We open with the do-firsts: confirm true hypercalcemia (ionized preferred; corrected total if needed), grab PTH → PTHrP/25-OH D/1,25-(OH)₂D, BMP/Phos/Mg, ECG for shortened QT, and scan meds (thiazides, lithium, vit D/Ca, vit A). Severity matters and speed kills: mild hyperplasia > carcinoma).
• Others: granulomatous disease, meds, milk-alkali, thyrotoxicosis, adrenal insufficiency, immobilization, toxins.
Diagnosis pearls:
• Ionized Ca beats “corrected” when albumin or pH is off.
• Low PTH → hunt malig...
2025-10-0233 minHospital Medicine UnpluggedHypocalcemia in the Hospitalized Patient: Master the ICU Paradox and Achieve Precision Calcium Management Using ATA and KDIGO GuidelinesIn this episode of Hospital Medicine Unplugged, we blitz through hypocalcemia—measure ionized calcium, treat symptoms now, fix the cause, and avoid reflex over-correction in the ICU.
We open with the do-firsts: confirm with ionized Ca (total Ca lies in hypoalbuminemia), check Mg/Phos/Cr, PTH, 25-OH D, ECG for QT prolongation, and scan the story (neck surgery, CKD, vitamin D deficiency, sepsis, pancreatitis, meds, massive transfusion).
Call the problem when ionized Ca
2025-10-0233 minHospital Medicine UnpluggedThe Hospitalist's Roadmap for Inpatient Hepatic Encephalopathy: Crisis Management, Pitfalls, and the Protein Paradox
In this episode of Hospital Medicine Unplugged, we power through hepatic encephalopathy—find the trigger fast, start lactulose early, layer rifaximin when needed, and protect the airway and the brain.
We open with the do-firsts: stabilize ABCs, grade mental status (West Haven), check glucose/electrolytes, and hunt precipitants—infection (incl. SBP), GI bleed, AKI/dehydration, constipation, hyponatremia/hypokalemia, sedatives/opioids, and post-TIPS/large shunts. Image the brain only if the story doesn’t fit or focal signs appear. Treat while you evaluate—don’t wait for ammonia levels to “confirm.”
Core therapy—nonabsorbable disaccharides (lactulose) are first-line:
2025-10-0230 minHospital Medicine UnpluggedPneumothorax Paradigm Shift in the Hospitalized Patient: When to Watch, When to Tube, and Why POCUS Changes EverythingIn this episode of Hospital Medicine Unplugged, we tackle pneumothorax in the inpatient world—stabilize first, size it right, choose the least invasive path that’s safe, and never miss tension physiology.
We open with the first five minutes: is the patient stable? Check vitals and work of breathing, then confirm with imaging—CXR first-line, POCUS for speed/supine patients, CT when the picture’s hazy or occult. If tension is suspected, treat now—don’t wait for imaging. Tube thoracostomy is definitive.
Classification that actually changes management: primary spontaneous (PSP), secondary spontaneous (SSP), iatrogenic, traumatic, a...
2025-10-0224 minHospital Medicine UnpluggedHypernatremia's High Stakes: Customized Correction Rates and the Catastrophic Risk of Over-Correction in the Hospitalized PatientIn this episode of Hospital Medicine Unplugged, we tackle hypernatremia—spot it early, fix the water–salt mismatch, and keep brains safe while you correct.
We open with who’s at risk and why it matters: older adults, nursing-home residents, cognitively impaired, immobilized, and ICU patients (prevalence up to 27%). Consequences aren’t subtle: delirium, falls, functional decline, and in-/post-discharge mortality often >30–40% in severe cases—and many survivors lose independence. Iatrogenesis is common.
Diagnosis done fast and right:
• History that hunts intake/losses/meds (diuretics, hypertonic infusions, tube feeds).
• Exam for volume status and mental statu...
2025-10-0130 minHospital Medicine UnpluggedAirway First, Artery Next: Mastering the Evidence-Based Management of Massive Hemoptysis (ACCP/ACR Guidelines) in the Hospitalized PatientIn this episode of Hospital Medicine Unplugged, we dive into massive hemoptysis—stabilize fast, protect the airway, localize the bleed, and stop it for good.
We start with the killer reality: mortality isn’t from bleeding out, it’s from asphyxiation. Even small volumes can flood the airways and crash oxygenation. Massive hemoptysis = ≥200 mL/24 h or any volume causing respiratory/hemodynamic compromise.
Immediate moves:
• Airway first—large-bore cuffed ETT, consider selective mainstem if bleeding side known.
• Positioning: bleeding lung down.
• Oxygen + resuscitation, reverse coagulopathy, crossmatch blood.
• Call the multidisciplinary team early—pulmonology, IR, tho...
2025-10-0137 minHospital Medicine UnpluggedHypertensive Crisis in the Hospitalized Patient: Urgency vs. Emergency, Avoiding Harm, and Mastering the ACC/AHA GuidelinesIn this episode of Hospital Medicine Unplugged, we break down hypertensive crisis—separating urgency from emergency, tailoring the pace of reduction, and choosing the right IV agent for the right patient.
We open with the definitions:
• Hypertensive emergency = BP >180/120 with acute target-organ damage (brain, arteries, retina, kidneys, heart). These patients need monitored ICU care and IV titratable agents.
• Hypertensive urgency = same severe BP, but no acute injury—safe to manage with oral meds + outpatient follow-up, not IV drips or rapid lowering.
Why it matters: rapid BP reduction in urgency risks AKI, cerebral hypoperfusion, and long...
2025-10-0127 minHospital Medicine UnpluggedEarly vs. Late Enteral Nutrition in the Hospitalized Patients: Evidence-Based Enteral Nutrition and the High-Protein, Low-Calorie ParadoxIn this episode of Hospital Medicine Unplugged, we tackle enteral nutrition (EN) in hospitalized patients—screen early, start within 24–48 h when indicated, tailor the route and formula, and prevent complications like refeeding syndrome.
We start with the definitions and routes:
• Short-term (4–6 weeks): PEG or jejunostomy, with endoscopic placement safest.
Gastric access is standard; switch to postpyloric if aspiration risk or intolerance.
When to use EN? If the patient cannot meet needs orally and has no contraindication (e.g., obstruction, uncontrolled shock, ischemia, high-output fistula, massive GI bleed). EN beats PN—lower infections, cost, and compli...
2025-10-0127 minHospital Medicine UnpluggedPrimary Aldosteronism in the Hospitalized Patient: Master the AHA/ACC Guidelines for Diagnosis and Organ-Sparing Management in the Acute Care SettingIn this episode of Hospital Medicine Unplugged, we break down hyperaldosteronism—recognize fast, test smart, and treat to protect the heart and kidneys.
We start with the big picture: primary aldosteronism (PA) drives up to 10% of hypertension cases, especially resistant hypertension, and carries outsized risks—atrial fibrillation, stroke, MI, CKD—even when BP looks controlled. Aldosterone excess wreaks havoc via sodium retention, potassium wasting, and vascular fibrosis.
When to screen? Think resistant hypertension, hypokalemia, adrenal incidentaloma, family history of early-onset HTN or stroke, and hypertension + OSA. Order PAC, PRA, and ARR (cutoff ARR ≥30 with PAC ≥10 ng/dL). Co...
2025-10-0131 minHospital Medicine UnpluggedHAP and VAP Decoded: Mastering MDRO Risk, Empiric Therapy, and the 7-Day Standard for Hospital PneumoniaIn this episode of Hospital Medicine Unplugged, we tackle hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP)—spot early, culture smart, treat right, and prevent relentlessly.
We open with the definitions: HAP = ≥48 h after admission in non-ventilated patients; VAP = ≥48 h after intubation. Both drive ICU stays, mortality, and costs, with Gram-negatives + MRSA leading the charge and MDROs reshaping therapy.
Risk factors: prior antibiotics, prolonged hospitalization, intubation, comorbidities (lung disease, diabetes, CKD, immunosuppression), and high local MDRO burden. Pathogenesis is microaspiration + impaired defenses + hospital flora colonization, amplified by invasive devices.
Diagnosis: need new/progressive infiltrate + fever...
2025-10-0137 minHospital Medicine UnpluggedAcute Hepatitis in the Hospitalized Patient: Triage, Scores, and the Critical Race Against Liver Failure (ALF vs. ACLF)In this episode of Hospital Medicine Unplugged, we sprint through acute hepatitis—find the cause fast, stabilize early, risk-stratify smart, treat the etiology, and don’t miss ALF.
We open with the do-firsts: airway/breathing/circulation, focused exam (jaundice, asterixis, volume), and a broad lab bundle—AST/ALT, bilirubin, INR/PT, albumin, CBC, BMP, glucose, acetaminophen level, pregnancy test when relevant. Send viral serologies (HAV IgM, HBsAg + anti-HBc IgM, HCV Ab → HCV RNA, HEV IgM/RNA, HDV testing if HBV+). Image with RUQ ultrasound to exclude biliary obstruction and vascular issues. Flag precipitating drugs and toxins early.
Ca...
2025-09-3038 minHospital Medicine UnpluggedOsteomyelitis in the Hospitalized Patient: Master the MRSA, MRI, and Mandatory Biopsy Rules for HospitalistsIn this episode of Hospital Medicine Unplugged, we sprint through osteomyelitis—spot early, culture smart, hit bugs hard, cut dead bone, mobilize the team.
We open with the do-firsts: risk scan (diabetes, PAD, trauma/surgery, prosthetics, IVDU, MRSA exposure), focused exam for focal bony pain, warmth, swelling, sinus tracts, and labs (ESR/CRP↑ > WBC). Get blood cultures if febrile or vertebral disease. MRI is your early, high-sensitivity imaging to map abscesses and necrotic bone. Definitive diagnosis = bone biopsy for microbiology + histopathology—avoid swabs/sinus cultures.
Epidemiology & bugs: S. aureus (MSSA/MRSA) dominates; add gram-negatives (esp. in tra...
2025-09-3035 minHospital Medicine UnpluggedBeyond Acid Reflux: Mastering the Complex Inpatient Diagnosis and Tailored Management of EsophagitisIn this episode of Hospital Medicine Unplugged, we sprint through esophagitis—spot it fast, pin the cause, heal the mucosa, prevent complications.
We open with the do-firsts: identify alarm features (dysphagia, weight loss, GI bleed, IDA), review meds (bisphosphonates, NSAIDs, tetracyclines), immune status, tube size/position, and supine time. Frame the epidemiology for inpatients: ~1/3 of scoped inpatients have esophagitis, morbidity is meaningful, and higher short-term mortality usually mirrors comorbidity—not the mucositis itself. Prefer fine-bore NG tubes when you must feed.
Call the diagnosis: symptoms alone are messy. Endoscopy for alarms or refractory symptoms—grade erosio...
2025-09-3026 minHospital Medicine UnpluggedHypokalemia in the Hospitalized Patient: The 0.05 Rule, IV Safety Protocols, and Why You Must Check the MagIn this episode of Hospital Medicine Unplugged, we sprint through hypokalemia—define fast, find the source, replete safely, prevent rebounds.
We open with the do-firsts: confirm K+
2025-09-3028 minHospital Medicine UnpluggedHyperkalemia Crisis Protocol: Acute Management Playbook and the Calcium Conundrum in High-Stakes Hospital MedicineIn this episode of Hospital Medicine Unplugged, we power through hyperkalemia—confirm fast, monitor the heart, stabilize the membrane, shift K⁺ in, and remove K⁺ out—while fixing the cause and keeping RAASi on board when safe.
We open with the do-firsts: repeat K⁺ to exclude pseudohyperkalemia; 12-lead ECG + telemetry; hunt triggers (AKI/CKD, meds, acidosis, tissue breakdown). Remember: no ECG changes ≠ safe—severe hyperkalemia can be silent.
Call it when serum K⁺ >5.0 mmol/L (often severe ≥6.0). High-risk hosts: CKD, HF, diabetes, RAASi/K-sparing diuretics, hospitalized/critically ill. Why it matters: arrhythmias & sudden death—risk climbs with rapid ri...
2025-09-3031 min
Hospital Medicine UnpluggedStatus Epilepticus for the Hospitalist: Master the 5-Minute Crisis and Escalating Refractory CareIn this episode of Hospital Medicine Unplugged, we blitz status epilepticus (SE)—recognize at 5 minutes, give a full benzo dose fast, load a second-line ASD without delay, and escalate to ICU infusions + EEG when needed.
We open with the do-firsts (0–5 min): ABCs, oxygen, lateral positioning, monitors, IV/IO access, check glucose (give thiamine → dextrose if at risk), draw labs, consider tox screen, and don’t miss mimics. If persistent altered consciousness, order EEG early to uncover nonconvulsive SE.
Diagnosis & triage: SE = continuous seizure ≥5 min or recurrent seizures without recovery. Includes convulsive and nonconvulsive phenotypes; the latter is...
2025-09-2727 min
Hospital Medicine UnpluggedAcute Brain Failure in the Hospitalized Patient: Mastering the Evidence-Based Prevention and Management of Delirium in Acute CareIn this episode of Hospital Medicine Unplugged, we race through delirium in hospitalized adults—spot it early, fix the causes, deploy bundles, and medicate only when safety’s at stake.
We open with the scale and stakes: delirium hits ~11–42% of general inpatients and up to 87% of older surgical patients, driving falls, longer LOS, institutionalization, cognitive/functional decline, and higher mortality. Hypoactive phenotypes hide in plain sight—look for inattention + fluctuation.
Diagnosis & risk stratification—make screening routine:
• Bedside tools: CAM (and Short-CAM/3D-CAM), 4AT, CAM-S (severity).
• Method: pair direct interview with chart review; anchor on acute onset...
2025-09-2742 min
Hospital Medicine UnpluggedAcute Myocarditis in the Hospital Setting: Triage, Targeted Therapy, and the Genetics of Sudden DeathIn this episode of Hospital Medicine Unplugged, we tackle myocarditis in hospitalized patients—recognize fast, stratify risk, escalate support, and target therapy when needed.
We start with the do-firsts: triage to the right care setting, exclude obstructive coronary artery disease, and launch diagnostic testing with ECG, hs-troponin, natriuretic peptides, CRP, and echocardiography. If the picture remains uncertain, CMR confirms inflammation and endomyocardial biopsy (EMB) is reserved for high-risk or atypical cases where histology can guide therapy.
Risk stratification drives location of care:
• Stable patients (preserved EF, no arrhythmias or instability) → general ward with monitoring.
•...
2025-09-2726 min
Hospital Medicine UnpluggedAcute Pericarditis in the Hospitalized Patient: Master Risk Stratification, NLRP3, and Why Steroids Cause RelapseIn this episode of Hospital Medicine Unplugged, we sprint through pericarditis—diagnose fast, cool the inflammation, prevent tamponade, crush recurrences.
We open with the do-firsts: history/exam (rub), ECG, CRP/ESR + leukocytosis/fever, and TTE to size the effusion and exclude tamponade/constriction. CMR is reasonable in complicated/recurrent/incessant cases to confirm pericardial inflammation or myocardial involvement.
Call the diagnosis when ≥2 of 4: typical chest pain, pericardial rub, diffuse ST↑/PR↓, new/worsening effusion. Support with ↑CRP and CMR LGE/pericardial edema when the picture is hazy.
Risk-stratify for admission (any = admit): fever >38°C, subacute...
2025-09-2727 min
Hospital Medicine UnpluggedAtrial Flutter for Hospitalists: Inpatient Management, Stroke Risk, and the Ablation AdvantageIn this episode of Hospital Medicine Unplugged, we sprint through atrial flutter—spot the sawtooth, choose the fastest safe path to sinus, and keep strokes off the table.
We open with the do-firsts: confirm the rhythm and triage the “why.” Grab a 12-lead ECG—regular narrow tachycardia with classic sawtooth F-waves (atrial ~240–300 bpm, often 2:1 AV → ~150 bpm). Don’t confuse variable conduction with AF. Put the patient on telemetry; replete K/Mg (K ≥4, Mg ≥2). Hunt triggers (infection, hypoxia, decomp HF, stimulants, post-op). Get an echo to size up structure/valves; plan TEE if cardioversion and duration ≥48 h or unknown.
Acut...
2025-09-2728 min
Hospital Medicine UnpluggedDVT Prophylaxis in Hospitalized Patients: Master the High-Stakes Balance of VTE and Bleeding Risk in Hospital MedicineIn this episode of Hospital Medicine Unplugged, we sprint through inpatient VTE prevention—screen fast, prophylax right, and use system nudges so clots don’t slip through.
We open with the do-firsts: risk-stratify at admission and again daily. Use Padua/IMPROVE for medical patients, Caprini for surgical; pair with a bleeding check (IMPROVE-Bleed or clinical gestalt). If high VTE risk and bleeding risk is acceptable, start chemoprophylaxis now; if bleeding risk is high or there’s active bleeding, go mechanical and reassess q24h. Don’t let missed doses happen.
Prophylaxis decisions—match risk to modality:
2025-09-2725 min
Hospital Medicine UnpluggedMetabolic Acidosis in the Hospitalized Patient: The Anion Gap, Bicarb Controversy, and Why Your Patient’s pH is Killing Their HeartIn this episode of Hospital Medicine Unplugged, we dive into metabolic acidosis—how to identify it quickly, match treatment to the underlying cause, and manage it effectively to avoid complications.
We start by confirming the diagnosis—check arterial blood gas (ABG) and serum electrolytes for a low pH and bicarbonate (HCO₃⁻). Next, calculate the anion gap (use the formula: [Na⁺] – [Cl⁻] – [HCO₃⁻]) to classify it as high anion gap (e.g., lactic acidosis, diabetic ketoacidosis, uremia, toxins) or normal anion gap (hyperchloremic) (e.g., gastrointestinal bicarbonate loss, renal tubular acidosis, saline overuse). A urine anion gap can help distinguish ren...
2025-09-2736 min
Hospital Medicine UnpluggedMetabolic Alkalosis in the Hospitalized Patient: The Silent Killer Driving Poor Outcomes in the ICU (Workup, Management, and Why the Urine Chloride Te...In this episode of Hospital Medicine Unplugged, we dive deep into metabolic alkalosis, a common but often overlooked acid-base disturbance in hospitalized patients. From pathophysiology to evidence-based management, we’ll explore strategies for both acute and chronic cases, especially in critically ill patients.
We begin with the fundamentals: metabolic alkalosis is defined by an elevated serum bicarbonate (HCO₃⁻) and arterial pH, with a compensatory increase in Pco₂. It's frequently seen in ICU patients, often due to diuretics, vomiting, or volume resuscitation. While mild cases are typically asymptomatic, severe alkalosis (pH >7.55) can lead to arrhythmias, neuromuscular irritability, and impaired...
2025-09-2729 min
Hospital Medicine UnpluggedThe Hospitalist’s Management of Epistaxis: Evidence-Based Management, From ABCs to Topical TXA and Anticoagulation TightropesIn this episode of Hospital Medicine Unplugged, we discuss epistaxis—from initial management to preventing recurrence, with evidence-based strategies for hospitalized patients.
We start with stabilization—the priority is always airway, breathing, and circulation. Massive epistaxis can compromise hemodynamic stability, so monitoring vital signs and ensuring hemodynamic support is crucial. Begin with digital compression of the lower third of the nose for 15-20 minutes and ensure the patient leans forward to prevent aspiration. This simple maneuver is often enough to control bleeding in many cases.
If bleeding persists, we move to first-line therapies: apply topical vaso...
2025-09-2723 min
Hospital Medicine UnpluggedAcute Compartment Syndrome: Beat the Clock, Save the Limb: Diagnosis, Delta P, and Emergency FasciotomyIn this episode of Hospital Medicine Unplugged, we tackle compartment syndrome—diagnose early, intervene fast, and prevent long-term complications.
We start with the essentials: pain management and serial assessments. The hallmark symptom is pain out of proportion to the injury. Administer analgesics promptly, but adjust based on the severity. For pain refractory to standard treatment, consider regional anesthesia or nerve blocks—but be cautious, as these may mask symptoms and delay diagnosis. Pain with passive stretch and paresthesias are critical early signs.
Next, we focus on diagnosis—it’s all about clinical assessment and intracompartmental pressure...
2025-09-2728 min
Hospital Medicine UnpluggedSIADH in the Hospitalized Patient: Master the Evidence-Based Diagnosis and Safe Management of Hyponatremia (Urea vs. Vaptans)In this episode of Hospital Medicine Unplugged, we dive into Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH)—diagnose it early, treat fluid imbalances, and carefully manage hyponatremia.
We start with the essentials: identify and treat reversible causes first. Whether it’s medications, malignancy, or pulmonary/CNS disorders, addressing the underlying issue is key. For life-threatening symptoms like seizures or coma, 3% sodium chloride is recommended to quickly reverse cerebral edema, followed by specialist consultation.
For nonemergent cases, fluid restriction remains the first-line therapy—typically 1–1.5 liters/day. However, randomized trials show modest benefits. If that doesn't work, consider...
2025-09-2730 min
Hospital Medicine UnpluggedSickle Cell Crisis in the Hospitalized Patient: Pain Protocols, Balanced Fluids, and Why You Must Review Hydroxyurea NowIn this episode of Hospital Medicine Unplugged, we tackle sickle cell disease (SCD)—manage pain, prevent complications, and optimize long-term care.
We start with the essentials: rapid pain management and early intervention. For vaso-occlusive crisis (VOC), opioids should be administered within 1 hour of presentation, with individualized dosing based on previous effective regimens. Monitor closely and adjust as needed to achieve adequate analgesia. Adjuncts like NSAIDs can be used when appropriate, and for opioid-refractory pain, consider ketamine infusions or regional anesthesia—but only in select cases, with specialist input.
Next, we talk fluids—balanced is the new st...
2025-09-2736 min
Hospital Medicine UnpluggedNAFLD & NASH in the Hospitalized Patient: The Hospitalist’s Guide to Fibrosis Triage, Comorbidity Control, and Advanced ManagementIn this episode of Hospital Medicine Unplugged, we tackle NAFLD—screen smart, stage fibrosis fast, and treat the heart to save the liver.
We open with the do-firsts: targeted case-finding, not blanket screening. Prioritize patients with obesity, T2D, metabolic syndrome. Start with FIB-4 (age/AST/ALT/platelets): 2.67 = high risk. For indeterminate/high, add elastography (VCTE/MRE). Reserve biopsy for discordant NITs or when confirming NASH/advanced fibrosis will change management. Flag that acute illness skews labs—repeat FIB-4 after discharge if values were “hot.”
Lifestyle is the therapy with the biggest effect size:
• Weight los...
2025-09-2641 min
Hospital Medicine UnpluggedAscites Management in Cirrhosis: AASLD Guidelines, SBP, and HRS-AKI ExplainedIn this episode of Hospital Medicine Unplugged, we sprint through ascites—tap early, diurese smarter, and keep kidneys/brains out of trouble while you line up the definitive plan.
We open with the do-firsts: confirm the syndrome and name the driver. Diagnostic paracentesis on arrival (don’t wait for the CT): send cell count/diff (SBP if PMN ≥250/µL), albumin + total protein (for SAAG), culture (inoculate blood culture bottles at bedside), ± cytology/ADA/amylase if the story is atypical. Read the fluid: SAAG ≥1.1 g/dL → portal HTN (usually cirrhosis); SAAG 2.5 g/dL points to cardiac. Baseline labs: CMP/Cr, INR...
2025-09-2629 min
Hospital Medicine UnpluggedPleural Effusions in the Hospitalized Patient: A Hospitalist’s Evidence-Based Roadmap for Diagnosis, POCUS, and Tailored ManagementIn this episode of Hospital Medicine Unplugged, we sprint through pleural effusions—scan smart, tap safer, and match treatment to mechanism so your patients breathe easier with fewer procedures.
We open with the do-firsts: confirm the effusion and triage the “why.” Go POCUS-first (size, septations, safe pocket), use CXR for laterality, save CT for complexity. Tap if it’s new, unexplained, unilateral, febrile/suspected infection or cancer, or large/symptomatic. Send a full panel: protein, LDH, pH, glucose, cell count/diff, Gram/culture, cytology; add ADA/TB PCR when TB’s on the table. Call it with Light’s cr...
2025-09-2625 min
Hospital Medicine UnpluggedRhabdomyolysis in the Hospitalized Patient: The High-Stakes Guide to Early Diagnosis, AKI Prevention, and Fluid ResuscitationIn this episode of Hospital Medicine Unplugged, we sprint through rhabdo—spot it early (even without the classic triad), flood fast, and keep kidneys out of trouble.
We open with the do-firsts: confirm the syndrome and size the risk. Order CK (diagnostic at >5× ULN; think >5,000 IU/L non-exertional, >10,000 IU/L exertional), BMP (K⁺/Cr), Ca/Mg/Phos, AST/ALT, LDH, UA ± myoglobin, ECG, and urine output with a Foley. Calculate a McMahon score to estimate AKI risk. Hunt the culprit now—trauma/immobility, heat/exertion, alcohol/illicit drugs, statins/antipsychotics/SSRIs/colchicine, infections (including COVID-19), metabolic/endocrine hits, se...
2025-09-2626 min
Hospital Medicine UnpluggedPressure Injuries in Hospitalized Patients: Why Your Braden Score Isn’t Enough and the Multicomponent Protocols That Truly Save Skin and BillionsIn this episode of Hospital Medicine Unplugged, we cut through pressure injuries—who to flag on day 1, which beds and dressings actually help, and how to run a wound plan that heals instead of lingers.
We open with the do-firsts: risk-stratify (Braden + clinical judgment), full head-to-toe skin check with stage + size + photo, float the heels now, reposition q2h (individualize if unstable), and put silicone prophylactic dressings on sacrum/heels in high-risk patients. Build a moisture plan (barrier creams, manage incontinence, minimize device pressure), order nutrition consult, and page wound care early for Stage 3–4 or anything you’re uns...
2025-09-2629 min
Hospital Medicine UnpluggedMastering Evidence-Based Goals of Care: Your Guide to Structured, High-Quality GOC Discussions and EHR-Driven EquityIn this episode of Hospital Medicine Unplugged, we cut through goals-of-care (GOC) conversations—who to flag, what to say, how to document it so the whole team actually uses it.
We open with the do-firsts: identify the right patients (surprise question “Would I be surprised…?”, acute deterioration, high-risk admits, ≥2 recent hospitalizations). Prep before you walk in: scan prior ACP notes/POLST/advance directives, locate the surrogate, check capacity, order an interpreter if needed, and secure a quiet space (+ tissues, sitter coverage). Set the agenda up front: “I want to understand what matters to you and make a plan that fi...
2025-09-2638 min
Hospital Medicine UnpluggedAcute Pancreatitis Deep Dive: Nailing the First 48 Hours—Fluids, Necrosis, and the Step-Up Survival StrategyIn this episode of Hospital Medicine Unplugged, we demystify acute pancreatitis—diagnose fast, hydrate smart, feed early, and know when to escalate.
We open with getting the diagnosis and severity right: use the rule of 2/3 (typical pain, lipase/amylase >3× ULN, or imaging) and stage by revised Atlanta (mild, moderately severe, severe). BISAP/APACHE II help risk-stratify on day 1 without replacing judgment.
Resuscitation playbook: start lactated Ringer’s early (first 12–24 h). Typical initial rate 5–10 mL/kg/h, then titrate to targets—MAP 65–85 mmHg, HR 0.5–1 mL/kg/h, hematocrit 35–44%. Reassess often and avoid over-hydration (watch lungs/BNP/creatinine).
...
2025-09-2532 min
Hospital Medicine UnpluggedThe Evidence-Based Inpatient Pathway for Acute Choledocholithiasis: Guidelines, Risks, and Single-Stage SolutionsIn this episode of Hospital Medicine Unplugged, we demystify acute choledocholithiasis—who needs urgent decompression, how to clear the duct, and how to prevent the encore.
We open with the sick first: suspected cholangitis or biliary sepsis = urgent ERCP (4 mg/dL plus CBD dilation) → straight to ERCP.
Intermediate risk → EUS or MRCP (pick by availability/expertise) or IOC.
Low risk → lap chole with selective IOC.
Diagnostics that matter: RUQ ultrasound first; MRCP/EUS confirm stones when the pretest probability is mid-range. Use IOC intraop when pre-op imaging is equivocal—if stones are there, you’ve got...
2025-09-2535 min
Hospital Medicine UnpluggedAcute COPD Exacerbation (AECOPD) Evidence Unlocked: 5-Day Steroids, 88-92% Oxygen, and NIV First for Hypercapnic Respiratory FailureIn this episode of Hospital Medicine Unplugged, we cut through inpatient COPD exacerbations—how to stabilize fast, choose the right meds, and know when to put the mask on.
We open with the do-firsts: grab a chest X-ray and ABG to rule in AECOPD and rule out the mimics (pneumonia, HF, PE) and acute respiratory acidemia. Start controlled O₂ targeting SpO₂ 88–92%. Hit bronchi with short-acting bronchodilators—albuterol ± ipratropium via neb or MDI+spacer, front-loaded and frequent. Systemic steroids for all inpatients: prednisone 40 mg PO daily × 5 days (or equivalent IV if NPO). Loop in RT early; reassess after each treatme...
2025-09-2528 min
Hospital Medicine UnpluggedAcute Infective Endocarditis: Deep Dive into Rapid Diagnosis, Antibiotics, and the Critical Surgery CallIn this episode of Hospital Medicine Unplugged, we cut through acute infective endocarditis—how to confirm it fast, start the right drugs, and know when the valve team needs to move.
We open with the do-firsts: draw three sets of blood cultures from separate sticks, then start empiric IV therapy—vancomycin + ceftriaxone for most native valves (daptomycin if vanc-intolerant). TTE now; TEE early (prosthetic/device, nondiagnostic TTE, or high suspicion). If cultures stay negative, send serologies/PCR (Coxiella, Bartonella, Brucella) and consider FDG-PET/CT for prostheses or suspected paravalvular infection. Loop in ID, cardiology, and cardiac surgery upfr...
2025-09-2534 min
Hospital Medicine UnpluggedHyponatremia Emergency: The Evidence-Based Roadmap to Correction, ODS Prevention, and the Desmopressin Clamp StrategyIn this episode of Hospital Medicine Unplugged, we cut through inpatient hyponatremia—how to triage by symptoms and acuity, push 3% safely, prevent overcorrection, and fix the cause.
We open with the do-firsts: confirm it’s true hypotonic hyponatremia (check measured serum osmolality; correct Na for glucose), assess duration (48 h), and stratify symptoms. Severe symptoms (seizure, coma, cardiorespiratory distress) or moderate symptoms with high-risk context (post-op, intracranial disease) → treat now. Place in a monitored setting; q2–4 h Na checks.
Hypertonic saline—how to do it without hurting anyone
• Give 3% NaCl 100–150 mL IV bolus, repeat up to 2–3 times a...
2025-09-2538 min
Hospital Medicine UnpluggedCellulitis Roadmap for the Hospitalist: 5-Day Treatment, MRSA Myths, and Why Your Patient Keeps Coming BackIn this episode of Hospital Medicine Unplugged, we demystify inpatient cellulitis—who to admit, what to cover, and when to stop.
We open with the right patients: nonpurulent, warm, tender, spreading erythema—and the red flags for a bed (systemic toxicity, rapid progression, immunocompromise, failed outpatient therapy, hand/face, or NSTI concern). Use bedside ultrasound to unmask abscess; skip routine blood cultures unless severe, immunocompromised, or unusual exposure. Mark borders and reassess at 24–48 hours.
Therapy that works:
• Nonpurulent: IV streptococcal coverage—cefazolin or penicillin G (ceftriaxone if once-daily helps).
• Purulent/MRSA risk: drain early; add M...
2025-09-2427 min
Hospital Medicine UnpluggedPyelonephritis in the Hospitalized Patient: Mastering Evidence-Based Management, Antibiotic Stewardship, and the IV-to-Oral ShiftIn this episode of Hospital Medicine Unplugged, we get practical about inpatient pyelonephritis—how to stop sepsis, protect kidneys, and prevent complications.
We open at the door: recognize sepsis, two IV lines + fluids, draw urine and blood cultures (don’t delay antibiotics for tough sticks), check creatinine and lactate, and assess for obstruction/retention.
Then hit bugs fast—empiric IV antibiotics tailored to local resistance and risk of MDR:
• Ceftriaxone (many hospitalized patients) or cefepime.
• Piperacillin–tazobactam if healthcare exposure or Pseudomonas risk.
• Carbapenem (ertapenem/meropenem) if ESBL risk or prior colonization.
• Aminogly...
2025-09-2430 min
Hospital Medicine UnpluggedFidaxomicin First, FMT Future in C. Difficile Colitis: Mastering CDI Diagnosis, Recurrence Prevention, and the Microbiome ShiftIn this episode of Hospital Medicine Unplugged, we tackle Clostridioides difficile infection (CDI) on the wards—fast, practical, guideline-driven care from test ordering to recurrence prevention.
We open with the first moves: test only the right patient—≥3 unformed stools in 24 h (or ileus/toxic megacolon). Use a two-step algorithm: GDH + toxin EIA up front; NAAT as the tiebreaker if discordant. No “test of cure.” While labs cook, fix the basics: stop the inciting antibiotic if you can (or narrow), review meds (especially PPIs), start IV fluids/electrolytes, and avoid antimotility agents in severe/fulminant disease. Early nutrition, VTE prophy...
2025-09-2327 min
Hospital Medicine UnpluggedAcute Ischemic Stroke: Reperfusion, Supportive Care, and the Great Shift from Time-Based to Tissue-Based ManagementIn this episode of Hospital Medicine Unplugged, we demystify PFO workup and closure after ischemic stroke—who to test, who to close, and how to run a tight inpatient pathway.
We open with the right patients: nonlacunar, embolic-appearing infarcts in adults 18–60 with no better cause on initial workup. Everyone gets vascular imaging, inpatient rhythm monitoring, DVT screening, and risk-factor assessment before we even say “PFO.”
Then the diagnostics that matter: start with TTE + agitated-saline bubble, but plan for TEE with bubble to define shunt size, tunnel length, and atrial septal aneurysm (ASA)—the anatomy that changes de...
2025-09-2332 min
Hospital Medicine UnpluggedAcute Lower GI Bleeding: Evidence-Based Management, Restrictive Transfusion, and the Critical 7-Day Antithrombotic Restart WindowIn this in-depth episode of Hospital Medicine Unplugged, we tackle the evidence-based inpatient management of lower gastrointestinal bleeding (LGIB)—from first contact in the ED to secondary prevention at discharge.
We start with stabilization and triage: ABCs, two large-bore IVs, targeted labs, and a restrictive transfusion strategy—generally transfuse at Hb 7), or >9 g/dL if significant cardiovascular disease or ongoing instability. We cover how to separate brisk UGIB from true LGIB, when an NG lavage helps, and how to use (but not overtrust) tools like the Oakland score alongside clinical judgment and ICU criteria.
Diagnostics and...
2025-09-2330 min
Hospital Medicine UnpluggedAcute Upper GI Bleeding: The Definitive Guide to Stabilization, Restrictive Transfusion, and Timely Endoscopy (ACG Guidelines)In this episode of Hospital Medicine Unplugged, we unpack the evidence-based inpatient management of upper gastrointestinal bleeding (UGIB)—from triage at the door to secondary prevention at discharge.
We open with stabilization: airway protection when mental status or torrential hematemesis threatens, two large-bore IVs, targeted labs (CBC, CMP, coagulation studies, type & cross), and a restrictive transfusion strategy (Hb
2025-09-2333 min
Hospital Medicine UnpluggedDecompensated Cirrhosis Inpatient Management: Avoiding Fatal Errors in Acute Triage and StabilizationIn this in-depth episode of Hospital Medicine Unplugged, we walk through the evidence-based hospital management of decompensated cirrhosis. From triage to discharge, we cover the full playbook hospitalists need on the wards.
We start with rapid assessment and risk stratification—how to find precipitating factors (infection, GI bleed, alcohol, meds/nephrotoxins), what to order up front (CBC, CMP, INR, cultures), and how to use MELD-Na and ACLF scores to guide level of care.
Next, we hit the time-critical moves:
Early diagnostic paracentesis for any new/worsening ascites—don’t delay. If SBP (PMN ≥250): ceftriax...
2025-09-2338 min
Hospital Medicine UnpluggedInpatient OUD Mastery: Protocols for MOUD, Fentanyl Induction, and Saving Lives Post-DischargeIn this in-depth episode of Hospital Medicine Unplugged, we walk through evidence-based inpatient care for opioid use disorder (OUD)—from triage to transition of care—so hospitalists can start, continue, and optimize medications for opioid use disorder (MOUD) on the wards.
We start with bedside assessment and risk stratification—confirming OUD by history and DSM-5, using the Clinical Opiate Withdrawal Scale (COWS) to time inductions, and ordering high-yield labs (CBC, CMP, HIV/HBV/HCV, pregnancy when relevant) plus an ECG when methadone is on the table.
Next, the core moves:
Make MOUD the defaul...
2025-09-2325 min
Hospital Medicine UnpluggedAF Management Redefined: Early Rhythm Control, Ablation, and the 48-Hour Anticoagulation Rule in Atrial FibrillationIn this episode of Hospital Medicine Unplugged, we decode inpatient atrial fibrillation (AF): why it matters, how to triage fast, and what to do from trigger hunt to discharge.
We start with the stakes: AF is the most common inpatient arrhythmia—tied to stroke, HF decompensation, longer LOS. Pathophysiology in a sentence: vulnerable atria + triggers (infection, hypoxia, electrolytes, ACS, surgery) → chaotic atrial activity and rapid ventricles. Step one is fixing what lit the fuse.
Time-zero checklist: confirm on ECG, put on telemetry, check K/Mg (replete), look for hypoxia, sepsis, pain, anemia, thyroid issues, ischemia. Trea...
2025-09-2334 min
Hospital Medicine UnpluggedEvidence-Based Acute Coronary Syndromes Management in the Hospitalized PatientIn this in-depth episode of Hospital Medicine Unplugged, we discuss acute coronary syndromes (ACS)—why minutes matter, how to sort risk fast, and the exact moves from triage to discharge.
We frame the stakes (plaque rupture → thrombus → myocardium at risk), then run a time-zero checklist: 12-lead ECG within 10 minutes (repeat if nondiagnostic), high-sensitivity troponin on a 0/1–2-hour pathway, telemetry, and GRACE/TIMI to separate low/intermediate/high risk. Use bedside echo for wall-motion clues; consider CT-coronary angiography only in selected low–intermediate-risk uncertainty.
The treatment playbook:
ABCs, two IVs, monitors; oxygen only if SpO₂
2025-09-2333 min
Hospital Medicine UnpluggedAlcohol Withdrawal Syndrome Management and Pharmacotherapy in Hospitalized PatientsIn this in-depth episode of Hospital Medicine Unplugged, we tackle alcohol withdrawal syndrome (AWS)—why it’s high-stakes on the wards, how to risk-stratify fast, and exactly what to do from triage through discharge.
We open with the “why”: AWS is common, dangerous, and time-sensitive. We review the pathophysiology (rebound CNS hyperexcitability after abrupt cessation) and the clinical spectrum—from mild tremor and autonomic surge to seizures and delirium tremens—framing why early recognition changes outcomes.
Diagnosis and risk stratification come next. We show how to get the story that matters (prior DTs/seizures, daily quantity, la...
2025-09-2235 min
Hospital Medicine UnpluggedInpatient Management of Acute Decompensated Heart Failure: Aggressive Decongestion Meets Quadruple Therapy: Mastering the Inpatient ADHF Optimization ...In this in-depth episode of Hospital Medicine Unplugged, we walk through the evidence-based inpatient management of acute decompensated heart failure (ADHF)—from the ED door to safe discharge and early follow-up. We frame every step around two goals: rapid, complete decongestion and in-hospital optimization of guideline-directed medical therapy (GDMT) to change long-term outcomes.
We start with triage and diagnosis: how to profile “wet/warm” vs “wet/cold,” read the neck veins like a pro, and use point-of-care ultrasound, chest imaging, and natriuretic peptides (BNP/NT-proBNP) without overcalling confounders (obesity, CKD, ARNI use). We cover the top precipitants to search...
2025-09-2232 min
Hospital Medicine UnpluggedThe Systematic Hospitalist's Guide to Anemia: Systematic Diagnosis and Modern Management of Low Hemoglobin in Hospitalized PatientsIn this in-depth episode of Hospital Medicine Unplugged, we walk through the evidence-based hospital management of anemia in the inpatient setting—a condition that affects nearly half of hospitalized adults and directly impacts morbidity, length of stay, and readmission risk. From first-line diagnosis to tailored therapy, we cover the practical tools hospitalists need on the wards.
We start with classification and diagnostic approach:
Confirming anemia with age- and sex-specific hemoglobin cutoffs.
Morphologic classification by MCV into microcytic, normocytic, and macrocytic anemia.
Physiologic classification into hypoproliferative vs. hyperproliferative states using the reticulocyte co...
2025-09-2236 min
Hospital Medicine UnpluggedBloodstream Infections in the Hospital: From Scrubbing the Hub to Surviving Septic Shock—Mastering High-Stakes Hospital Bloodstream Infection Prevention and Antimicrobial StrategyIn this in-depth episode of Hospital Medicine Unplugged, we walk through the evidence-based hospital management of gram-positive bacteremia, one of the most critical scenarios hospitalists face. From first-line antibiotic selection to workup and follow-up, we cover the full spectrum of care needed on the wards.
We start with antibiotic therapy—why cefazolin or antistaphylococcal penicillins (nafcillin/oxacillin) remain the gold standard for MSSA, and how vancomycin and daptomycin are the pillars of MRSA treatment. We also review the clinical implications of an elevated vancomycin MIC and when to switch therapy.
Next, we move to diagnostic ev...
2025-09-2236 min
Hospital Medicine UnpluggedVTE Management: Guidelines, Risk Stratification, and Outpatient Care of DVT and PE in Hospitalized PatientsIn this in-depth episode of Hospital Medicine Unplugged, we walk through the evidence-based hospital management of pulmonary embolism (PE) and deep vein thrombosis (DVT). From bedside diagnosis to long-term follow-up, we cover the full spectrum of care hospitalists need on the wards.
We start with diagnosis and risk stratification—how to use Wells criteria, D-dimer, ultrasound, and CT angiography effectively, and when imaging can safely be avoided. For PE, we break down high-risk (massive), intermediate-risk (submassive), and low-risk categories, and how these guide management.
Next, we move to acute therapy:
Anticoagulation as the co...
2025-09-2229 min
Hospital Medicine UnpluggedDiagnosis and Management of Community-Acquired Pneumonia in Hospitalized PatientsIn this episode of Hospital Medicine Unplugged, we explore the evolving science and clinical realities of community-acquired pneumonia (CAP) in hospitalized adults. Drawing from leading journals such as The New England Journal of Medicine and JAMA, we walk through practical approaches every hospitalist needs when managing pneumonia on the wards.
We start with diagnosis: recognizing new infiltrates on chest imaging in the right clinical context, and how severity scoring tools like the Pneumonia Severity Index (PSI) or ATS/IDSA criteria should guide triage—but always supplemented with bedside judgment.
Next, we dive into treatment strategies:...
2025-09-2229 min
SAID - Architecture Interior Design PodcastStarting a firm and architecture in the Dominican Republic -- Interview with Luis Sabater MusaToday I interview Luis Sabater Musa an architect who lives and works in the Dominican Republic. Luis recounts his experience starting his firm A20 Arquitectos. We also talk about architecture in the Dominican and advice for students and young professionals starting their careers!
Links: www.a20arquitectos.com -- Follow Luis on Instagram @luissabatermusa -- Follow us on Instagram @said_podcast
Thanks, everyone! Stay safe out there!
2020-03-1848 min