Hospital Medicine Unplugged

In this episode of Hospital Medicine Unplugged, we sprint through aplastic anemia—recognize the pancytopenia, confirm marrow failure, suppress the immune attack, and watch for clonal evolution. We open with the diagnostic framework that defines disease severity. The Camitta criteria remain the standard classification. Severe aplastic anemia requires bone marrow cellularity <25% plus at least tw...

In this episode of Hospital Medicine Unplugged, we sprint through Brugada syndrome—spot the ECG, stratify the risk, prevent sudden cardiac death, and avoid the triggers that unmask malignant arrhythmias. We start with the ECG that makes the diagnosis. Type 1 Brugada pattern is the only diagnostic finding: coved ST elevation ≥2 mm in ≥1 right precordial lead (V1–V3) followed by a negative T wave. T...

In this episode of Hospital Medicine Unplugged, we tackle one of the most ethically charged and clinically challenging topics in inpatient care: the use of restraints in the hospital setting. When are restraints justified, why do we still use them so often, and what does the evidence actually show about benefit versus harm? We start by defining physical restraints—any device or method that limits...

In this episode of Hospital Medicine Unplugged, we tackle dementia with behavioral and psychological symptoms (BPSD) in the hospitalized patient—why it happens, how to assess it fast, and how to manage it safely without making things worse. We start with the big picture: BPSD affects >90% of people with dementia, often driving hospital admissions. Symptoms span agitation, aggression, psychosis,...

In this episode of Hospital Medicine Unplugged, we tackle one of the most anxiety-provoking inpatient consults: acute facial weakness—Bell’s palsy or stroke? We break down how to tell them apart fast, why the distinction matters, and how to manage each safely in hospitalized patients. We start with the bedside exam that saves lives. Forehead involvement = peripheral (Bell’s palsy); forehead sparin...

In this episode of Hospital Medicine Unplugged, we get practical about single vs dual antiplatelet therapy after ischemic stroke—who gets what, for how long, and when DAPT does more harm than good. We start by framing the landscape: noncardioembolic vs cardioembolic stroke, small-vessel vs large-artery disease, and why platelets are center stage in atherothrombotic stroke but not in AF-driven card...

In this episode of Hospital Medicine Unplugged, we hit the brakes on routine bridging—who actually needs LMWH/UFH when you stop warfarin, and who is safer with no bridge at all? We start by nailing the definition: bridging = temporarily swapping a long-acting oral anticoagulant (usually warfarin) for short-acting heparin (UFH/LMWH) during interruptions for procedures or bleeding. Then we zoom out...

In this episode of Hospital Medicine Unplugged, we run the inpatient anticoagulation playbook—pick the right drug, dose it safely, and dodge both clots and bleeds. We start with why we anticoagulate in hospital: VTE treatment and prophylaxis, AF stroke prevention, ACS, and valve/bridging scenarios—always walking the tightrope between thrombosis and bleeding. Then we map the four main drug classes:...

In this episode of Hospital Medicine Unplugged, we unpack iron deficiency anemia (IDA) and anemia of chronic disease/inflammation (ACD/AI)—absolute iron depletion versus hepcidin-driven iron lock-down, and why that distinction matters on the wards. We sprint through the core physiology: IDA runs on empty iron stores—low ferritin, low TSAT, low hepcidin, microcytosis. ACD/AI keeps iron trapped insi...

In this episode of Hospital Medicine Unplugged, we crack open Against Medical Advice (AMA) discharges—why patients walk, who’s at highest risk, what really happens after they leave, and how to respond in a way that’s ethical, patient-centered, and legally defensible. We start with the basics: AMA = patients leaving before the team thinks it’s safe. It’s only ~1–2% of discharges, but clustered in y...

In this episode of Hospital Medicine Unplugged, we dive into evidence-based, hospital-focused management of resistant hypertension—a condition affecting up to 1 in 5 hypertensive adults and carrying ≥50% higher risk of MI, stroke, ESKD, and cardiovascular death. We start by drawing the line between true resistant hypertension (BP above goal despite 3 complementary agents including a diuretic, or c...

In this episode of Hospital Medicine Unplugged, we tackle opioid withdrawal on the inpatient ward—a syndrome that’s not usually lethal, but absolutely destabilizing, deeply uncomfortable, and a leading driver of patient-directed discharge. We open with why this matters now: fentanyl has changed everything. Its high potency and lipophilicity make withdrawal more severe, more unpredictable, and ofte...

In this episode of Hospital Medicine Unplugged, we plug into evidence-based blood transfusion—who really needs blood, how much, and when a “top-up” quietly harms more than it helps. We start with the big pivot: why modern practice has moved to a restrictive transfusion strategy (Hb <7 g/dL for most hemodynamically stable adults) and what the RCTs and Cochrane data actually show. We walk through...

In this episode of Hospital Medicine Unplugged, we take a rapid, evidence-packed tour through unintentional weight loss (UWL) in hospitalized patients—screen fast, diagnose with structure, separate fluid from true tissue loss, and never miss the reversible causes. We open with the do-firsts: screen within 24–48 hours using MUST, NRS-2002, SNAQ, or MST; older adults get the MNA-SF. Positive screen?...

In this episode of Hospital Medicine Unplugged, we tackle in-hospital falls—how often they happen, why they’re so devastating, and how to build a multifactorial, restraint-sparing prevention bundle that actually works at the bedside. We start with the scope: typical acute-care fall rates run 1.5–4.2 falls per 1,000 patient-days, with geriatric and medical units hit hardest. Up to half of fallers a...

In 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 wi...

In 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 derange...

In 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), kidne...

In 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...

In 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 stac...

In 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 + platele...

In 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 m...

In 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 urge...

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...

In 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 a...