Hospital Medicine Unplugged

In 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 sh...

In 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...

In 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, ren...

In 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...

In 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 <2.5 mg/dL (mild 2–2.5, moderate 1–1.9, severe <1). High-risk crowds: ICU, alcohol use disorder, refeeding, DKA treatment, post-op. Why we care: respiratory failure, myocardial dysfunction/arr...

In 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, n...

In 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 fractu...

In 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 bleedin...

In 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 i...

In this episode of Hospital Medicine Unplugged, we blitz adrenal crisis—recognize fast, give hydrocortisone now, flood with isotonic saline, fix triggers, and keep it from coming back. We open with the do-firsts: suspect crisis in any patient with known/suspected adrenal insufficiency who rolls in with hypotension/shock, abdominal pain, collapse, or altered mentation. Don’t wait for labs—this is a...

In this episode of Hospital Medicine Unplugged, we sprint through oncologic emergencies—recognize early, stabilize ABCs, start disease-directed therapy fast. We sort the chaos into four bins: metabolic, hematologic, structural, and treatment-related. Across all bins: secure airway/breathing/circulation, get oncology on board, control symptoms, and loop in palliative care for values-aligned decisio...

In this episode of Hospital Medicine Unplugged, we blitz superior vena cava syndrome (SVCS)—recognize fast, image smart, stent early, treat the cause. We open with the do-firsts: airway and hemodynamic check, head-of-bed elevation, supplemental O₂, and lower-threshold ICU triage if stridor, confusion/syncope, hypotension. Contrast CT chest is your workhorse—maps level of obstruction, thrombus vs c...

In this episode of Hospital Medicine Unplugged, we face medical futility head-on—fair process over unilateral calls, structured communication over chaos, and ethics consultation as the engine that moves hard cases forward. We start with the do-firsts: name the problem, clarify goals, and convene the team (primary, ICU, nursing, palliative, social work, chaplaincy). Square the facts with values: pr...

In this episode of Hospital Medicine Unplugged, we take on thrombotic thrombocytopenic purpura (TTP)—a hematologic sprint against time. Recognize fast, exchange plasma early, shut down antibody production, and stay ahead of relapse. TTP is a life-threatening thrombotic microangiopathy marked by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia. Two types: immune-mediat...

In this episode of Hospital Medicine Unplugged, we blitz fungemia—treat early, pull the source, and outpace resistance (looking at you, Candida auris). We open with the do-firsts: draw blood cultures (multiple sets) before therapy if you can, then start an echinocandin—caspofungin, micafungin, or anidulafungin—for most adults. They’re fungicidal, safe, and activity spans non-albicans. Layer rapid...

In this episode of Hospital Medicine Unplugged, we blitz Febrile Nonhemolytic Transfusion Reactions (FNHTRs)—the common post-transfusion fever that looks scary, wastes resources, but rarely bites. Diagnose fast, exclude the killers, treat supportively, and don’t give unnecessary meds or antibiotics. We start with the definition & frequency: ≥1°C rise to ≥38°C or chills/rigors within 4 hours of...

In this episode of Hospital Medicine Unplugged, we decode Euthyroid Sick Syndrome (ESS)—also known as Non-Thyroidal Illness Syndrome (NTIS)—the deadly lab mirage that looks like hypothyroidism but demands restraint, not replacement. This syndrome appears in the sickest hospitalized patients—sepsis, trauma, burns, heart failure, renal or hepatic failure—where thyroid tests go haywire without true t...

In this episode of Hospital Medicine Unplugged, we tackle ischemic limb—act fast for ALI, plan smart for CLTI, save the patient and the leg. We open with the two phenotypes: • ALI (acute limb ischemia)—sudden arterial cut-off with the 6 Ps: pain, pallor, pulselessness, poikilothermia, paresthesia, paralysis. • CLTI (chronic limb-threatening ischemia)—rest pain, non-healing ulcers, or gangrene on a...

In this episode of Hospital Medicine Unplugged, we sprint through necrotizing fasciitis & Fournier’s gangrene—cut early, cut often, cover broadly, resuscitate hard. We open with the do-firsts: STAT surgical consult and to-OR now when you see rapid progression, systemic toxicity, crepitus/necrosis, or failure to respond to antibiotics. Delays kill—plan repeat debridements q12–36h until only hea...

In this episode of Hospital Medicine Unplugged, we tackle hospital malnutrition and refeeding syndrome—screen early, feed smart, monitor relentlessly. We start with the inpatient playbook: screen every adult at admission (MNA-SF, MUST, NRS-2002), then confirm with GLIM and document the diagnosis. Build an individualized nutrition plan: counseling + the right route—oral first (precision nutrition +...

In this episode of Hospital Medicine Unplugged, we tackle septic arthritis—recognize fast, tap the joint early, drain decisively, hit bugs smartly, and protect the cartilage. We open with who gets it: elderly, diabetes, immunosuppressed, post-arthroscopy/joint surgery, prostheses, dialysis, active skin infection. Culprits are S. aureus (incl. MRSA), streptococci, and less often Gram-negatives—with...

In this episode of Hospital Medicine Unplugged, we unpack fever of unknown origin (FUO) in hospitalized adults—define precisely, chase clues relentlessly, use PET-CT wisely, avoid reflex antibiotics. We open with the definitions that matter: classic FUO (≥38.3°C on several occasions, ≥3 weeks, no diagnosis after appropriate evaluation) and nosocomial FUO (fever >48 hrs into hospitalization with...

In this episode of Hospital Medicine Unplugged, we blitz through VTE prevention in hospitalized patients—risk-stratify early, anticoagulate wisely, protect the bleeders, and hard-wire the system so the right patient gets the right prophylaxis at the right time. We open with the do-firsts: Padua (medical), IMPROVE (medical/bleeding), Caprini (surgical) embedded in the admission workflow. High VTE r...

In this episode of Hospital Medicine Unplugged, we cut through pericardial effusion in the inpatient setting—spot it fast with TTE, act early on tamponade, spare procedures when safe, and tailor to cause. We open with the do-firsts: focused history/exam (dyspnea, chest pressure/fullness, pulsus paradoxus), ECG, CRP/ESR, CBC/chemistry ± troponin if myopericarditis suspected. TTE is first-line to co...

In this episode of Hospital Medicine Unplugged, we sprint through inpatient gout—confirm the diagnosis, kill the flare fast (safely), and treat to target so patients stop bouncing back. We open with the do-firsts: aspirate the joint or tophus when feasible to see MSU crystals under polarized light—doubles as a septic arthritis rule-out. If aspiration’s a no-go, lean on classic features and, when n...