Hospital Medicine Unplugged

In this episode of Hospital Medicine Unplugged, we sprint through septic shock—treat it like the medical emergency it is: move fast, restore perfusion, hit early antibiotics, control the source, and individualize hemodynamics. We open with the do-firsts: rapid recognition via Sepsis-3 (infection + organ dysfunction; shock = vasopressors to keep MAP ≥65 and lactate ≥2 after fluids). Fire the Hour-1...

In this episode of Hospital Medicine Unplugged, we sprint through hyperosmolar hyperglycemic state (HHS)—spot early, rehydrate hard (safely), fix electrolytes, start insulin after fluids, and hunt the trigger. We open with the do-firsts: ABCs, tele, frequent vitals, bedside neuro checks, and labs that matter—glucose, BMP with corrected Na⁺, calculated effective osmolality (>320 mOsm/kg), serum/...

In this episode of Hospital Medicine Unplugged, we sprint through thyrotoxicosis and thyroid storm—recognize early, stabilize in the ICU, stop hormone effects fast, and line up definitive therapy. We open with the do-firsts: high-acuity triage, tele + frequent vitals, broad labs (TSH↓, free T4/T3↑), cultures/CXR/UA if infection suspected, and an immediate search for triggers (infection, surgery, t...

In 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...

In 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...

In 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, pan...

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, hyponat...

In 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 ha...

In 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-disch...

In 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 compr...

In 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 tit...

In 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): NG, NJ, or nasoduodenal tubes. • Long-term (>4–6 weeks): PEG or jejunostomy, with endos...

In 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...

In 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 c...

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 wh...

In 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...

In 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...

In 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+ <3.5 mmol/L (<3.0 severe), review meds (loop/thiazide diuretics, insulin, steroids), check GI losses, volume/BP, and get serum/urine electrolytes + acid–base. ECG if symptomatic or K+ ≤3.0. Distinguish renal vs ex...

In 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 cha...

In 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 scree...

In 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 mort...

In 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...

In 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...

In 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...

In 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⁻])...