Hospital Medicine Unplugged

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 bi...

In 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 wit...

In 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 re...

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-threate...

In 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...

In 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): <1.3 (or <2.0 if >65) = low risk; 1.3–2.67 = indeterminate; >2.67 = high ri...

In 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 (in...

In 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, unilater...

In 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...

In 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 pu...

In 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/a...

In 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 replac...

In 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 (<24 h) for decompression and cultures, alongside IV fluids and broad-spectrum antibiotics. If ERCP fails or isn’t feasible, pivot to EUS-gui...

In 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 bronch...

In 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 (pr...

In 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 vs >48 h), and stratify symptoms. Severe symptoms (seizure,...

In 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 rout...

In 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 antibi...

In 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. N...

In 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 asses...

In 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 g/dL (aim >7), or >9 g/dL...

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 restr...

In 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, I...

In 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 Withdr...

In 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, te...