Hospital Medicine Unplugged

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 disease. MRI is your early, high-se...

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 inpatients have esophagitis, morbid...

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 extrarenal losses early with urine K+...

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 changes ≠ safe—severe hyperkalemia can...

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 screen, and don’t miss mimics. If persis...

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 mortality. Hypoactive phenotypes hide i...

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 remains uncertain, CMR confirms in...

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 myocardial involvement.

Call the d...

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 with AF. Put the patient on telemetry...

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 risk is acceptable, start chemoprop...

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⁻]) to classify it as high anion gap (...

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, ...

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 with digital compression of the lower ...

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 regional anesthesia or nerve blocks—b...

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...

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 and adjust as needed to achieve ad...

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 risk. For indeterminate/high, add ela...

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 (inoculate blood culture bottles at be...

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, unilateral, febrile/suspected infection or ...