In this episode of Hospital Medicine Unplugged, we sprint through urticaria—recognize the wheal, distinguish acute from chronic disease, uncover autoimmune drivers, and step through a modern treatment ladder that now includes biologics and BTK inhibitors. We start with the definition and epidemiology. Urticaria is characterized by transient pruritic wheals, angioedema, or both, typically resolving within 24 hours without scarring. While about 20% of people experience urticaria at some point in l...
Mar 13, 2026•30 min•Ep. 103
In this episode of Hospital Medicine Unplugged, we sprint through acute exacerbation of interstitial lung disease (AE-ILD)—recognize the sudden decline, rule out infection and cardiac causes, support oxygenation, and navigate a disease with limited treatment options and high mortality. We begin with the diagnostic framework defined by the 2016 International Working Group. Acute exacerbation is characterized by rapid respiratory deterioration within about 1 month, accompanied by new bilateral gro...
Mar 11, 2026•45 min•Ep. 102
In this episode of Hospital Medicine Unplugged, we sprint through status epilepticus—stop the seizure fast, escalate therapy on time, protect the brain, and treat the cause before refractory disease sets in. We begin with the modern definition that changed emergency care. Status epilepticus is now defined as ≥5 minutes of continuous seizure activity or ≥2 seizures without return to baseline. The old 30-minute threshold is obsolete because neuronal injury and benzodiazepine resistance begin early...
Mar 09, 2026•44 min•Ep. 101
In this episode of Hospital Medicine Unplugged, we sprint through measles—one of the most contagious infectious diseases known—covering transmission, classic clinical presentation, complications, diagnosis, and prevention through vaccination. We start with the big picture. Measles (rubeola) is a highly contagious viral illness caused by a paramyxovirus and remains a major global public health concern despite the availability of an effective vaccine. Clinically, the disease is defined by fever, c...
Mar 09, 2026•34 min•Ep. 112
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 two of three cytopenias: • ANC <500/μL • Platelets <20,000/μL • Reticulocytes <60,000/μL Very...
Mar 08, 2026•32 min•Ep. 100
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. The 2013 consensus simplified the diagnosis—a Type 1 pattern alone (spontaneous or drug-induced) is s...
Mar 08, 2026•37 min•Ep. 99
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 a patient’s movement, from wrist and ankle restraints to vests, belts, bed rails, and enclosure beds...
Dec 26, 2025•40 min•Ep. 98
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, depression, anxiety, apathy, sleep disturbance, and disinhibition—and they’re not benign. In the ho...
Dec 26, 2025•27 min•Ep. 97
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 sparing = central (stroke)—until proven otherwise. Bell’s palsy presents with acute unilateral facial para...
Dec 26, 2025•40 min•Ep. 96
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 cardioembolism. Then we walk through who actually qualifies for DAPT: Minor noncardioembolic ischemic s...
Dec 06, 2025•32 min•Ep. 95
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 to the core tension: tiny peri-procedural thromboembolic risk vs a 3–4× jump in major bleeding with...
Dec 06, 2025•34 min•Ep. 94
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: • DOACs as default for most nonvalvular AF and VTE—rapid onset, predictable PK, no routine monitor...
Dec 06, 2025•32 min•Ep. 93
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 inside macrophages—normal/high ferritin, low TSAT, low transferrin, high hepcidin—producing a functiona...
Dec 06, 2025•33 min•Ep. 92
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 younger patients, men, people with substance use and psychiatric disorders, those who are uninsured,...
Dec 06, 2025•41 min•Ep. 91
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 controlled BP on ≥4 meds) and the look-alikes: refractory HTN (uncontrolled on ≥5 agents including an...
Dec 05, 2025•26 min•Ep. 90
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 often prolonged, leaving standard opioid agonist approaches underpowered. Add in common polysubstance us...
Dec 05, 2025•37 min•Ep. 89
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 nuanced thresholds for cardiac and orthopedic surgery, preexisting cardiovascular disease, ICU pat...
Dec 05, 2025•39 min•Ep. 88
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? Move straight into GLIM—you need ≥1 phenotypic + ≥1 etiologic criterion before calling malnutrition...
Dec 05, 2025•33 min•Ep. 87
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 are injured; in older adults, major injuries are ~8× more common, with hip fractures, subdurals, and...
Dec 05, 2025•34 min•Ep. 86
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; replete K/Mg (K ≥4, Mg ≥2). Hunt triggers (infection, hypoxia, ...
Oct 19, 2025•31 min•Ep. 85
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 derangements, volume shifts, ACS/PE, surgery, alcohol/withdrawal, stimulants. Treat the cause; the rhythm o...
Oct 19, 2025•39 min•Ep. 84
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), kidney US (should look normal), and hunt triggers (SBP, GI bleed, overdiuresis). Albumin challenge (≈1 g/...
Oct 19, 2025•31 min•Ep. 83
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 (acute renocardiac), Type 4 (chronic renocardiac), Type 5 (secondary/systemic). Classification isn’...
Oct 19, 2025•43 min•Ep. 82
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 stack the odds. It’s uncommon but not benign—~7.5/100,000 hospitalized patients, with a small but high-r...
Oct 17, 2025•27 min•Ep. 81
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 + platelets for risk (rule-in ≥25 kPa or rule-out <20 kPa with high platelets), and confirm with varices o...
Oct 17, 2025•26 min•Ep. 80
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 may go outpatient; everyone else is inpatient/urgent care. Resuscitation that matters: balanced cryst...
Oct 16, 2025•31 min•Ep. 79
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 urgent endoscopy. Pull CBC, chemistries, INR, type & cross. Resuscitation that helps, not harms: lar...
Oct 16, 2025•41 min•Ep. 78
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-firsts in the ED/ward: IV access, analgesia (acetaminophen first; minimize opioids; avoid routine N...
Oct 16, 2025•34 min•Ep. 77
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 and rebleeding. Protect the airway early; intubate if hematemesis or encephalopathy loom. Pharmacolog...
Oct 16, 2025•26 min•Ep. 76
In this episode of Hospital Medicine Unplugged, we tackle Prinzmetal’s (variant) angina—catch the transient ST changes, prove the spasm, stop the vasoconstriction, and prevent malignant arrhythmias. We open with the do-firsts: targeted history (rest pain, night/early-AM clustering, hyperventilation/cold/drug triggers), ECG during pain (repeat until you catch it), high-sensitivity troponin, and continuous ST-segment/telemetry because events are brief and dangerous. Call the diagnosis when you hav...
Oct 15, 2025•28 min•Ep. 75
