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 endoscopic placement safest. Gastric access is standard; switch to postpyloric if aspiration risk or into...
Oct 01, 2025•27 min•Ep. 14
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 wreaks havoc via sodium retention, potassium wasting, and vascular fibrosis. When to screen? Think r...
Oct 01, 2025•32 min•Ep. 13
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 charge and MDROs reshaping therapy. Risk factors: prior antibiotics, prolonged hospitalization, intub...
Oct 01, 2025•37 min•Ep. 12
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 when relevant. Send viral serologies (HAV IgM, HBsAg + anti-HBc IgM, HCV Ab → HCV RNA, HEV IgM/RNA, HD...
Sep 30, 2025•38 min•Ep. 11
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-sensitivity imaging to map abscesses and necrotic bone. Definitive ...
Sep 30, 2025•35 min•Ep. 10
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, morbidity is meaningful, and higher short-term mortality usually mirror...
Sep 30, 2025•26 min•Ep. 9
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+ (spot or 24-hr) and chloride. Call the diagnosis and risk: hyp...
Sep 30, 2025•29 min•Ep. 8
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 be silent. Call it when serum K⁺ >5.0 mmol/L (often severe ≥6...
Sep 30, 2025•32 min•Ep. 7
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 persistent altered consciousness, order EEG early to uncover nonconvuls...
Sep 27, 2025•28 min
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 in plain sight—look for inattention + fluctuation. Diagnosis &...
Sep 27, 2025•43 min
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 inflammation and endomyocardial biopsy (EMB) is reserved for high-r...
Sep 27, 2025•27 min
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 diagnosis when ≥2 of 4: typical chest pain, pericardial rub, diffu...
Sep 27, 2025•28 min
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 chemoprophylaxis now; if bleeding risk is high or there’s active bleeding,...
Sep 27, 2025•26 min
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 (e.g., lactic acidosis, diabetic ketoacidosis, uremia, toxins) or ...
Sep 27, 2025•37 min
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, with a compensatory increase in Pco₂. It's frequently seen in ICU...
Sep 27, 2025•29 min
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 third of the nose for 15-20 minutes and ensure the patient leans ...
Sep 27, 2025•24 min
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—but be cautious, as these may mask symptoms and delay diagnosis. P...
Sep 27, 2025•29 min
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, 3% sodium chloride is recommended to quickly reverse cerebral e...
Sep 27, 2025•30 min
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 adequate analgesia. Adjuncts like NSAIDs can be used when appropria...
Sep 27, 2025•37 min
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 elastography (VCTE/MRE). Reserve biopsy for discordant NITs or when ...
Sep 26, 2025•41 min
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 bedside), ± cytology/ADA/amylase if the story is atypical. Read the...
Sep 26, 2025•29 min
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 cancer, or large/symptomatic. Send a full panel: protein, LDH, pH...
Sep 26, 2025•26 min
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 urine output with a Foley. Calculate a McMahon score to estimate AKI risk. Hunt the culprit now—trau...
Sep 26, 2025•27 min
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 put silicone prophylactic dressings on sacrum/heels in high-risk patients. Build a moisture plan (barr...
Sep 26, 2025•29 min
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/advance directives, locate the surrogate, check capacity, order an interpreter if needed, and secure ...
Sep 26, 2025•38 min
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 replacing judgment. Resuscitation playbook: start lactated Ringer’s early (first 12–24 h). Typical initial...
Sep 25, 2025•32 min
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-guided or percutaneous drainage. Then the risk tiers that steer the workup (ASGE): High risk (stone see...
Sep 25, 2025•36 min
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 bronchodilators—albuterol ± ipratropium via neb or MDI+spacer, front-loaded and frequent. Systemic steroid...
Sep 25, 2025•29 min•Ep. 1
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 (prosthetic/device, nondiagnostic TTE, or high suspicion). If cultures stay negative, send serologies/P...
Sep 25, 2025•34 min
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, coma, cardiorespiratory distress) or moderate symptoms with high-risk context (post-op, intracranial...
Sep 25, 2025•39 min
