In this episode of Hospital Medicine Unplugged, we rapid-fire hip fracture care—spot it early, operate within 24–48 hours, mobilize fast, prevent complications, and lock in secondary prevention. We open with the do-firsts: anterior groin pain, inability to bear weight, shortened/external rotation. Get AP pelvis + cross-table lateral; if films are normal but suspicion stays high, MRI (occult fracture catcher)—CT is reasonable if faster/available. Triage & team: orthopedics + hospitalist/geria...
Oct 07, 2025•24 min•Ep. 44
In this episode of Hospital Medicine Unplugged, we cut through DIC—systemic coagulation activation that causes microvascular thrombosis + consumptive bleeding—and show how to diagnose fast, treat the trigger, and tailor hemostatic support without fueling harm. We open with the core phenotypes: SIC (sepsis) → early microthrombosis/organ dysfunction with modest bleeding; TIC (trauma) → early bleeding that later flips prothrombotic. Always anchor to context (sepsis, trauma, malignancy, obstetrics)....
Oct 06, 2025•35 min•Ep. 43
In this episode of Hospital Medicine Unplugged, we sprint through febrile neutropenia (FN)—antibiotics within 1 hour, risk-stratify smartly, de-escalate responsibly, and don’t miss invasive fungi. We open with the do-firsts: rapid triage + focused exam (subtle signs count), two sets of blood cultures (peripheral + each central-line lumen), CBC with differential, renal/hepatic panels, early chest imaging if any respiratory hint, and targeted swabs/cultures per symptoms & season. Start empiric...
Oct 06, 2025•25 min•Ep. 42
In this episode of Hospital Medicine Unplugged, we blitz adrenal crisis—recognize fast, give hydrocortisone now, flood with isotonic saline, fix triggers, and keep it from coming back. We open with the do-firsts: suspect crisis in any patient with known/suspected adrenal insufficiency who rolls in with hypotension/shock, abdominal pain, collapse, or altered mentation. Don’t wait for labs—this is a clinical diagnosis. Grab baseline tests while treating: Na/K/glucose/urea–creatinine, CBC, cortisol...
Oct 06, 2025•28 min•Ep. 41
In this episode of Hospital Medicine Unplugged, we sprint through oncologic emergencies—recognize early, stabilize ABCs, start disease-directed therapy fast. We sort the chaos into four bins: metabolic, hematologic, structural, and treatment-related. Across all bins: secure airway/breathing/circulation, get oncology on board, control symptoms, and loop in palliative care for values-aligned decisions. Metabolic—act now: • Tumor lysis syndrome (TLS): Aggressive IV hydration (≈ 2–3 L/m²/day, target...
Oct 06, 2025•32 min•Ep. 40
In this episode of Hospital Medicine Unplugged, we blitz superior vena cava syndrome (SVCS)—recognize fast, image smart, stent early, treat the cause. We open with the do-firsts: airway and hemodynamic check, head-of-bed elevation, supplemental O₂, and lower-threshold ICU triage if stridor, confusion/syncope, hypotension. Contrast CT chest is your workhorse—maps level of obstruction, thrombus vs compression, collaterals, and guides the plan. MRV/US are add-ons when CT is contraindicated. Name th...
Oct 05, 2025•33 min•Ep. 39
In this episode of Hospital Medicine Unplugged, we face medical futility head-on—fair process over unilateral calls, structured communication over chaos, and ethics consultation as the engine that moves hard cases forward. We start with the do-firsts: name the problem, clarify goals, and convene the team (primary, ICU, nursing, palliative, social work, chaplaincy). Square the facts with values: prognosis, likely outcomes, and what the patient would accept as a life worth living. Call the concept...
Oct 05, 2025•30 min•Ep. 38
In this episode of Hospital Medicine Unplugged, we take on thrombotic thrombocytopenic purpura (TTP)—a hematologic sprint against time. Recognize fast, exchange plasma early, shut down antibody production, and stay ahead of relapse. TTP is a life-threatening thrombotic microangiopathy marked by microangiopathic hemolytic anemia, severe thrombocytopenia, and organ ischemia. Two types: immune-mediated (iTTP) from anti-ADAMTS13 autoantibodies, and congenital (cTTP) from inherited ADAMTS13 mutations...
Oct 05, 2025•32 min•Ep. 37
In this episode of Hospital Medicine Unplugged, we blitz fungemia—treat early, pull the source, and outpace resistance (looking at you, Candida auris). We open with the do-firsts: draw blood cultures (multiple sets) before therapy if you can, then start an echinocandin—caspofungin, micafungin, or anidulafungin—for most adults. They’re fungicidal, safe, and activity spans non-albicans. Layer rapid diagnostics (e.g., β-D-glucan, T2Candida where available) but don’t delay therapy. Source control is...
Oct 05, 2025•35 min•Ep. 36
In this episode of Hospital Medicine Unplugged, we blitz Febrile Nonhemolytic Transfusion Reactions (FNHTRs)—the common post-transfusion fever that looks scary, wastes resources, but rarely bites. Diagnose fast, exclude the killers, treat supportively, and don’t give unnecessary meds or antibiotics. We start with the definition & frequency: ≥1°C rise to ≥38°C or chills/rigors within 4 hours of transfusion, no other cause. Despite universal leukoreduction, FNHTRs still occur in ~0.1–0.3% of t...
Oct 05, 2025•33 min•Ep. 35
In this episode of Hospital Medicine Unplugged, we decode Euthyroid Sick Syndrome (ESS)—also known as Non-Thyroidal Illness Syndrome (NTIS)—the deadly lab mirage that looks like hypothyroidism but demands restraint, not replacement. This syndrome appears in the sickest hospitalized patients—sepsis, trauma, burns, heart failure, renal or hepatic failure—where thyroid tests go haywire without true thyroid disease . The classic lab pattern? Low T3, normal or low T4, normal or low TSH, and often ele...
Oct 04, 2025•35 min•Ep. 34
In this episode of Hospital Medicine Unplugged, we tackle ischemic limb—act fast for ALI, plan smart for CLTI, save the patient and the leg. We open with the two phenotypes: • ALI (acute limb ischemia)—sudden arterial cut-off with the 6 Ps: pain, pallor, pulselessness, poikilothermia, paresthesia, paralysis. • CLTI (chronic limb-threatening ischemia)—rest pain, non-healing ulcers, or gangrene on a PAD backdrop (diabetes, renal disease, smoking, age). Rapid bedside triage—decide viability, not vo...
Oct 04, 2025•26 min•Ep. 33
In this episode of Hospital Medicine Unplugged, we sprint through necrotizing fasciitis & Fournier’s gangrene—cut early, cut often, cover broadly, resuscitate hard. We open with the do-firsts: STAT surgical consult and to-OR now when you see rapid progression, systemic toxicity, crepitus/necrosis, or failure to respond to antibiotics. Delays kill—plan repeat debridements q12–36h until only healthy, bleeding tissue remains. Imaging (CT) helps map disease only if stable and must never delay so...
Oct 04, 2025•30 min•Ep. 32
In this episode of Hospital Medicine Unplugged, we tackle hospital malnutrition and refeeding syndrome—screen early, feed smart, monitor relentlessly. We start with the inpatient playbook: screen every adult at admission (MNA-SF, MUST, NRS-2002), then confirm with GLIM and document the diagnosis. Build an individualized nutrition plan: counseling + the right route—oral first (precision nutrition + fortified ONS), enteral if the gut works, parenteral if it doesn’t. Day-to-day targets: ~20–30 kcal...
Oct 04, 2025•29 min•Ep. 31
In this episode of Hospital Medicine Unplugged, we tackle septic arthritis—recognize fast, tap the joint early, drain decisively, hit bugs smartly, and protect the cartilage. We open with who gets it: elderly, diabetes, immunosuppressed, post-arthroscopy/joint surgery, prostheses, dialysis, active skin infection. Culprits are S. aureus (incl. MRSA), streptococci, and less often Gram-negatives—with MRSA = higher morbidity and mortality. Call the diagnosis, don’t guess: acute monoarthritis (pain, ...
Oct 04, 2025•30 min•Ep. 30
In this episode of Hospital Medicine Unplugged, we unpack fever of unknown origin (FUO) in hospitalized adults—define precisely, chase clues relentlessly, use PET-CT wisely, avoid reflex antibiotics. We open with the definitions that matter: classic FUO (≥38.3°C on several occasions, ≥3 weeks, no diagnosis after appropriate evaluation) and nosocomial FUO (fever >48 hrs into hospitalization with nondiagnostic initial workup). Debate continues, but “reasonable diagnostic evaluation” beats rigid...
Oct 04, 2025•27 min•Ep. 29
In this episode of Hospital Medicine Unplugged, we blitz through VTE prevention in hospitalized patients—risk-stratify early, anticoagulate wisely, protect the bleeders, and hard-wire the system so the right patient gets the right prophylaxis at the right time. We open with the do-firsts: Padua (medical), IMPROVE (medical/bleeding), Caprini (surgical) embedded in the admission workflow. High VTE risk + acceptable bleed risk = pharmacologic prophylaxis. High bleed risk = mechanical prophylaxis un...
Oct 04, 2025•41 min•Ep. 28
In this episode of Hospital Medicine Unplugged, we cut through pericardial effusion in the inpatient setting—spot it fast with TTE, act early on tamponade, spare procedures when safe, and tailor to cause. We open with the do-firsts: focused history/exam (dyspnea, chest pressure/fullness, pulsus paradoxus), ECG, CRP/ESR, CBC/chemistry ± troponin if myopericarditis suspected. TTE is first-line to confirm effusion, size it, and look for tamponade physiology (RA/RV diastolic collapse, plethoric IVC,...
Oct 03, 2025•28 min•Ep. 27
In this episode of Hospital Medicine Unplugged, we sprint through inpatient gout—confirm the diagnosis, kill the flare fast (safely), and treat to target so patients stop bouncing back. We open with the do-firsts: aspirate the joint or tophus when feasible to see MSU crystals under polarized light—doubles as a septic arthritis rule-out. If aspiration’s a no-go, lean on classic features and, when needed, ultrasound/DECT—but don’t anchor on serum urate alone (can be normal in flares). Map comorbid...
Oct 03, 2025•32 min•Ep. 26
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 moves: obtain cultures (don’t delay therapy), start broad-spectrum antibiotics within 1 hour, and b...
Oct 03, 2025•37 min•Ep. 25
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/urine ketones (minimal/absent), β-hydroxybutyrate, VBG/ABG, CBC, lactate, UA/cultures, CXR/ECG as in...
Oct 03, 2025•42 min•Ep. 24
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, trauma, stopped ATDs, iodinated contrast, amiodarone). Don’t miss mimics—sepsis, sympathomimetic toxi...
Oct 03, 2025•26 min•Ep. 23
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-before-LP: altered mental status, focal deficits, papilledema, immunocompromise, known CNS disease,...
Oct 02, 2025•36 min•Ep. 22
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 and speed kills: mild <12 mg/dL; moderate 12–14; severe ≥14 mg/dL or any altered mentation. Etiol...
Oct 02, 2025•34 min•Ep. 21
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, pancreatitis, meds, massive transfusion). Call the problem when ionized Ca <1.1 mmol/L (or total Ca ...
Oct 02, 2025•34 min•Ep. 20
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, hyponatremia/hypokalemia, sedatives/opioids, and post-TIPS/large shunts. Image the brain only if the story ...
Oct 02, 2025•31 min•Ep. 19
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 hazy or occult. If tension is suspected, treat now—don’t wait for imaging. Tube thoracostomy is defini...
Oct 02, 2025•25 min•Ep. 18
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-discharge mortality often >30–40% in severe cases—and many survivors lose independence. Iatrogenesis i...
Oct 01, 2025•30 min•Ep. 17
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 compromise. Immediate moves: • Airway first—large-bore cuffed ETT, consider selective mainstem if bleedin...
Oct 01, 2025•38 min•Ep. 16
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 titratable agents. • Hypertensive urgency = same severe BP, but no acute injury—safe to manage with ora...
Oct 01, 2025•28 min•Ep. 15
