In this episode of Hospital Medicine Unplugged, we tackle hospital-focused TB—isolate fast, diagnose accurately, treat immediately, and coordinate with public health. We open with the do-firsts: airborne isolation (negative pressure + N95s), notify public health, obtain CXR and 2–3 sputums for AFB smear/culture, and run first-line NAAT (Xpert MTB/RIF or Ultra) to both confirm TB and detect rifampin resistance within hours. If no sputum: induce or test extrapulmonary samples; in HIV or the critic...
Oct 15, 2025•33 min•Ep. 74
In this episode of Hospital Medicine Unplugged, we cut through hospital-focused amputation decisions—prioritize life over limb, align with patient goals, and plan for function from day one. We open with the do-firsts: stabilize sepsis and perfusion, control infection with source control, tighten inpatient glucose, and stage limb threat (WIfI, GLASS). Loop in vascular, ortho/plastics, ID, endocrine, rehab, palliative, and social/behavioral health—decisions are team sport. Call amputation when abs...
Oct 15, 2025•23 min•Ep. 73
In this episode of Hospital Medicine Unplugged, we unpack contrast-induced nephropathy (CIN)—spot the risks, flood the kidneys (not the lungs), cut the contrast, and prevent a hospital-acquired AKI before it starts. We open with the do-firsts: identify high-risk inpatients—those with CKD (especially eGFR <30), diabetes, heart failure, advanced age, or prior contrast within 72 hours. Draw a baseline creatinine and estimate GFR pre-procedure; no shortcuts here. Intra-arterial studies (PCI, angi...
Oct 14, 2025•30 min•Ep. 72
In this episode of Hospital Medicine Unplugged, we dive into hungry bone syndrome (HBS)—spot it early, replace hard, monitor relentlessly, and shorten the stay. We open with the do-firsts: check calcium, phosphate, magnesium, ALP, and PTH q6–12h in the first 48–72 hours post-op; screen symptoms (paresthesias, cramps, tetany) and get an ECG for QTc if calcium is low. In dialysis patients, sync labs with the dialysis schedule. Call the diagnosis when you see rapid, profound, and prolonged hypocalc...
Oct 14, 2025•26 min•Ep. 71
In this episode of Hospital Medicine Unplugged, we take on pleural empyema in the hospital—recognize fast, drain early, cover smart, escalate on time—because delays and resistant bugs kill. We set the stage: hospital-acquired empyema hits harder than community-acquired (~47% vs ~17% mortality), driven by MRSA and Pseudomonas/Gram-negatives, poly-microbial mixes, and sicker hosts. Translation: broader empiric antibiotics, earlier drainage, lower threshold for surgery. Diagnosis you can’t miss: pe...
Oct 13, 2025•33 min•Ep. 70
In this episode of Hospital Medicine Unplugged, we tackle hospital-acquired dysphagia—spot it early, screen systematically, intervene fast—to cut pneumonia, malnutrition, and mortality. We start with the big drivers: critical illness, intubation/mechanical ventilation, tracheostomy, prolonged stay, and neuro disease (esp. acute stroke). In the ICU, post-extubation dysphagia (PED) hits ~12–26%—higher after emergency admits, severe illness, and long ventilation or RRT. Mechanisms stack up: airway ...
Oct 13, 2025•35 min•Ep. 69
In this episode of Hospital Medicine Unplugged, we blitz Guillain–Barré Syndrome (GBS)—recognize early, monitor relentlessly, start immunotherapy on time, prevent complications. We open with the do-firsts in the hospital: admit all suspected GBS; check vital capacity (VC) & negative inspiratory force (NIF) at baseline and serially; continuous telemetry & BP for dysautonomia; early swallow screen to prevent aspiration. Move moderate–severe weakness or bulbar signs to a monitored/ICU setti...
Oct 13, 2025•30 min•Ep. 68
In this episode of Hospital Medicine Unplugged, we discuss Wernicke–Korsakoff syndrome—spot it early, slam thiamine, stop the slide to irreversible amnesia. We open with the do-firsts: high clinical suspicion in anyone with alcohol use disorder, malnutrition, bariatric surgery, cancer, hyperemesis, or refeeding. Don’t chase labs; give thiamine now—before glucose—and correct magnesium to make the thiamine work. Clinical diagnosis that doesn’t miss: the classic triad (confusion, ophthalmoplegia, a...
Oct 12, 2025•27 min•Ep. 67
In this episode of Hospital Medicine Unplugged, we untangle type 1 vs type 2 NSTEMI—different mechanisms, different playbooks, different outcomes—and why hospital factors often tip the scales for type 2. We set the stage fast: • Type 1 NSTEMI = atherothrombosis—plaque rupture/erosion → thrombus. Classic chest pain, ischemic ECG, higher use of angiography/PCI, and evidence-based cardioprotective therapy (aspirin + P2Y12, anticoagulation, high-intensity statin, beta-blocker). Protocols are tight a...
Oct 12, 2025•32 min•Ep. 66
In this episode of Hospital Medicine Unplugged, we demystify inpatient thrombophilia workups—why not to test now, who (rarely) to test later, and how to time it so results actually matter. We start with the do-firsts: treat the clot (full-intensity anticoagulation), document provoking factors, and plan follow-up. Thrombophilia status does not change acute management. Why routine inpatient testing is discouraged: • Low clinical yield in the hospital; results rarely alter immediate care. • Distort...
Oct 12, 2025•29 min•Ep. 65
In this episode of Hospital Medicine Unplugged, we put hospital dialysis on the clock—HD for speed and control, PD for stability and flexibility—and show you how to choose fast and safely at the bedside. We open with what hospitals actually do: HD is the default—3x weekly with AVF/AVG/catheter, machines, trained staff, and water systems—because it rapidly clears solute and removes fluid, perfect for hyperK, acidosis, toxins, and crashing volume overload. PD is used less (infrastructure/training ...
Oct 11, 2025•38 min•Ep. 64
In this episode of Hospital Medicine Unplugged, we pit CPAP vs BPAP—who’s first-line, who’s for the exceptions, and how to choose fast at the bedside. We open with the big picture: CPAP remains first-line for uncomplicated OSA—it’s effective, more cost-effective, and no clear superiority of BPAP for routine outcomes or adherence in general OSA. BPAP shines when ventilation needs a boost or when CPAP isn’t tolerated. How we call it (efficacy & outcomes): • Both reduce AHI, sleepiness, and imp...
Oct 11, 2025•33 min•Ep. 63
In this episode of Hospital Medicine Unplugged, we get hands-on with evidence-based wound care—assess precisely, prevent infection, match the dressing to the wound, and escalate smartly for the tough ones. We start with the do-firsts: identify wound type (SSI, pressure injury, DFU, traumatic), map size/depth/exudate, scan for infection signs, and hunt barriers (ischemia, diabetes, edema, malnutrition, meds, pressure). Document with photos and a consistent ruler; add ABI/pulses for leg ulcers. Cl...
Oct 11, 2025•30 min•Ep. 62
In this episode of Hospital Medicine Unplugged, we cut straight into heparin-induced thrombocytopenia (HIT)—the paradoxical clotting disorder that flips heparin from anticoagulant to prothrombotic trigger. Fast recognition and decisive action save lives here. The first move: stop all heparin—IV, subQ, flushes, even coated catheters—and immediately start a therapeutic-dose, non-heparin anticoagulant. Never “hold and watch.” This isn’t a bleeding problem; it’s a thrombin storm. Diagnosis is clinic...
Oct 11, 2025•39 min•Ep. 61
In this episode of Hospital Medicine Unplugged, we sprint through pheochromocytoma—confirm biochemically, block before you cut, resect definitively, and guard the perioperative hemodynamics. We open with the do-firsts: biochemical confirmation (plasma-free or 24-h urine fractionated metanephrines/normetanephrines; >3× ULN is highly suggestive), then localize with adrenal-protocol CT or MRI. Reserve functional imaging (MIBG, SSTR/FDG PET) for suspected multifocal/metastatic disease. Genetic co...
Oct 11, 2025•25 min•Ep. 60
In this episode of Hospital Medicine Unplugged, we sprint through heparin-induced thrombocytopenia (HIT)—recognize early, stop heparin immediately, and start full-dose non-heparin anticoagulation to prevent limb- and life-threatening thrombosis. We open with the do-firsts: discontinue ALL heparin (including flushes, heparin-coated lines) and start a therapeutic-dose alternative—not prophylactic dosing—because HIT is prothrombotic even without visible clots. Call the probability before the proof:...
Oct 11, 2025•31 min•Ep. 59
In this episode of Hospital Medicine Unplugged, we spotlight vitamin D deficiency in hospitalized patients—who’s at risk, how to diagnose, and when (and how) to treat. We start with definitions that matter: deficiency = <20 ng/mL, severe = <12 ng/mL, though the 2024 Endocrine Society now urges individualized assessment over rigid cutoffs. Hospital patients—especially the elderly, critically ill, malnourished, NPO, obese, or post-bariatric—sit at the crossroads of low intake, limited sunlig...
Oct 11, 2025•33 min•Ep. 58
In this episode of Hospital Medicine Unplugged, we run the playbook for small bowel obstruction (SBO)—triage fast, resuscitate early, image smart, don’t miss strangulation, and know when to operate. We open with the do-firsts: IV access + balanced crystalloids, labs (CBC, electrolytes, creatinine, lactate), strict NPO, NG tube for decompression when vomiting/distended, and analgesia/antiemetics. Broad antibiotics if fever, leukocytosis, peritonitis, or suspected perforation. Diagnosis & imag...
Oct 10, 2025•37 min•Ep. 57
In this episode of Hospital Medicine Unplugged, we tackle Takotsubo cardiomyopathy (TTC)—spot the mimic fast, stabilize without harming LVOTO, prevent thromboembolism, and plan recovery. We open with the do-firsts: treat like ACS until proven otherwise—ECG, troponin, CXR, labs; urgent coronary angiography to exclude obstruction. Then confirm with imaging: TTE for pattern (apical ballooning most common), complications (LVOTO, MR, RV involvement, LV thrombus). Add CMR if the picture is hazy (edema...
Oct 10, 2025•30 min•Ep. 56
In this episode of Hospital Medicine Unplugged, we sprint through cerebral venous sinus thrombosis (CVST)—diagnose fast, anticoagulate early (even with ICH), escalate wisely, and individualize duration. We open with the do-firsts: therapeutic heparin now—LMWH preferred for predictable dosing and lower HIT risk; UFH is fine if procedures are likely or renal function is tenuous. Anticoagulate even when intracranial hemorrhage is present unless there’s a specific contraindication (e.g., massive hem...
Oct 10, 2025•36 min•Ep. 55
In this episode of Hospital Medicine Unplugged, we sprint through hematuria in the hospital—classify fast, stabilize what’s dangerous, risk-stratify smartly, and image with purpose. We open with the do-firsts: confirm gross vs. microscopic (≥3 RBC/HPF) on a proper urinalysis; repeat if contamination or a transient cause is likely. Don’t blame anticoagulation—it can unmask disease, not explain it away. Take a tight history (infection, stones, trauma/instrumentation, menstruation, exercise, meds, ...
Oct 10, 2025•33 min•Ep. 54
In this episode of Hospital Medicine Unplugged, we cut through ascending cholangitis—recognize fast, resuscitate early, hit bugs hard, drain the duct. We open with the do-firsts: aggressive IV fluids, hemodynamic stabilization, early broad-spectrum antibiotics, and urgent source control planning. Loop in GI/advanced endoscopy, interventional radiology, surgery, and ICU from the start. How to call it—diagnosis without delay: fever, RUQ pain, jaundice (Charcot’s triad) when present, plus labs of i...
Oct 09, 2025•40 min•Ep. 53
In this episode of Hospital Medicine Unplugged, we race through acute mesenteric ischemia (AMI)—recognize early, image fast, revascularize now, salvage bowel. We open with the do-firsts: high-flow crystalloids, bowel rest + NG decompression, broad-spectrum antibiotics, and therapeutic anticoagulation (arterial/venous causes) unless contraindicated. Loop in surgery, vascular, interventional radiology, and ICU immediately. Diagnosis that doesn’t dawdle: • Classic clue: severe abdominal pain out of...
Oct 09, 2025•35 min•Ep. 52
In this episode of Hospital Medicine Unplugged, we sprint through syncope—recognize the dangerous few, spare the benign many, and let the ECG lead the way. We open with the do-firsts: define it right—transient LOC from global cerebral hypoperfusion with rapid, spontaneous recovery. Sort into the big three: cardiac, reflex/neurally mediated, and orthostatic. Cardiac etiologies drive morbidity/mortality—find them fast. Initial evaluation that actually moves the needle: history (context, prodrome, ...
Oct 09, 2025•23 min•Ep. 51
In this episode of Hospital Medicine Unplugged, we sprint through pulmonary hypertension (PH)—confirm the hemodynamics, protect the right ventricle, keep PAH therapy on, and don’t confuse Group 1 with the rest. We open with the do-firsts: classify and hunt triggers. PH is mPAP >20 mm Hg; PAH (Group 1) adds PAWP ≤15 mm Hg and PVR ≥3 WU. Identify precipitants fast—infection, arrhythmia, volume shifts, med nonadherence—and correct them early. RV function drives outcomes. Diagnostic snap: TTE for...
Oct 09, 2025•31 min•Ep. 50
In this episode of Hospital Medicine Unplugged, we sprint through antiphospholipid syndrome (APS)—spot it early, anticoag fast, prevent recurrence, never miss CAPS. We open with the do-firsts: assess for acute thrombosis (venous/arterial/microvascular), pregnancy history, triggers (infection, surgery, anticoagulant interruption), and extra-criteria clues (thrombocytopenia, livedo, valvular disease, neuro). Send aPL panel—LAC, aCL, anti-β2GPI—knowing diagnosis requires ≥1 clinical event + persist...
Oct 08, 2025•43 min•Ep. 49
In this episode of Hospital Medicine Unplugged, we tackle cyclic vomiting syndrome (CVS) in the inpatient world—abort fast, hydrate smart, calm the gut–brain axis, and plan the relapse-proof discharge. We open with the do-firsts: confirm the stereotyped episodes + symptom-free intervals (Rome IV vibe), rule out red flags (intracranial, obstruction, metabolic), grab labs (electrolytes, glucose, renal, LFTs, lipase) and start dextrose-containing IV fluids early. Keep the room dark, quiet, low-stim...
Oct 07, 2025•31 min•Ep. 48
In this episode of Hospital Medicine Unplugged, we cut through appendicitis—risk-stratify early, choose surgery vs. antibiotics deliberately, and match therapy to CT and patient factors. We open with the do-firsts: focused history/exam, labs (CBC, CRP), pregnancy test when relevant, urinalysis, and CT A/P (gold standard in adults) to confirm and stage—high-risk CT flags include appendicolith, mass effect/phlegmon, or diameter ≥13 mm. Layer in frailty and peri-op risk tools (e.g., NSQIP) to perso...
Oct 07, 2025•26 min•Ep. 47
In this episode of Hospital Medicine Unplugged, we sprint through hypophosphatemia—spot it early, fix the shift, replenish smart, protect the diaphragm and heart. We open with the essentials: phosphate <2.5 mg/dL (mild 2–2.5, moderate 1–1.9, severe <1). High-risk crowds: ICU, alcohol use disorder, refeeding, DKA treatment, post-op. Why we care: respiratory failure, myocardial dysfunction/arrhythmias, rhabdo/hemolysis, encephalopathy. Mechanisms at a glance: • Redistribution (insulin, gluco...
Oct 07, 2025•29 min•Ep. 46
In this episode of Hospital Medicine Unplugged, we blitz hyperviscosity syndrome (HVS)—recognize fast, de-sludge the blood, protect the brain/retina, fix the cause. We open with the big picture: HVS = impaired microcirculation from thick blood, most often paraproteins (IgM/IgG/IgA), cellular overload (erythrocytosis/leukocytosis), or cryoproteins. Classic triad: mucosal bleeding, visual changes, neurologic symptoms—but treat the patient, not the viscosity number. Do-firsts at the bedside: focuse...
Oct 07, 2025•31 min•Ep. 45
