Case 4

tan-zebra-case-04-image

A 29-year-old man with no significant past medical history presented to the emergency room with a high fever, chills, sore throat, cough, shortness of breath, and diffuse myalgias in April 2020. He was found to be febrile to 107°F and tachycardic with a HR of 140. WBC count was 38. Covid testing was negative. Chest […]

Case 3

tan-zebra-case-03-image

An 18-year-old patient with a PMH significant for childhood medulloblastoma requiring cerebellar resection, radiation, and chemotherapy all around age 5 and mild developmental delay presented to the emergency room with 2 weeks of dyspnea and 2 days of non-productive cough. Chest X-ray showed a large right-sided pleural effusion. She was tachycardic with a heart rate […]

Case 2

tan-zebra-case-02-image

A 21-year-old, 37-week pregnant woman, G1P0, with a PMH significant for diet-controlled gestational diabetes presented to the hospital with regular uterine contractions. She was admitted to the ob/gyn service for delivery. She didn’t use cigarettes, alcohol, or illicit substances, and her only medications were pre-natal vitamins and folate. She had a normal CBC and glucose […]

Case 1

tan-zebra-case-01-image

A 60-year-old woman with a PMH significant for hypertension, hypothyroidism, and frontotemporal dementia presented to the emergency department with one day of unsteady gait and left-sided facial droop. Also, she was having new bilateral hip pain and low-back pain for the past week. She endorsed having a self-resolving diarrheal illness 2 weeks ago, and she […]

GI Bleeding

Gastrointestinal hemorrhage can be lethal, but fortunately, the management is usually cognitively straightforward. Most patients do fine. Our job is to put blood into the patient faster than the blood is leaving the patient until a gastroenterologist, interventional radiologist, or surgeon can perform procedures to achieve a definitive diagnosis and management strategy. The treatment of […]

Insomnia

Patients Lose Sleep in the Hospital Pain, noise, acute illness, stress, unfamiliar environment/bed, procedures, blood draws, and other diagnostic tests are a few of the things that keep our patients awake. Inpatient insomnia can be frustrating to treat. For example, you get paged in the middle of the night by a nurse who wants help […]

Atrial Fibrillation

Atrial fibrillation is a very common arrhythmia in the hospital. Fortunately, it is usually easy to manage. In general, I treat a-fib with RVR in the following way: As you start to follow this algorithm, you should simultaneously try to identify the provoking factor for the atrial fibrillation (if new) or RVR. Is the patient […]

Alcohol Withdrawal

There are two conventional strategies to treat alcohol withdrawal: symptom-driven administration of benzodiazepines, and phenobarbital monotherapy. Patients with alcohol withdrawal syndrome (AWS) have relative GABA deficiency in their brains, and the mainstay of treatment is GABA agonism. Benzodiazepines (and barbiturates) are GABA agonists and are effective at treating alcohol withdrawal. To find the right dose […]

Ischemic Stroke

“Brain Attack” Every stroke is different, but the principles of stroke management are always the same. An ischemic stroke occurs when there is an issue with blood flow to some area of the brain. The neurologic impact is dependent on what part of the brain is affected. Considerations in Acute Stroke Revascularization The decision to […]