Hospital Medicine Unplugged
Hospital Medicine Unplugged delivers evidence-based updates for hospitalists—no fluff, just the facts. Each 30-minute episode breaks down the latest guidelines, clinical pearls, and practical strategies for inpatient care. From antibiotics to risk stratification, radiology to discharge planning, you’ll get streamlined insights you can apply on the wards today. Perfect for busy physicians who want clarity, accuracy, and relevance in hospital medicine.
Episodes
Mixed Connective Tissue Disease in the Hospitalized Patient: Anti-U1 RNP, Overlap Syndromes, and the Lungs That Kill
In this episode of Hospital Medicine Unplugged, we unpack mixed connective tissue disease—recognize the overlap syndrome hiding between lupus, scleroderma, and myositis, and aggressively monitor the pulmonary complications that drive morbidity and mortality.
MCTD is defined by high-titer anti-U1 RNP antibodies plus overlapping connective tissue disease features. The hallmark clues:
• Raynaud pheno
Myelodysplastic Syndromes in the Hospitalized Patient: Clonal Cytopenias, Risk Stratification, and When to Transplant
In this episode of Hospital Medicine Unplugged, we break down myelodysplastic syndromes—recognize the unexplained cytopenias, understand the modern molecular classification, and risk-stratify patients before progression to AML.
The WHO 2022 classification shifted MDS from a purely morphologic disease to a genetically informed diagnosis. New entities include MDS with SF3B1 mutation, isolated del(5q
Cardiac Amyloidosis in the Hospitalized Patient: The HFpEF Diagnosis You’re Missing
In this episode of Hospital Medicine Unplugged, we unpack cardiac amyloidosis—recognize the red flags hiding inside “routine HFpEF,” diagnose ATTR noninvasively, and start disease-modifying therapy before restrictive physiology becomes irreversible.
ATTR cardiac amyloidosis is far more common than previously recognized, especially in older adults with HFpEF and increased LV wall thickness. Key clu
Sarcoidosis in the Hospitalized Patient: Multisystem Granulomas and the Organs You Can’t Miss
In this episode of Hospital Medicine Unplugged, we tackle sarcoidosis—recognize the classic presentations, screen aggressively for silent organ involvement, and treat the patients at highest risk for irreversible damage or sudden death.
Diagnosis requires three things: compatible clinical presentation, non-caseating granulomas, and exclusion of alternative granulomatous disease like TB, fungal inf
Autoimmune Encephalitis in a Hospitalized Patient: Diagnose Early, Treat Fast, Recover Long
In this episode of Hospital Medicine Unplugged, we unpack autoimmune encephalitis—recognize the red flags early, treat aggressively before antibody results return, and support the long recovery arc that often extends years beyond discharge.
We open with the bedside reality: autoimmune encephalitis is frequently missed because it masquerades as psychiatry, infection, toxic-metabolic disease, or une
Acute Interstitial Nephritis in the Hospitalized Patient: Drug-Induced AKI and Modern Diagnosis
In this episode of Hospital Medicine Unplugged, we unpack acute interstitial nephritis (AIN)—a frequently overlooked cause of acute kidney injury (AKI) driven largely by medications, immune reactions, and systemic diseases.
We start with epidemiology clinicians should recognize. AIN accounts for roughly 15–27% of kidney biopsies performed for AKI and about 2.8% of all kidney biopsies overall. Amon
Celiac Disease in the Hospitalized Patient: Diagnosis, Complications, and the Future Beyond Gluten-Free Diets
In this episode of Hospital Medicine Unplugged, we break down celiac disease—from epidemiology and modern diagnostic strategies to life-threatening complications and emerging therapies beyond the gluten-free diet.
We start with epidemiology clinicians should know. The global prevalence of celiac disease is ~1.4% based on serology and ~0.7% with biopsy confirmation. Incidence rates are ~17 per 100,
Polypharmacy & Deprescribing in the Hospitalized Patient: Safer Medication Use in Older Adults
In this episode of Hospital Medicine Unplugged, we tackle polypharmacy and deprescribing—how to recognize problematic medication overload, quantify its harms, and apply structured, patient-centered strategies to safely reduce medication burden.
We begin with definitions that shape clinical practice. Polypharmacy is most commonly defined as the use of ≥5 medications, though definitions vary. Import
Primary Hyperparathyroidism in the Hospitalized Patient: Diagnosis, Imaging, and When to Operate
In this episode of Hospital Medicine Unplugged, we break down primary hyperparathyroidism (PHPT)—from epidemiology and pathophysiology to modern imaging, surgical indications, and evolving medical therapies.
We start with who gets PHPT and how often it occurs. The condition affects ~0.8–0.9% of the general population, with an incidence of 4–6 cases per 10,000 person-years. It is 2.5 times more com
ANCA Vasculitis: From Pathophysiology to Precision Treatment in the Hospitalized Patient
In this episode of Hospital Medicine Unplugged, we break down ANCA-associated vasculitis (AAV)—granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA)—focusing on modern epidemiology, complement-driven pathophysiology, ANCA serotypes, and the rapidly evolving treatment landscape.
We start with epidemiology clinicians should r
Clinical Management and Metabolism of Fat-Soluble Vitamins in the Hospitalized Patient
In this episode of Hospital Medicine Unplugged, we sprint through fat-soluble vitamins—A, D, E, and K—focusing on how they’re absorbed, why deficiencies happen, and the clinical syndromes hospitalists must recognize early. From intestinal transporters to neurologic deficits and neonatal bleeding, we connect physiology to bedside decision-making.
We start with absorption mechanics, which are more c
Thalassemias: Genetics, Pathophysiology, and Clinical Manifestations in the Hospitalized Patient
In this episode of Hospital Medicine Unplugged, we sprint through thalassemia—an inherited hemoglobinopathy defined by reduced or absent globin chain production, ineffective erythropoiesis, and chronic anemia. We break down the genetics, pathophysiology, clinical spectrum, and why this disorder remains the most common monogenic disease worldwide.
We start with the big picture. About 5% of the glob
Clinical Guide to Axial Spondyloarthritis and Ankylosing Spondylitis
In this episode of Hospital Medicine Unplugged, we sprint through ankylosing spondylitis and axial spondyloarthritis—recognize inflammatory back pain early, understand the disease spectrum from non-radiographic to radiographic disease, and treat aggressively to prevent structural damage and disability.
We begin with the modern concept of axial spondyloarthritis (axSpA), which represents a disease
Prosthetic Heart Valve Selection and Clinical Management Guide for the Hospitalist
In this episode of Hospital Medicine Unplugged, we sprint through prosthetic heart valves—how to choose between mechanical and bioprosthetic valves, manage anticoagulation safely, recognize complications, and navigate the expanding role of transcatheter valve replacement.
We begin with the two major categories of prosthetic valves: mechanical valves and bioprosthetic (tissue) valves. Mechanical va
Asbestosis: Pathogenesis, Clinical Diagnosis, and Management Strategies in the Hospitalized Patient
In this episode of Hospital Medicine Unplugged, we sprint through asbestosis—understand how inhaled fibers trigger progressive pulmonary fibrosis, recognize key radiographic features, and manage patients with attention to malignancy risk and progressive fibrotic disease.
We start with pathophysiology, where the story begins decades before symptoms appear. After inhalation, asbestos fibers deposit
A Comprehensive Clinical Guide to Glomerulonephritis for the Hospitalist
In this episode of Hospital Medicine Unplugged, we sprint through glomerulonephritis—recognize the nephritic syndrome, decode complement patterns and immunofluorescence clues, and manage diseases ranging from self-limited post-infectious GN to rapidly progressive crescentic disease.
We start with the clinical syndrome of glomerulonephritis, defined by glomerular inflammation producing hematuria, h
Modern Clinical Management of Thyroid Carcinoma and the Hospitalist's Role in Coordination
In this episode of Hospital Medicine Unplugged, we sprint through thyroid cancer—understand the epidemiologic paradox of rising incidence but stable mortality, stage disease using modern AJCC criteria, apply ATA recurrence risk stratification, and tailor therapy from surgery and radioiodine to targeted molecular treatments.
We start with the epidemiology of thyroid carcinoma, the most common endoc
Anaphylaxis: Mechanisms, Triggers, and Clinical Management in the Hospitalized Patient
In this episode of Hospital Medicine Unplugged, we sprint through anaphylaxis—recognize the rapid systemic reaction, understand the mast-cell storm driving shock, and deliver epinephrine immediately to prevent cardiovascular collapse.
We begin with the definition and diagnostic framework. Anaphylaxis is a severe, rapid-onset, life-threatening systemic hypersensitivity reaction. When it progresses
Upper Motor Neuron Syndrome: Pathophysiology and Clinical Management in the Hospitalized Patient
In this episode of Hospital Medicine Unplugged, we sprint through upper motor neuron (UMN) syndromes—how spasticity develops, how to separate true reflex hyperexcitability from fixed stiffness, and how to diagnose and manage major UMN diseases like PLS and hereditary spastic paraplegia.
We begin with spasticity, a defining feature of UMN injury that is not simply an immediate “release phenomenon.”
Endovascular Infections: Vascular Grafts, CIEDs, Mycotic Aneurysms & Lemierre Syndrome
In this episode of Hospital Medicine Unplugged, we break down endovascular infections—vascular graft infections, mycotic aneurysms, CIED infections, and septic thrombophlebitis syndromes—focusing on modern epidemiology, evolving microbiology, advanced imaging, and high-yield management strategies.
We begin with epidemiology clinicians should know. Vascular graft infections occur in ~0.5–6% of vasc
Clinical Pathophysiology and Evidence-Based Management of Delirium Tremens in the Hospitalized Patient
In this episode of Hospital Medicine Unplugged, we sprint through delirium tremens—the most dangerous stage of alcohol withdrawal—recognize the neurochemical storm, identify high-risk patients, and treat aggressively with benzodiazepines and supportive care to prevent fatal complications.
We begin with epidemiology and why DTs matter. Delirium tremens occurs in 3–5% of hospitalized patients with a
Evidence-Based Advances in Chronic Spontaneous Urticaria Management in the Hospitalized Patient
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
Managing Acute Exacerbations in Fibrotic Interstitial Lung Disease in the Hospitalized Patient
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 cha
Status Epilepticus Evidence-Based Management and Escalation Algorithms for the Hospitalist
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 o
Measles: Clinical Pathology and Global Public Health Trends in the Hospitalized Patient
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 conc
Clinical Perspectives on Acquired Aplastic Anemia Management in the Hospital Setting
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 tw
Brugada Syndrome in the Inpatient Setting: Clinical Diagnosis and Management Strategies for the Hospitalist
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. T
When Safety Becomes Harm and Why Less Is More. The Evidence, Ethics, and Hidden Harms of Hospital Restraints
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
Management of Dementia with Behavioral and Psychological Symptoms of Dementia (BPSD) in Acute Hospital Care: Taming Agitation Without Making It Worse
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,
Bell's Palsy Versus Stroke: Inpatient Diagnosis and Management
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 sparin
Aspirin Alone or Dual Antiplatelet Therapy (DAPT) with Clopidogrel? The Hospitalist's Guide to Early Stroke Recurrence Prevention
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 card
To Bridge or Not to Bridge: Perioperative Anticoagulation Bridging Risks, Guidelines, and Strategies in Hospitalized Patients
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
The Hospitalist's Guide to Inpatient Anticoagulation: Choose Fast, Dose Smart, Avoid Disaster
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:
Anemia Diagnosis and Management in the Hospitalized Patient: How to Differentiate between Iron-Deficiency Anemia and Anemia of Chronic Disease
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 insi
The Against Medical Advice (AMA) Discharge of the Hospitalized Patient: Risks, Ethics, and Best Practices
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 y
Resistant Hypertension in the Hospitalized Patient: Cutting Through Pseudoresistance, Volume Overload, and Aldosterone to Get BP Under Control
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 c
Managing Opioid Use Disorder (OUD) and Withdrawal in the Fentanyl-Era: Fast, Compassionate Inpatient Management That Keeps Patients Safe
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 ofte
Blood Transfusion Guidelines in the Hospitalized Patient: Modern Hospital Blood Practice, Restrictive Strategies, and the Ethics That Shape Them
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
Malnutrition in the Hospitalized Patient: Diagnosis and Assessment of Unintentional Weight Loss and Malnutrition
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?
Hospital Falls: Risk, Assessment, and Prevention Strategies
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 a
Atrial Flutter for Hospitalists: Master the ECG, Anticoagulation, Critical Distinction from Atrial Fibrillation, and the Ablation Advantage
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 wi
Atrial Fibrillation Management in Hospitalized Patients: Early Rhythm Control, Ablation, and the 48-Hour Anticoagulation Rule
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 derange
Hepatorenal Syndrome (HRS-AKI) in Hospitalized Patients: Navigating the Razor-Thin Margin of Survival in Cirrhosis—New Guidelines, Albumin, and the Transplant Bridge
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), kidne
Cardiorenal Syndrome in the Hospitalized Patient: Targeting Venous Congestion and Pseudo-AKI with the VeXUS Protocol
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
Mallory-Weiss Tears in Hospitalized Patients: Identifying the High-Stakes Bleeders and Mastering Mechanical Hemostasis
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 stac
Inpatient Management of Portal Hypertension: Decompensation and the Preemptive TIPS Revolution in Hospitalized Patients
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 + platele
Acute Upper GI Bleeding (UGIB) in Hospitalized Patients: Mastering the Critical First Hours of Hematemesis Management for Hospitalists
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 m
Peptic Ulcer Bleeding in the Hospitalized Patient: From Emergency Resuscitation to the 72-Hour PPI Mandate and Anticoagulation Balancing Act
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 urge
Diverticulitis in Hospitalized Patients: The New Evidence on Antibiotics, Abscess Drainage, and Who Needs Surgery
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,
Acute Variceal Bleeding in the Hospitalized Patient: The Critical 3-Step Protocol, Restrictive Resuscitation, and Why Early TIPS is a Game Changer for High-Risk Patients
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 a
Prinzmetal's Angina for the Hospitalist: The Supply-Side Crisis—Diagnosis, Monitoring, and Why Beta Blockers Are Deadly
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 con
Management of TB in the Hospitalized Patient: Molecular Speed, Isolation Rules, and Tailored Drug Strategies for Hospitalists
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 rifampi
Life Over Limb: Decoding the High-Stakes Decision for Lower Extremity Amputation in the Hospitalized Patient
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
Contrast-Induced Nephropathy in Hospitalized Patients: KDIGO Guidelines, Dual Mechanism Injury, and Essential Prevention Protocols
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 base
Hungry Bone Syndrome: Decoding the Post-Surgery Mineral Debt, Risk Stratification, and Aggressive Management Protocols in Hospitalized Patients
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
Empyema Management in the Hospitalized Patient: Conquering the 47% Mortality Risk in Hospital-Acquired Pleural Infections
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: broa
The Hospitalist's Guide to Dysphagia: Stroke, ICU, and the Stepwise Guide to Diagnosis and Management in Hospital Medicine
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%—high
Guillain-Barré Syndrome (GBS): The Hospitalist's Guide to Early Recognition, Prognosis, and Choosing IVIg vs. Plasma Exchange
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
Wernicke-Korsakoff in the Hospitalized Patient: Why the Preventable Brain Disease is Still Critically Underdiagnosed and Demanding 500mg IV Thiamine
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 t
Type 1 vs. Type 2 NSTEMI: The Critical Distinction Hospitalists Must Master for Life-Saving Care
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 th
Why We Must STOP Routine Inpatient Thrombophilia Testing for Acute VTE: ASH Guidelines, False Positives, and the Harm of Mislabeling in the Hospitalized Patient
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
Hemodialysis vs. Peritoneal Dialysis: Understanding the Differences Between HD versus PD for Optimal Patient Outcomes
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 f
CPAP vs. BiPAP in the Hospitalized Patient: The Hospitalist's Guide on When to Ventilate and When to Oxygenate
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 CP
Evidence-Based Wound Care for the Hospitalist: TIME Framework, Debridement, and Why Your Wounds Get Stuck
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, malnutrit
Inpatient Dialysis in the Hospitalized Patient: Mastering Urgent AKI Management, AEIOU Criteria, and Safe Prescription Secrets
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 anticoagulan
Pheochromocytoma and Paraganglioma Crisis Management: The Essential Step-by-Step Guide for Hospitalists
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. Res
HIT or HITT? Mastering Heparin-Induced Thrombocytopenia Diagnosis, The 4Ts Score, and Therapeutic Management Pitfalls in Hospitalized Patients
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 do
The Great Vitamin D Paradox: Targeting Severe Deficiency and Rethinking the Magic Number 30 in Hospital Medicine
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, crit
Small Bowel Obstruction in the Hospitalized Patient: The 72-Hour Rule, Strangling Signs, and When to Call the Surgeon
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. B
Takotsubo Cardiomyopathy Crisis: Decoding the Catecholamine Storm, LVOTO Risk, and Critical Acute Management in the Hospitalized Patient
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 co
Cerebral Venous Sinus Thrombosis in the Hospitalized Patient: The Hospitalist's Roadmap to Diagnosis, Anticoagulation (Even with Bleeding), and Long-Term Outcomes
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 w
Hematuria in the Hospitalized Patient: Master the Evidence-Based Approach to Risk, Workup, and The Anticoagulation Trap
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 a
Ascending Cholangitis Emergency in Hospitalized Patients: The Core Triad Roadmap to Biliary Decompression and Why Every Hour Counts
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
Acute Mesenteric Ischemia in the Hospitalized Patient: The Abdominal Stroke Protocol—Early Anticoagulation, CTA, and Why You Can't Wait for Labs
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 radiolo
Syncope Simplified: An Evidence-Based Hospitalist's Guide to Risk Stratification and Management (ACC/AHA/HRS Guidelines)
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/morta
Right Ventricular Crisis Management: Inpatient Pulmonary Hypertension, Hemodynamics, and the Failing Right Ventricle in the Hospitalized Patient
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 sh
Catastrophic Clotting and the Triple Threat: Diagnosing and Managing Antiphospholipid Syndrome (APS) in the Hospitalized Patient
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
Cyclic Vomiting Syndrome in the Hospitalized Patient: Master the Acute Inpatient Protocol, Dextrose, and Opioid-Sparing Pain Control
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, ren
Appendicitis Revolution: Risk Stratification, Antibiotics-First, and the End of Automatic Surgery in Hospitalized Patients
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
Hypophosphatemia in the Hospitalized Patient: Mastering Hypophosphatemia Risk, Mechanisms, and Repletion Protocols in High-Acuity Patients
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/arr
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