Objective To determine if a hospital-wide symptom-based alcohol withdrawal protocol may result in significant clinical improvements to patient outcomes, safety, and hospital efficiency. Methods Retrospective/prospective cohort study between January 1, 2016 and December 31, 2016 (pre-protocol), and between March 1, 2017 and August 7, July 2017 (post-protocol). Pre-protocol patients were identified retrospectively using International Classification of Diseases, 10 th revision codes (F10.1, F10.2, and Z71.4). Post-protocol patients were identified by the use of a unique alcohol withdrawal order set in their electronic medical record. The primary endpoint was average length of stay. Secondary outcomes included death, escalation of care as defined as requiring intensive care unit (ICU) consultation or the rapid response team, average ICU length of stay, respiratory failure, average benzodiazepine usage, and incidence of seizures. Results The study included 276 patients in the pre-protocol group and 145 patients in the post-protocol group. There was a significant reduction found in the primary endpoint of average length of stay (7.15 ± 6.5 days vs 5.7 ± 5.6 days; P =.02). There was a significant reduction in the average benzodiazepine use, use of adjunctive medications, need for ICU consultation or rapid response team, respiratory failure, average ICU length of stay, use of neurologic imaging, and the need for lumbar puncture. Conclusion Implementation of a Clinical Institute Withdrawal Assessment for Alcohol, Revised–based alcohol withdrawal protocol may significantly improve quality of care, patient safety, and treatment effectiveness in a large, mixed medical/surgical, urban community-based academic medical center.

Primary lung lymphoma (PLL) is a rare unilateral or bilateral lung disorder that is challenging to diagnose solely based on clinical and radiological presentation. PLL may be misdiagnosed as pneumonia or a lung tumor due to non-specific findings. PLL is most frequently a mucosa-associated lymphoid tissue (MALT) lymphoma, a type of extranodal low-grade B-cell lymphoma most commonly discovered in the gastrointestinal tract. PLL should be considered in the differential diagnosis of non-resolving pneumonias. Herein we present a case of an 84-year-old patient discovered to have a primary pulmonary MALT lymphoma presenting as a non-resolving pneumonia causing a clinical challenge.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a public health crisis that has resulted in the death of thousands within the United States. The large influx of patients requiring mechanical ventilation for acute respiratory distress syndrome (ARDS) has necessitated the utilization of ventilators from a variety of sources. We hypothesized that ventilator model may be an independent risk factor for mortality in mechanically ventilated patients with COVID-19. METHODS: We retrospectively reviewed the medical records of 147 patients admitted to the adult intensive care unit of a tertiary hospital [New York Presbyterian Queens (NYPQ), Flushing, NY] from 1 March 2020 to 2 April 2020 in whom COVID-19 was confirmed and mechanical ventilation was initiated. Patients <18 years old were excluded as were patients who were pregnant. Diagnosis of COVID-19 was based on a positive result from a probe-based reverse transcriptase polymerase chain reaction (RT-PCR) test for SARS-CoV-2 from a nasopharyngeal swab. This observational retrospective study without any specific intervention was reviewed and exempted by the hospital Institutional Review Board, and all data were deidentified prior to processing.

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Ventriculo-pleural shunts (VPLS), is an alternative management of hydrocephalus, where excess cerebrospinal fluid is drained to the pleural cavity. Imbalances between production and absorption of CSF will lead to the accumulation and development of pleural effusion. We describe a case of a pleural effusion related to a VPLS. CASE PRESENTATION: A 42 year old female with CSF leak managed by VPLS, previous STEMI with stent placement, and asthma, presented with retrosternal, right chest discomfort and dyspnea. Dyspnea began four months prior, and a right-sided thoracentesis had been performed two weeks earlier. Her pulmonologist previously noted small chronic pleural effusions insufficient for thoracentesis. From her previous thoracentesis, cultures were negative and cytology showed chronic inflammation. Cell profile, LDH, and protein were not tested. Subsequent thoracentesis yielded 165 WBC, <2000 RBC, 25 neutrophils, 39 lymphocytes. Cultures were negative and cytology showed acute and chronic inflammation. The fluid was transudative with an LDH of 109 U/L and a protein of 1.6 g/dL. She underwent a revision of her shunt to the peritoneal cavity.