Skin Discoloration from Amiodarone

An 81-year-old man with atrial fibrillation who was being treated with amiodarone presented to the ED after a fall. Physical examination revealed blue and gray discoloration of his nose, cheeks, and forehead. This discoloration is associated with amiodarone.

Treating Addiction as a Terminal Disease

Ms. A. had a history of opioid use longer than her adulthood and had been through inpatient rehabilitation, methadone maintenance, and buprenorphine treatment programs without lasting success. Now she had endocarditis, and she wanted only to be discharged to hospice.

Treating Hypertension in Chronic Obstructive Pulmonary Disease

This review considers recent evidence concerning hypertension management in patients with chronic obstructive pulmonary disease, including the effects of antihypertensive-drug classes on exacerbations, hospitalizations, and adverse pulmonary outcomes.

Venous Thrombosis during Spaceflight

An obstructive jugular-vein thrombosis developed in an astronaut 2 months into a 6-month space mission, a clinical scenario with no evidence base to support the choice of a management approach. The thrombosis was managed with enoxaparin, followed by apixaban, which was discontinued 4 days before Earth landing. No adverse sequelae were noted.