Cardiac Arrest from Postpartum Spontaneous Coronary Artery Dissection

<p>We present the case of a 32-year-old woman who presented to the emergency department with a witnessed cardiac arrest. She was otherwise healthy with no cardiac risk factors and had undergone an uneventful repeated cesarean section 3 days priorly. The patient underwent defibrillation, out of ventricular fibrillation to a perfusing sinus rhythm, and was taken to the catheterization laboratory where coronary angiography findings showed spontaneous dissection of the left anterior descending artery. The patient received a total of 6 stents during her hospital stay and was eventually discharged in good condition. Spontaneous coronary artery dissection is a rare entity with a predilection for pregnant or postpartum women. Early diagnosis and treatment are key for survival, and when identified early, mortality is good. [West J Emerg Med. 2011;12(4):567–570.]</p

Use of Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) to Determine the Health Literacy Rate of the Spanish-speaking Population in an Urban Emergency Department

Background: The Hispanic population presents a great opportunity in terms of potential improvements in clinical outcomes and cost reduction for interventions through assessing and improving health literacy. While there are various tools to assess health literacy, many do not assess comprehensive Spanish health literacy. Objectives: We sought to determine the health literacy rate of our Spanish-speaking population in the ED using the SAHLSA-50 tool. Methods: We surveyed a convenience sample of 300 patients from October to November 2012 that presented to our busy, high volume, urban ED. All subjects completed the SAHLSA-50 tool and demographic form with Spanish-speaking research assistants. Results: 63.3% were women. 8% were age 18-25, 42% were 26-40, 45% were 41-65, and 5% were 65+. 11% had less than 3 years of school, 30% had 4-6 years of school, and 59% had at least 7 years of school. Overall, 83% respondents were health literate. Those with less than 3 years of school were95% in those with 7 or more years of school. The elderly (65+) reported least years of school completed and had the lowest health literacy (56.3%). Conclusions: There was an overall health literacy rate of 83.0%. Importantly, those with lower levels of education and elderly patients were more likely to not be health literate. As a next step, targeting those with less education and the elder within the Hispanic population may yield the most impact for improving health literacy and outcomes

Illness Severity among Non-English, Non-Spanish Speaking Patients in a Public Emergency Department

Background: Patients with limited English proficiency (LEP) have poor health outcomes compared to English proficient patients. Most studies on language proficiency and health disparities focus on Spanish. Objective: This study examines whether non-Spanish speaking LEP patients experience greater disparities than Spanish speaking LEP patients by comparing disease acuity and language proficiency in an emergency department. Design: This is a retrospective case-control study from November 2010 to February 2012 comparing differences between non-English non-Spanish (NENS) speaking patients to English speaking patients with differences between Spanish speaking and English speaking patients. Main outcomes: Primary endpoints include the emergency severity index (ESI) score, area of triage, days in hospital, and the rates of admission, in-hospital surgery, intensive care unit admission, and all-cause mortality. Results: Among all of the study patients, the average age was 55.1 (+/- 12.4). Comparing the NENS sample to the English sample yielded differences in surgery rates (NENS 11.3%, English 1.9%, p=0.002), admission rates (NENS 38.8%, English 24.7%, p=0.025), and days in hospital (NENS 2.49 +/-5.43, English 1.93+/-8.56, p Conclusions and relevance: We were able to demonstrate greater healthcare needs among NENS patients compared to the other two groups. The NENS patients were more likely to be admitted, have surgery, and stay longer than those speaking English or Spanish. These findings are important because they suggest further research, awareness of these disparities by healthcare providers, and public health interventions focusing on this population are warranted

Social media guidelines and best practices - Recommendations from the council of residency directors (cord) social media taskforce

Social media has become a staple of everyday life among over one billion people worldwide. A social networking presence has become a hallmark of vibrant and transparent communications. It has quickly become the preferred method of communication and information sharing. It offers the ability for various entities, especially residency programs, to create an attractive internet presence and “brand� the program. Social media, while having significant potential for communication and knowledge transfer, carries with it legal, ethical, personal, and professional risks. Implementation of a social networking presence must be deliberate, transparent, and optimize potential benefits while minimizing risks. This is especially true with residency programs. The power of social media as a communication, education, and recruiting tool is undeniable. Yet the pitfalls of misuse can be disastrous, including violations in patient confidentiality, violations of privacy, and recruiting misconduct. These guidelines were developed to provide emergency medicine residency programs leadership with guidance and best practices in the appropriate use and regulation of social media, but are applicable to all residency programs that wish to establish a social media presence

Levamisole-adulterated Cocaine Induced Vasculitis with Skin Ulcerations

[West J Emerg Med 2013;14(2):149-150.

Oral Lesions Secondary to Cocaine Use

[West J Emerg Med. 2012;13(4):362.

Levamisole-adulterated Cocaine Induced Vasculitis with Skin Ulcerations

None Case Repor