Heparin-induced anaphylactoid reaction associated with heparin-induced thrombocytopenia in the ED.

Although rare, heparin-induced anaphylactic and anaphylactoid reactions have been previously described in the literature. We present a case of a patient who presented to the emergency department with dyspnea and was subsequently diagnosed with an acute pulmonary venous thromboembolism. Shortly after being started on intravenous unfractionated heparin, she developed sudden cardiovascular collapse leading to a cardiopulmonary arrest. She was successfully resuscitated and, after further diagnostic evaluation, was found to have developed a heparin-induced anaphylactoid reaction.

Case writing as a vehicle for promoting cultural competency: a retrospective, descriptive qualitative analysis.

BACKGROUND: A variety of approaches are available that provide cultural competency education for practicing physicians. There is, however, still a need for additional, innovative approaches that address continuing education and professional improvement regarding cultural competency for physicians after their training. OBJECTIVE: To assess the potential impact on established clinicians of writing an extended case narrative on cultural competency. METHODS: We conducted structured interviews of physician contributors (n = 14) to a book of cases on cultural competency. Authors were invited to contribute to the book based on their experiences as established clinicians, and previous expertise in cultural competency research or education was not required. Because of this, the editors employed a process in which they worked with contributors in a one-on-one manner to develop their case(s). RESULTS: The participants were experienced physicians (all > 10 years since medical school graduation), most of whom were white (64%) and affiliated with an academic medical center (86%). The majority of the contributors (1) reported that writing their case(s) increased their awareness of, and sensitivity to, issues of cultural competency; (2) indicated that the writing of their case(s) changed their approach to patient care and/ or their education of medical students or graduate medical trainees; and (3) would recommend case writing as a vehicle for promoting cultural sensitivity and awareness. CONCLUSIONS: Although preliminary, these data suggest that the cultural awareness, sensitivity, and competence of established physicians might be enhanced by a process in which clinicians are facilitated in the writing of cases that address issues of culture that are pertinent to their practice and patient experiences.