Cannabis use has been evolving in both recreational drug use and medicinal uses, in part due to the recent introduction of various strains and components. With increasing use, we have seen emergence of a hyperemesis syndrome called cannabinoid hyperemesis syndrome characterized as intractable vomiting, nausea, and abdominal pain in the context of prolonged cannabinoid use. Although the antiemetic properties of cannabis have been known for years, the paradoxical effect of hyperemesis has yet to be elucidated. Herein we discuss the current research, epidemiology, and diagnosis and treatment of cannabinoid hyperemesis syndrome. Without timely diagnosis and treatment, patients may experience significant physical and emotional distress, as well as place unnecessary financial burden on the medical system.

Purpose of Study Following devastating twin earthquakes in 2015, Nepali people continue to face energy shortages, political instability, poverty, physical and mental traumas, infectious diseases, pollution, and malnutrition. Orphans in Kathmandu are a vulnerable and underrepresented subset of this population. Identifying their health needs and their understanding of their needs is an important part in ensuring their well-being. Methods Used We used a qualitative methodology derived from Photovoice to investigate pressing health needs of Nepali orphans. Cameras were distributed and children (n=16) were given the option to photograph or draw pictures of "healthy and unhealthy behaviour". Photos were categorized and a 3-hour focus group provided an opportunity for the children to explore the meaning and stories behind what they captured. Summary of ResultsThe 151 images collected and the focus group transcripts revealed four themes: 1. Environmental pollution, 2. Preventative actions (e.g. nutrition and exercise), 3. Self-awareness (e.g. self-image and identity), and 4. Self-discipline and social expectations (e.g. stigma, customs). Conclusions Our findings provide some insight into the health-related issues that are most pertinent to children who are orphans in Nepal, and help validate a methodology for capturing health needs and perspectives of vulnerable populations. The themes and examples explored help us understand their perceived sense of agency in meeting their health needs. These results can be helpful in navigating care of children (both directly and indirectly) and other vulnerable populations in low-income and post-disaster setting. A SKULL DEPRESSION IN A 9-MONTH OLD GIRLGalvis AE, Shoo A, Shedlock AR. University of Nevada School of Medicine, Reno, NV.10. 1136/jim-2016-000365.370 Case Report A 9-month old unvaccinated African American girl presents to the emergency department for an evaluation of an abnormal head "bump". When obtaining history, the mother reports that five days prior to presentation, the patient had rolled over on a bed and fell three feet to the ground. Following the fall there was no change in behavior from the patient, apparent pain, or emesis. Since the incident mother reports the patient has been doing well, however, the mother became concerned over the last two days when she noticed a depression on the patient's head while bathing her.The infant was born full term but small for gestational age. According to the parent, at birth, there were concerns for a leg deformity, and an X-ray was performed showing bilateral "bowed legs." However, patient was lost to follow-up after nursery discharge with no establishment of a primary care pediatrician On examination, her vital signs are within normal limits. The patient's weight and height are both below the 3rd percentile. The patient is interactive and playful. There is a small depression 4 centimeters in diameter on the left parietal region of her head with no associated crepitus or tenderness to palpation. The remaining physical exam...

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