The American journal of emergency medicine
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A hiatal herniation, which is a common disease worldwide, is associated with various complications. However, hiatal herniation has rarely been reported to cause life-threatening complications in emergency settings. ⋯ The patient was ultimately diagnosed with obstructive shock with inferior vena cava compression attributed to hiatal herniation upon imaging. Clinicians should consider the possibility that hiatal herniation can cause obstructive shock with inferior vena cava compression and take immediate steps to stabilize the vital signs.
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Improved data on spinal motion restriction (SMR) use can improve pediatric prehospital guidelines and inform the appropriate use of this procedure. We sought to evaluate the prevalence and factors associated with SMR among injured children in the prehospital setting. ⋯ We identified multiple factors associated with SMR use. These findings provide an opportunity to evaluate practices, track changes, and assess the impact of updated SMR guidelines in pediatric EMS.
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Chronic pruritus accounts for approximately 1 % of all physician visits, and providers are often confronted with how to treat patients with pruritus. Scabies is oftentimes a concern by both patients and providers, and anti-scabietic treatments are generally considered safe and effective. However, the pruritus will continue if there is an alternate etiology. ⋯ While scabies is one cause of chronic pruritus, its misdiagnosis may increase the chance that at-risk individuals, often those with prior substance abuse or psychiatric disorders, develop a persistent concern for ongoing infestation. It is possible that, in treating chronic pruritus with repeated empiric anti-scabietic treatments, the prescribing physician may contribute to the development of DI. We review the approach to a patient with chronic pruritus and ways to avoid unnecessary repeated anti-scabietic treatments.