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	<title>Comments for Jail Medicine</title>
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	<link>http://www.jailmedicine.com</link>
	<description>A Correctional Health Blog by Dr. Jeffrey Keller</description>
	<lastBuildDate>Sat, 18 May 2013 11:02:55 +0000</lastBuildDate>
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		<title>Comment on Price Check!  Estrogens. by Mark C.</title>
		<link>http://www.jailmedicine.com/price-check-estrogens/#comment-1559</link>
		<dc:creator>Mark C.</dc:creator>
		<pubDate>Sat, 18 May 2013 11:02:55 +0000</pubDate>
		<guid isPermaLink="false">http://www.jailmedicine.com/?p=1862#comment-1559</guid>
		<description><![CDATA[I have found Premarin to be the hormone most likely to worsen migraines. Very rapidly absorbed and metabolized. Often patients will start to have withdrawal hot flashes 12-14 hours after taking.   Diverse, unpredictable mix of of estrogens.]]></description>
		<content:encoded><![CDATA[<p>I have found Premarin to be the hormone most likely to worsen migraines. Very rapidly absorbed and metabolized. Often patients will start to have withdrawal hot flashes 12-14 hours after taking.   Diverse, unpredictable mix of of estrogens.</p>
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		<title>Comment on A Quick-and-Easy Solution to those Pesky &#8220;Own Shoes&#8221; Requests by jeffk2996</title>
		<link>http://www.jailmedicine.com/a-quick-and-easy-solution-to-those-pesky-own-shoes-requests/#comment-1538</link>
		<dc:creator>jeffk2996</dc:creator>
		<pubDate>Fri, 17 May 2013 18:52:19 +0000</pubDate>
		<guid isPermaLink="false">http://jailmedicine.com/?p=425#comment-1538</guid>
		<description><![CDATA[On its way via email, Lorraine!]]></description>
		<content:encoded><![CDATA[<p>On its way via email, Lorraine!</p>
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		<title>Comment on A Quick-and-Easy Solution to those Pesky &#8220;Own Shoes&#8221; Requests by Lorraine Walsh</title>
		<link>http://www.jailmedicine.com/a-quick-and-easy-solution-to-those-pesky-own-shoes-requests/#comment-1535</link>
		<dc:creator>Lorraine Walsh</dc:creator>
		<pubDate>Fri, 17 May 2013 16:55:57 +0000</pubDate>
		<guid isPermaLink="false">http://jailmedicine.com/?p=425#comment-1535</guid>
		<description><![CDATA[Thanks for the article. May I have a copy of your &#039;own shoe&#039; policy? Do inmates with Diabetes fall under the same policy?  Do you have an effective, inclusive mental health preliminary screening that you could foward to me as well?  Thanks so much.]]></description>
		<content:encoded><![CDATA[<p>Thanks for the article. May I have a copy of your &#8216;own shoe&#8217; policy? Do inmates with Diabetes fall under the same policy?  Do you have an effective, inclusive mental health preliminary screening that you could foward to me as well?  Thanks so much.</p>
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		<title>Comment on Case Study:  &#8220;I Fell and Hurt My Hand&#8221; by Al Cichon</title>
		<link>http://www.jailmedicine.com/case-study-i-fell-and-hurt-my-hand/#comment-1530</link>
		<dc:creator>Al Cichon</dc:creator>
		<pubDate>Fri, 17 May 2013 15:09:45 +0000</pubDate>
		<guid isPermaLink="false">http://www.jailmedicine.com/?p=1848#comment-1530</guid>
		<description><![CDATA[One additional thought (spurred by Mr. Davis) one key component to an ER HPI for trauma is &#039;mechanism of injury&#039;. There are countless times that has helped me in the jail when an individual is either over or under playing the injury. Reviewing the story presented – it seems clear that the injury is not consistent with the reported mechanism. Kind of like, seeing a clear imprint of a hand slap and being told ‘I just bumped my face on the wall’…]]></description>
		<content:encoded><![CDATA[<p>One additional thought (spurred by Mr. Davis) one key component to an ER HPI for trauma is &#8216;mechanism of injury&#8217;. There are countless times that has helped me in the jail when an individual is either over or under playing the injury. Reviewing the story presented – it seems clear that the injury is not consistent with the reported mechanism. Kind of like, seeing a clear imprint of a hand slap and being told ‘I just bumped my face on the wall’…</p>
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		<title>Comment on Case Study:  &#8220;I Fell and Hurt My Hand&#8221; by BRYAN DAVIS PA-C</title>
		<link>http://www.jailmedicine.com/case-study-i-fell-and-hurt-my-hand/#comment-1527</link>
		<dc:creator>BRYAN DAVIS PA-C</dc:creator>
		<pubDate>Fri, 17 May 2013 14:05:08 +0000</pubDate>
		<guid isPermaLink="false">http://www.jailmedicine.com/?p=1848#comment-1527</guid>
		<description><![CDATA[I would think our liability would not be very high in situations where a patient misrepresented the HPI.  From an access to care and treatment perspective, the patient was seen and evaluated in a timely manner, and from a medical perspective, you make the most appropriate decision based on the information that is presented to you at the time of your evaluation. As long as we are evaluating and documenting appropropriately, I don&#039;t think we can be held liable for not being mind-readers. A patient bears some responsibility in giving us the most accurate information they can and we in turn bear responsibility to examine and treat objectively. I think where we might get in trouble is if our objective findings clearly go against the subjective HPI and we fail to treat based on our objective findings. With that said, I am not a lawyer.  Just my opinion.  Good topic!]]></description>
		<content:encoded><![CDATA[<p>I would think our liability would not be very high in situations where a patient misrepresented the HPI.  From an access to care and treatment perspective, the patient was seen and evaluated in a timely manner, and from a medical perspective, you make the most appropriate decision based on the information that is presented to you at the time of your evaluation. As long as we are evaluating and documenting appropropriately, I don&#8217;t think we can be held liable for not being mind-readers. A patient bears some responsibility in giving us the most accurate information they can and we in turn bear responsibility to examine and treat objectively. I think where we might get in trouble is if our objective findings clearly go against the subjective HPI and we fail to treat based on our objective findings. With that said, I am not a lawyer.  Just my opinion.  Good topic!</p>
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		<title>Comment on Case Study:  &#8220;I Fell and Hurt My Hand&#8221; by Kathleen Gittins</title>
		<link>http://www.jailmedicine.com/case-study-i-fell-and-hurt-my-hand/#comment-1497</link>
		<dc:creator>Kathleen Gittins</dc:creator>
		<pubDate>Thu, 16 May 2013 15:27:38 +0000</pubDate>
		<guid isPermaLink="false">http://www.jailmedicine.com/?p=1848#comment-1497</guid>
		<description><![CDATA[I have had our doctor order Rocephin or invanz injections to go along with antibiotics when there was a bite or laceration, if it was known to have came from another inmate’s mouth. We have usually sent the inmate to the local ER but they have seldom sent the inmate to the OR.  I, like James, wonder what our liability would be if  there was a negative outcome when the inmate lied to the doctor in the first place about where the injury came from. I would think that very detailed, throrough charting would be helpful.]]></description>
		<content:encoded><![CDATA[<p>I have had our doctor order Rocephin or invanz injections to go along with antibiotics when there was a bite or laceration, if it was known to have came from another inmate’s mouth. We have usually sent the inmate to the local ER but they have seldom sent the inmate to the OR.  I, like James, wonder what our liability would be if  there was a negative outcome when the inmate lied to the doctor in the first place about where the injury came from. I would think that very detailed, throrough charting would be helpful.</p>
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		<title>Comment on Case Study:  &#8220;I Fell and Hurt My Hand&#8221; by Al Cichon</title>
		<link>http://www.jailmedicine.com/case-study-i-fell-and-hurt-my-hand/#comment-1470</link>
		<dc:creator>Al Cichon</dc:creator>
		<pubDate>Thu, 16 May 2013 10:00:54 +0000</pubDate>
		<guid isPermaLink="false">http://www.jailmedicine.com/?p=1848#comment-1470</guid>
		<description><![CDATA[The only additional thought would be to anesthetize and explore / visualize the wound. If you can, and no tendon or other deep structure injury is revealed, that may save some transport etc. 

Incidentally, recently had an inmate who worked off-site at an animal shelter return with a ‘cat scratch’ from as feral cat. The report was ‘you might want to take a look before the person goes to work’. Clearly a cat bite on evaluation that was starting to ‘go south’ – no work, intensive (though not IV) antibiotics and symptomatic care brought it under control. Moral – beware of ‘under reporting’.

What would you say is the liability  situation if the iinmate is assessed - misrepresents the HPI and has a bad outcome - assuming that there is a good evaluatioin / documentation?]]></description>
		<content:encoded><![CDATA[<p>The only additional thought would be to anesthetize and explore / visualize the wound. If you can, and no tendon or other deep structure injury is revealed, that may save some transport etc. </p>
<p>Incidentally, recently had an inmate who worked off-site at an animal shelter return with a ‘cat scratch’ from as feral cat. The report was ‘you might want to take a look before the person goes to work’. Clearly a cat bite on evaluation that was starting to ‘go south’ – no work, intensive (though not IV) antibiotics and symptomatic care brought it under control. Moral – beware of ‘under reporting’.</p>
<p>What would you say is the liability  situation if the iinmate is assessed &#8211; misrepresents the HPI and has a bad outcome &#8211; assuming that there is a good evaluatioin / documentation?</p>
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		<title>Comment on Case Study:  &#8220;I Fell and Hurt My Hand&#8221; by jeffk2996</title>
		<link>http://www.jailmedicine.com/case-study-i-fell-and-hurt-my-hand/#comment-1428</link>
		<dc:creator>jeffk2996</dc:creator>
		<pubDate>Wed, 15 May 2013 02:56:47 +0000</pubDate>
		<guid isPermaLink="false">http://www.jailmedicine.com/?p=1848#comment-1428</guid>
		<description><![CDATA[My goodness, Bryan!  Do you have experience in emergency medicine?  Because your post is is a perfect description of a proper ER evaluation of such an injury, right down to looking for a partial endow laceration.  The full range of motion will also sometimes show capsular tears of the MC joint that are invisible except at just the right degree of extension.  I particularly liked that you would not close the wound--delayed primary closure is the way to go in this case.  Many ER docs would use two antibiotics to double cover Eikenella corrodens and skin flora.]]></description>
		<content:encoded><![CDATA[<p>My goodness, Bryan!  Do you have experience in emergency medicine?  Because your post is is a perfect description of a proper ER evaluation of such an injury, right down to looking for a partial endow laceration.  The full range of motion will also sometimes show capsular tears of the MC joint that are invisible except at just the right degree of extension.  I particularly liked that you would not close the wound&#8211;delayed primary closure is the way to go in this case.  Many ER docs would use two antibiotics to double cover Eikenella corrodens and skin flora.</p>
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		<title>Comment on Case Study:  &#8220;I Fell and Hurt My Hand&#8221; by Bryan Davis</title>
		<link>http://www.jailmedicine.com/case-study-i-fell-and-hurt-my-hand/#comment-1426</link>
		<dc:creator>Bryan Davis</dc:creator>
		<pubDate>Wed, 15 May 2013 01:28:25 +0000</pubDate>
		<guid isPermaLink="false">http://www.jailmedicine.com/?p=1848#comment-1426</guid>
		<description><![CDATA[I wouldn&#039;t necessarily send him out emergently unless a practitioner could not evaluate the wound in a timely maner. If there is going to be a delay, then he would need an ER trip. He would definitely need a thorough eval by a practicioner to explore the wound through full range of motion, as the position of the possible tendon injury would move into view as he brings his hand back into a fist. We&#039;d be concerned of developing tenosynovitis as well, so we&#039;d want to irrigate she snot out of it, NOT close it, and be able to document full range of motion and then immobilize it. I wouldn&#039;t give Keflex or Rocephin, but rather Augmentin. I&#039;d give a tetanus booster, and likely send him to ortho for a consult.  You&#039;re absolutely right in that these wounds may not look like a big deal, because the laceration may only be 1 cm long and not gaping open, but they truly can be nasty.   Another point I would make is to caution folks not to fall into the trap of assuming that there is no tendon injury just because the patient can move their finger. I have seen plenty of folks with partial tendon lacerations that maintain full range of motion.]]></description>
		<content:encoded><![CDATA[<p>I wouldn&#8217;t necessarily send him out emergently unless a practitioner could not evaluate the wound in a timely maner. If there is going to be a delay, then he would need an ER trip. He would definitely need a thorough eval by a practicioner to explore the wound through full range of motion, as the position of the possible tendon injury would move into view as he brings his hand back into a fist. We&#8217;d be concerned of developing tenosynovitis as well, so we&#8217;d want to irrigate she snot out of it, NOT close it, and be able to document full range of motion and then immobilize it. I wouldn&#8217;t give Keflex or Rocephin, but rather Augmentin. I&#8217;d give a tetanus booster, and likely send him to ortho for a consult.  You&#8217;re absolutely right in that these wounds may not look like a big deal, because the laceration may only be 1 cm long and not gaping open, but they truly can be nasty.   Another point I would make is to caution folks not to fall into the trap of assuming that there is no tendon injury just because the patient can move their finger. I have seen plenty of folks with partial tendon lacerations that maintain full range of motion.</p>
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		<title>Comment on Case Study:  &#8220;I Fell and Hurt My Hand&#8221; by Jeff D</title>
		<link>http://www.jailmedicine.com/case-study-i-fell-and-hurt-my-hand/#comment-1399</link>
		<dc:creator>Jeff D</dc:creator>
		<pubDate>Mon, 13 May 2013 15:36:43 +0000</pubDate>
		<guid isPermaLink="false">http://www.jailmedicine.com/?p=1848#comment-1399</guid>
		<description><![CDATA[Someone in the public health community should consider running a PSA on this topic. &quot;If you are thinking about punching someone in the mouth today, here&#039;s what you should know...&#039;]]></description>
		<content:encoded><![CDATA[<p>Someone in the public health community should consider running a PSA on this topic. &#8220;If you are thinking about punching someone in the mouth today, here&#8217;s what you should know&#8230;&#8217;</p>
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