A few weeks ago, I received a request from a psychiatry resident working at a state prison about the use of restraints with patients who engage in severe self-injury. He was looking for guidance on the use of physical restraints with this population in prison. He noted that his role of ordering and monitoring patients in restraints caused him to feel more like a provider for the facility, rather than for the patient. I shared with him with the best resources I know – Resource Document on the Use of Restraint and Seclusion in Correctional Mental Health Care (http://jaapl.org/content/35/4/417) as well as Dr. Applebaum’s commentary on the same (http://jaapl.org/content/jaapl/35/4/431.full.pdf). As I sat down to write this, I intended to discuss the rules and regulations surrounding restraint (e.g., Center for Medicare and Medicaid Services (CMS) 42 CFR § 482.13) but I stopped myself.
The inquiry was not about regulations and requirements for the use of restraints. The question was about patient care.
What do you think of the rule for lacerations that says a laceration has to be sutured within six hours or it cannot be sutured at all? At our facility, we send lots of inmates to the ER for simple cuts because the PA isn’t scheduled to be at the facility until the next day. If a cut is 10 hours old, why can’t it be fixed? Where did this rule come from?
Thanks for the question, Kim. The short answer to this question is that that this belief is a myth. Uncomplicated lacerations can, indeed, wait more than 6 hours to be repaired.
“There is a common misconception that all wounds must be either sutured within a few hours or left open and relegated to slow healing and an unsightly scar.” Roberts and Hedges’ Clinical Procedures in Emergency Medicine
An inmate presents to the medical clinic with a laceration on his hand overlying the knuckle of his small finger. He insists that he fell getting off of his bunk. He has no other injuries on examination. What do you think happened? How would you treat this? Continue reading →