Inmate trauma

I thought I'd cover the orange jumpsuit population since I work at the only hospital contracted to accept these patients in our county. Although it isn't the bulk of our patient population, we certainly do get incarcerated victims. Interestingly, the most common trauma mechanism in jail is blunt assault, whereas it is penetrating trauma (stab wounds) in state prison. The second most common mechanism is fall in jail and blunt assault in prison.

A common co-morbidity for both facility types is seizures. Psychiatric history is also common. Oftentimes these co-morbidities play a role in the inmate's trauma admission. For example, it is relatively common for an inmate to come in as a fall secondary to a seizure. Psychiatric illness can propagate an assault.

Sometimes we get inmates that come with a shady story about mechanism. You'll get a guy telling an elaborate story about how he fell getting out of the shower cell and yet his injuries are highly consistent with assault (like bilateral facial fractures!).

You also get often mysterious "fall from bunk" followed by an endless complaint of parasthesias. Of course everything must be taken seriously, just in case, so they get a full workup in hospital that include MRIs, neurology consults, neuro checks and observation. After days in hospital and the results are negative, as they often are, they go back to jail/prison.

But, despite their tendency to want to linger in the hospital, they are more often than not very polite and friendly! Perhaps it's because the environment is so different from their ususal day-to-day.

cactus trauma?

Who would think, right? I'm not sure if I'd go so far as to say trauma, but apparently anything goes. So what happens if you have a traumatic encounter with a cactus? It is probably pretty unlikely that you will suffer penetrating trauma unless you find a cactus with particularly long spines. But what you may get is dermatitis. The picture of papules above is typical of dermatitis secondary to cactus pricks.

Dermatitis from a cactus generally occurs because of the mechanical irritation. There can be immunologic or infectious reactions as well, though. The cactus spines can scratch the skin causing wounds or excoriations, and the spines may break off in the skin or subcutaneous tissue causing papules or nodules.

Apparently it is the smaller spines that are more troublesome than the long scary ones. This is because the little ones can be barbed, making removal difficult. If they aren't removed, dermatitis can persist for months. A popular and successful method for removing this tricky bristles is to cover the area with sticky plaster or hot wax and then quickly removing it.

I have to say this is a new one for me. I didn't know this much about a cactus or cactus care until I had a recent clinical encounter with a cactus run-in. But now we all know a little more!