Medical Puzzle Or Duped Again?

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Specializes in LTC, MNGMNT,CORRECTIONS.

:uhoh3:OK, I NEED SOME HELP. I HAVE HAD 3 HEALTHY MALE INMATES OVER THE LAST 3 WEEKS WITH A SWOLLEN ARM OR BOTH ARMS SWOLLEN. NEGATIVE X-RAY AND NEGATIVE ULTRASOUNDS. NO EXTERNAL MARKS RE: BUMPS, SCRATCHES,BRUISING OR DISCOLORATION OF ANYKIND. THE VERY NEXT DAY AFTER AN ER VISIT, THE SWELLING IS MIRACULOUSLY GONE, INMATE IS SMILING AND WANTING TO GO BACK TO GENERAL POP. THE JAIL DOCTOR AND THE ER DOCTOR CAN'T FIGURE OUT HOW THEY ARE DOING THIS. OFFICERS HAVE NOT SEEN ANYTHING UNUSUAL. ANY TAKERS?:uhoh21:

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Specializes in LTC, MNGMNT,CORRECTIONS.

:idea:After much research, I found the answer. Chronic Exertional Compartment Syndrome. Luckily, none of the inmates has taken it far enough to cause any permanent damage. We can't really charge them with self inflicted injury unless we see them doing the excessive exercising or the damage is enough to show up in the urine (myoglobin)and blood stream(creatinine kinase). What an exciting puzzle that was. It is often misdiagnosed since there is no injury or DVT to blame the swelling on. The first documented case was in an inmate on Reiker's island in 1940. Hope I spelled that right. Anyway, the inmate on Reiker's island was going through an initiation / hazing,,, sort of. He was made to pick up Chess pieces one at a time ( with his you know what )and set it down in another area. All in a very short amount of time. So it involved deep knee bends in rapid succession. He developed compartment syndrome the next day in his thighs. :uhoh21:

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Specializes in correctional, psych, ICU, CCU, ER.

Thanks--I never knew that--saw it a time or 2, figured the IM was jerking our chain...

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Specializes in ICU,ER,med-Surg,Geri,Correctional.

So would you see an elevation in CPK as in a rhabdo type situation? Excuse the spelling.

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Specializes in LTC, MNGMNT,CORRECTIONS.
So would you see an elevation in CPK as in a rhabdo type situation? Excuse the spelling.

THAT'S WHAT I FOUND IN MY SEARCH. THESE PARTICULAR INMATES HAD NOT TAKEN IT FAR ENOUGH TO DEVELOPE THE COMPARTMENT SYNDROME. AS THE SWELLING WENT DOWN AFTER 24 HOURS OF RESTING THE EXTREMITY. JUST ENOUGH TO BE SENT TO ER. BUT HAD THEY CONTINUED THE EXCESSIVE EXERCISE ONE MORE DAY,,,,RHABDOMYOLYSIS. THE INMATES DON'T REALIZE HOW SERIOUS IT COULD HAVE BEEN.

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Specializes in ICU,ER,med-Surg,Geri,Correctional.

Sounds like this would a good article in correctional magazine.

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Specializes in DIALYSIS, ICU/CCU, ONCOLOGY, CORRECTIONS.

Would it not be possible to check a serum lactic acid on these individuals, and if elevated, issue a misconduct on self harm and misappropriation of state funds. Lactic acid increase in excessive exercising and and muscle fatigue and might be a objective finding to prove this. Just a thought.

I know we were able to stop a epidemic of faux seizure and issue misconducts by checking CPK's; if not elevated after the inmate had a "seizure", inmate issued a misconduct and were charged with any ER charges, if they were able to fool staff and get sent out to the ER. We hit them with theft of state services, lying to staff, and their accounts were charged with the ER charges. Word got around and the seizures stopped

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