Most patients seen with heart disease are well controlled and on regular medication and present no
problems.
The most difficult complaint to assess is that of chest pain. It is obviously important to decide
whether it is cardiac or has some less life-threatening cause.
Most commonly a patient will be seen with a chronic condition such as angina, cardiac failure or a
stable arrhythmia such as atrial fibrillation. In these cases the regular medication can be continued
and prescribed in the normal way and the custody record annotated with drug dosage and the times
they should be given. Simple advice can be given such as, please ring me if the patient gets worse,
i.e. has chest pain, becomes breathless or is sweating.
The problems will arise with chest pain of a cardiac type and differentiating angina from infarction.
The police surgeon must take a detailed history of the type of pain and record this on the notes.
He/she must record the clinical examination of the heart and blood pressure and pulse rates and any
evidence of cardiac failure. The basic values apply as in general practice and referral to hospital is
indicated if in any doubt and a letter should be sent with the patient.
In cases where medication is needed, it should be prescribed in the doses and at the times that the
detainee would normally take it outside custody. If the detainee is on symptom led medication such
as a nitrate, he should be allowed to keep that in his cell unless there is a specific reason not to.
Doubt as to the identity of the medication, or regular abuse of any medication are examples of
where greater care of freedom to access of therapy is needed.
Epilepsy
The approach here is similar to that of cardiac disease. If you would not be happy to manage a
patient at home then hospital referral is safer.
Most epileptics seen in police custody are well controlled and know their own disease well.
However, many prisoners do not take their medication as prescribed and some have a high incidence
of fits.
The history is important and should elucidate:
—The type of epilepsy & the type or frequency of fits
—When the prisoner last had a fit
—The medication taken in detail
—When the last dose was taken
—What doses are necessary for that day and subsequent days in custody
Page 54
It is felt that one self limiting fit in custody is acceptable but a prisoner having more than one fit
needs hospital review. Similarly if the fit is the first ever, then this needs hospital investigation as
one would in general practice. Police officers are capable of immediate first aid and should be
instructed to put the patient in the recovery position and inform the doctor.
It is worthwhile recording clearly the type of Epilepsy.
Epilepsy is a group of syndromes, they constitute "a chronic brain disorder of various aetiologies
characterised by recurrent seizures due to excessive discharge of cerebral neurones." 34
The epilepsies can be classified in a number of ways. The International League Against Epilepsy
(ILEA) has produced a classification35 based on the clinical seizure type and the ictal and post ictal
EEG. As the police surgeon does not have recourse to sophisticated tertiary investigations, and often
has little history from the patient and none available from previous doctors, the seizure type
classification can be simplified thus:36
problems.
The most difficult complaint to assess is that of chest pain. It is obviously important to decide
whether it is cardiac or has some less life-threatening cause.
Most commonly a patient will be seen with a chronic condition such as angina, cardiac failure or a
stable arrhythmia such as atrial fibrillation. In these cases the regular medication can be continued
and prescribed in the normal way and the custody record annotated with drug dosage and the times
they should be given. Simple advice can be given such as, please ring me if the patient gets worse,
i.e. has chest pain, becomes breathless or is sweating.
The problems will arise with chest pain of a cardiac type and differentiating angina from infarction.
The police surgeon must take a detailed history of the type of pain and record this on the notes.
He/she must record the clinical examination of the heart and blood pressure and pulse rates and any
evidence of cardiac failure. The basic values apply as in general practice and referral to hospital is
indicated if in any doubt and a letter should be sent with the patient.
In cases where medication is needed, it should be prescribed in the doses and at the times that the
detainee would normally take it outside custody. If the detainee is on symptom led medication such
as a nitrate, he should be allowed to keep that in his cell unless there is a specific reason not to.
Doubt as to the identity of the medication, or regular abuse of any medication are examples of
where greater care of freedom to access of therapy is needed.
Epilepsy
The approach here is similar to that of cardiac disease. If you would not be happy to manage a
patient at home then hospital referral is safer.
Most epileptics seen in police custody are well controlled and know their own disease well.
However, many prisoners do not take their medication as prescribed and some have a high incidence
of fits.
The history is important and should elucidate:
—The type of epilepsy & the type or frequency of fits
—When the prisoner last had a fit
—The medication taken in detail
—When the last dose was taken
—What doses are necessary for that day and subsequent days in custody
Page 54
It is felt that one self limiting fit in custody is acceptable but a prisoner having more than one fit
needs hospital review. Similarly if the fit is the first ever, then this needs hospital investigation as
one would in general practice. Police officers are capable of immediate first aid and should be
instructed to put the patient in the recovery position and inform the doctor.
It is worthwhile recording clearly the type of Epilepsy.
Epilepsy is a group of syndromes, they constitute "a chronic brain disorder of various aetiologies
characterised by recurrent seizures due to excessive discharge of cerebral neurones." 34
The epilepsies can be classified in a number of ways. The International League Against Epilepsy
(ILEA) has produced a classification35 based on the clinical seizure type and the ictal and post ictal
EEG. As the police surgeon does not have recourse to sophisticated tertiary investigations, and often
has little history from the patient and none available from previous doctors, the seizure type
classification can be simplified thus:36
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