My patient this week was young (seems to be a trend with me!) and paralyzed from the waste down due to a birth defect. One of the biggest concerns for people who are immobile is the development of decubitus ulcers, also called pressure ulcers. When there is continuous pressure on a bony prominence for more than 2 hours, tissue damage occurs. If it is caught early, it looks like a warm, red spot on the skin, and extra care must be taken to prevent it from becoming worse. When care is NOT taken, it progresses to a stage 2 ulcer, which involves the breakdown of the top layers of skin, then to stage 3, where it becomes a huge, open sore with no skin covering it. The worse-case scenario is a stage 4 ulcer, where the tissue damage progresses through the muscle and to the bone. By this point there is usually tissue necrosis (death) and it will take a minimum of 6 months to heal.
My patient had a stage 4 ulcer on the tailbone area, which is really common for wheel-chair bound people. Because he needed to be off his back, he developed 2 more deep ulcers on the side he lies on most frequently. They got infected and he was admitted to the hospital for septic shock. He underwent temporary colostomy surgery to divert fecal matter away from the biggest ulcer near his rectum, but his abdominal wound got infected and opened up. So now he has FOUR major wounds, all connected to wound vacuums to help them heal. They had trouble getting the vacuum seal to "stick" on the tailbone area, so they took it off during the night and packed the wound with sterile dressing. When I got there, it was time to change the dressing and the nurse wanted me IN THERE, removing the packing. Another student helped and we both stood there in total shock at what we were seeing. This patient essentially had a 9-inch by 6-inch hole in his lower back, and it was probably 5 inches deep. You could see INSIDE him! I didn't feel queasy, just sad and frustrated that it could get so bad. I felt like crying. I don't know how nurses can leave this stuff at the hospital and not take it home with them. It's been absolutely haunting me. I so badly want to help him! But there's only so much you can do when the wounds get to this point. I can't fathom how something that deep can ever heal!!
I found a picture online of a similar ulcer. My patient's was much deeper and more pink inside because they were surgically debriding (cleaning) the wound out. But as you can see, it is horrific and should NEVER happen!
1 comment:
At least you'll probably never have to deal with maggots. Cleaning a deep wound filled with those squirmy little beggars is truely distgusting, and the patient obviously miserable. They do clean a necrotic wound up nicely, however. This country is now Screw Worn free, but I got to experience them in my younger years. They start in a wound, then go after living flesh. If you don't catch them very early, the results are fatal.
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