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Decubitus ulcers, Pressure ulcers

Discussion in 'Medical Students - MD' started by mjl1717, May 29, 2008.

  1. mjl1717

    mjl1717 Senior Member 10+ Year Member

    May 24, 2003
    These "things" are common... (once you see them you dont forget) In general Ive seen them treated with:

    1)frequent turning of the patient, in a perfect world every 2 hours..
    2)Saline wash
    3)liberal doses of Vitamin C, maybe 1000mg or 1500 every day
    4)Silvadene Cream...
    5)they are not always infected ..
    6) seems like a lot of times the treatment is ad lib.

    How have you guys seen this treated?? Anything worth mentioning other then the above??.. Is there anything else that had good results ??
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  3. Mozart45

    Mozart45 5+ Year Member

    Mar 12, 2008
    Stage I wound: No loss of tissue just red, does not blanch. Frequent turning repositioning. Topical lotions and creams.

    Stage II wound: Loss of top layer of skin: Continue to turn patient q2h. Frequent repositioning. Use of more would type specific tretments such as xenaderm or solusite for open but not deep wounds and surrounding areas. If area also has possibility of being contaminated with feces/urine. Use a barrier cream such as criticaid.

    Stage III-IV wound: Here we're talking large wounds/loss of tissue, can be down to muscle or bone, sometimes tunneling or undermining. If wound bed is clean with pink granulation tissue you can pack the wound with wet to dry dressing and let heal. However, if wound has large amounts of dead eschar tissue this needs to be debrided either surgically or by using ointments such as accuzyme or panafil. If using accuzyme make sure it is applyed only to the dead tissue or it can actually harm the good surrounding tissue.

    Hope this helps.
  4. mjl1717

    mjl1717 Senior Member 10+ Year Member

    May 24, 2003
    Yes, very good I have also seen numerous ointments like you mentioned. (I think numerous manufacturers want to get into the act)
    As you said avoiding feces and urine-seriously.. And of course moist normal skin heals better then dry skin...
    Plus this is something that some nurses will quickly run to you about!:thumbup:
  5. AmoryBlaine

    AmoryBlaine the last tycoon 7+ Year Member

    May 1, 2006
    You can also help prevent them by making your demented relatives DNR/DNI and not aggressively treating their acute illnesses.

    The treatment of decubs pretty much says it all when it comes to the ethics of trying to keep people artificially alive for years: turn them because they can't move, try not to have them lay in their own excrement for very long.
  6. Chizwheel

    Chizwheel Urology Resident 5+ Year Member

    Jan 18, 2006
    patients with large stage IV decubitus that have incontinence or infection involving the rectum will have to have on ostomy diversion and indwelling foley in order to prevent the decubitus from being further contaminated.
  7. Droopy Snoopy

    Droopy Snoopy 7+ Year Member

    Apr 3, 2006
    The Alamo
    Code the patient or don't, but I've never understood the shades of grey like DNI. Is someone supposed to stand there and bag grandpa for the rest of his life? We also have something called a 'soft code', where you can bag and give epi et al. but no chest compressions or intubation. Instead of a code blue they call it a code green, and instead of running to the bedside the on-call team walks, maybe grabs coffee on the way because they know it's a huge waste of time.
  8. AmoryBlaine

    AmoryBlaine the last tycoon 7+ Year Member

    May 1, 2006
    Fair enough. I mostly just meant "do not resuscitate" and for whatever reason I hear DNR/DNI thrown around alot together.

    "DNR" alone might not cover respiratory failure in the eyes of some family members because they might equate "resuscitate" with chest compressions and paddles.

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