Pressure ulcer: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
[[File:Imagen Bob 108.jpg|thumb|Stage IV decubitus ulcer.]] | |||
*Stage 1 - Skin intact, nonblanchable erythema | *Stage 1 - Skin intact, nonblanchable erythema | ||
*Stage 2 - Erosion into epidermis only (dermis is intact) | *Stage 2 - Erosion into epidermis only (dermis is intact) | ||
Revision as of 22:55, 4 January 2023
Background
- Classified into stages based on thickness
- External compression of skin causes ischemic tissue damage, necrosis which is common in
- Bedridden patients
- Nursing home patients
Clinical Features
- Stage 1 - Skin intact, nonblanchable erythema
- Stage 2 - Erosion into epidermis only (dermis is intact)
- Adipose tissue is not visible
- Stage 3 - Deep necrosis/ulceration with full-thickness skin loss
- Adipose tissue is visible
- Fascia, muscles, ligaments/tendons, cartilage/bone not visible
- Stage 4 - Full thickness ulceration revealing muscle and bone
- Unstageable - Full-thickness skin involvement with devitalized tissue/eschar obscuring view
Differential Diagnosis
Evaluation
- The most important piece of the evaluation is early identification and classification especially for patients being admitted.
- For deep wounds and in patients with signs of sepsis, evaluate for hematogenous spread (blood cultures) or osteomyelitis (imaging or deep culture)
Management
- Stage 1 and 2 ulcers
- Wound care and dressing changes in addition to padding to relief pressure
- Stage 2 and 3 ulcers
- Surgical debridement and ongoing intensive wound care and pressure relief
Disposition
- Disposition is not dependent on the degree of ulcer but rather depends on the patient's clincal condition
See Also
General Approach to EM Geriatrics