Pressure ulcer

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 - Epidermal redness only
• Stage 2 - Erosion into epidermis only (dermis is intact)
• Stage 3 - Deep necrosis/ulceration to all skin layers above fascia
• Stage 4 - Full thickness ulceration revealing muscle and bone

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