Management of Bedsores

Introduction: According to the European Pressure Ulcer Advisory Panel/National Pressure Ulcer Advisory Panel (EPUAP/NPUAP) a pressure ulcer is a, ‘localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear’. Pressure ulcers result in immense pain and distress for the individuals developing them. They can be seen secondary to spinal cord injuries, as in the case of our patient, due to prolonged periods of immobilization. Case presentation: We report a case of a 30-year-old female of Asian descent who presented in Surgery Department with a clinical presentation of bedsores. The patient was bedridden and immobilized for 1 year due to vertebral fracture resulting from a fall, which we believe precipitated the bed sores. As per the EPUAP/NPUAP 1–4 scale, category 2 ulcers or above are categorized as reportable incidents in official guidelines in the National Health Service (NHS) in England. While Category 3 and 4 ulcers (which involve injury deep into the skin, muscle, or bone) are widely termed severe pressure ulcers and have to be reported as serious untoward incidents. Factors precipitating pressure ulcers include old age, people with sensory loss of a particular region, immobilization, sitting or lying down for extended periods of time, history of pressure ulcer, have bowel or urinary incontinence, have poor nutrition or hydration. Primary care includes washing the area generally with mild soap and water. If needed skin injuries can be covered with transparent film for protection, should be cleaned with saline to rinse and remove loose dead tissue. These pressure injuries require a dressing that maintains a moist wound environment. Caution should be taken as to not use hydrogen peroxide or iodine cleanser as they can damage skin. Pressure or deeper injuries generally require debridement of necrotic tissue and coverage with appropriate dressings and possibly treatment of infection. Secondary management include redistributing pressure, minimizing friction and shear (via log rolling, draw sheets or trapeze), relieving pain, treating infection, optimizing nutrition and hydration and lastly for chronic cases, wound debridement. Conclusion: The management during admission included Inj IV Ceftrixone 1gm BD, Inj IV Kinz 20mg SOS, Inj IV Toradol 30mg diluted in 10Cc distal water TDS, Inj IV Risek 40mg OD, Surbex Z 1 OD, Cremaffin 30ml once 2 tablespoon and blood transfusion. Wound was managed with normal saline wash and daily dressing (Eusol). Nursing care included postural change every 2 hours. And lastly, due to the extent of the bed sore manifestation, wound debridement was done