Pressure ulcer: Difference between revisions
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==Background== | ==Background== | ||
[[File:Schema stades escarres.png|thumb|Decubitus ulcer stages I to IV.]] | {{Skin anatomy background images}} | ||
[[File:Schema stades escarres.png|100px|thumb|Decubitus ulcer stages I to IV.]] | |||
[[File:Pressure ulcer points.png|thumb|Common pressure ulcer points. Red: in supine position. Blue: in lateral-lying position.]] | [[File:Pressure ulcer points.png|thumb|Common pressure ulcer points. Red: in supine position. Blue: in lateral-lying position.]] | ||
*Classified into stages based on thickness | *Classified into stages based on thickness | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Skin breakdown=== | |||
*[[Cellulitis]] | |||
*[[Diabetic ulcer]] | |||
*[[Pressure ulcer]] | |||
*[[Pyoderma gangrenosum]] | |||
*[[Osteomyelitis]] | |||
*[[Venous ulcer]] | |||
==Evaluation== | ==Evaluation== | ||
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==See Also== | ==See Also== | ||
[[General Approach to EM Geriatrics]] | *[[General Approach to EM Geriatrics]] | ||
==External Links== | ==External Links== | ||
Latest revision as of 17:29, 11 December 2024
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
Skin breakdown
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