A Family Doctor's Tale - BED SORES

DOC I HAVE BEDSORES

A bed sores is skin which is damaged most commonly by
ischemic necrosis(lack of blood supply leading to breakdown of tissue cells) and ulceration of tissues overlying a bony prominence that has been subjected to prolonged pressure against an external object.

This typically occurs in a incapacitated person lying over a prolonged periods in bed hence the term bed sores.

Blood supply is impaired as a result of constant pressure on the blood vessel resulting in localized gangrene(death of tissue due to lack of blood supply)

The following are considered when determining the severity of the bed sores:

1.Degree of bed sores
2.Extent of the bed sores
3.Age of patient
4.Location of bed sores
5.Other illnesses and injuries

There are 6 stages of a bed sores:

First stage bed sores:
superficial redness of the skin

Second stage bed sores:
The skin is red, hot, swollen with induration. blister formation and desquamation(dropping of skin layer).
There may be some pain

Third stage bed sores:
The full thickness of the skin is damaged with ulceration.

Fouth stage bed sores:
The skin damage extends to the muscle often causing pain because of impingement on the nerve

Fifth stage bed sores:
The necrosis of skin tissue affects the muscles and fat tissue

Sixth stage bed sores:
There is associated bone destruction , bone or joint infection and septicemia(infection of the blood)

Illnesses such as those below can aggravate the severity of the bed soress and affect the healing:
1.Respiratory diseases
2.Diabetes
3.Heart disease
4.Injuries like fractures

Complications of bed sores are:
1.Septicemia or blood infection

2.Cellulitis or abscess formation

Treatment of bed sores:
In the early stage such as redness of the skin, prevention is the best treatment:
1.Encourage regular movement of the body every 2 hours

2.In cases of paralyzed or unconscious patients change position of the patients every 2 hours.

3.apply talcum powder or  soothing cream or lotion on the skin

4.Try not to break a blister. If a blister is already broken, apply an antiseptic lotion.

5.Painkillers may be necessary for pain.

6.Regular inspection of the skin for cleanliness and dryness.

7. Use of water beds, ripple mattress, inflatable rings, protective padding and Stryker frame for those with spinal cord paralysis all help to prevent bed sores.

More severe cases may need to be treated in a hospital:
1.the bed sores  gets infected(fever, pus formation and increasing pain, redness and swelling).

2.Appropriate antibiotics to treat infection

3.Hydrophilic beads of dextronomer may be useful to clean oozing lesions and promote granulation and recovery

4.Regular debridement(removal of infected tissues) with enzymatic digestive agents

5.In severe cases surgical debridement and skin grafts may be necessary.

6.Underlying medical illnesses such as diabetes, heart attack and stroke should be treated

Prognosis:
In early stage the prognosis is good with preventive measures.

Once ulcers are formed the prognosis is fair.