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Pressure ulcers - treatment by stages, prevention

Pressure ulcers are a violation of the integrity of the skin due to a disruption of the blood supply and innervation of a separate area, caused by prolonged compression.

The death of soft tissues often occurs in bedridden patients and, without treatment, extends to the depth down to the bones and tendons, forming cavities “pockets” in the muscle layer.

Effective treatment of pressure sores depends on the stage and depth of the lesion of soft tissues. However, it is much easier to prevent the development of pathology in bedridden patients than to eliminate the necrosis that has already appeared.

Content

Causes of pressure sores

Causes of pressure sores

The main reason for the formation of pressure sores is the compression of soft tissues for a long time. Constant pressure, which can disrupt the natural blood flow of the capillaries of the skin for 2 hours, provokes the appearance of initial signs of necrosis. Pressure ulcers are destined for bed patients.

Necrotic process develops in patients:

  • in coma;
  • with stroke (innervation is impaired);
  • with back injuries, brain;
  • infarcted and forced to lie still;
  • diabetics;
  • psychiatric patients (especially with catatonic syndrome);
  • with involuntary urination and defecation.

Especially quickly bedsores are formed in elderly, malnourished and obese patients.

The provoking factors are:

  1. Inadequate hygiene of the patient, especially during fever and excessive sweating.
  2. Lack of proper care - hard bed, folds in the sheets, wet underwear and bed linen.
  3. Allergy to patient care.
  4. Malnutrition with protein deficiency.

Pressure ulcers most often affect:

  • if the patient is lying on his back - heels, buttocks, sacrum, shoulder blades, elbows, neck;
  • if the patient is lying on the side - foot, toes, spit of the femur, the iliac crest, the elbow joint, the ear and the temporal region.

Sometimes necrosis is provoked by too tight plaster cast, improperly formed denture (bedsores are formed in the oral cavity) or prolonged stay in the urethra of the catheter.

Stages of bedsores in bed patients, photo

The treatment of pressure sores is radically different depending on the stage of the necrotic process. In the absence of proper care and appropriate treatment of pressure sores, the depth of tissue damage increases.

Stage 1

1-stage bedsores, photo

There is a venous erythema: certain areas of the skin become red-bluish in color, the skin color does not change after the pressure is prevented, the local temperature is normal or slightly reduced. The integrity of the skin while not broken (see photo).

The bruise and arterial hemorrhage under the skin initially have a bright red color, and the local temperature is slightly elevated. These differences are of great importance in the diagnosis of pressure sores at the initial stage of development and their timely treatment.

Stage 2

Primary damage to the integrity of the skin due to developing edema: the appearance of maceration (areas of thinned skin) against the background of hyperemia, peeling and small bubbles. Already from this stage, the accession of infection and the formation of purulent foci is possible.

Stage 3

3-stage-bedsore-photo

photo of the third stage

3-stage decubitus

Distribution of the necrotic process to the deeper layers up to the lesion of the muscle, clear signs of suppuration and discharge of serous fluid and pus from the wound.

Stage 4

4 stage bedsores photophoto 4th stage of bedsores

The formation of deep cavities with the exposure of tendons and bones. Depending on the pressure force, bedsores with different stages of tissue necrosis can form on different parts of the body (photo).

Treatment of purulent bedsores at home will not bring results: hospitalization of the patient is necessary.

Pressure ulcers can be complicated:

  • erysipelas caused by pyogenic bacteria - cold, dense to the touch, bright red, growing around the periphery of the lesion / lesions, hyperthermia up to 39ºС, signs of intoxication (nausea, headaches, increasing weakness);
  • cellulitis - diffuse purulent inflammation, which has no clear boundaries, extends to the subcutaneous layers, fascia muscles and intermuscular space;
  • gas gangrene - a putrefactive process that develops within 6-7 hours after contact with clostridia (often from the soil), characterized by crepitus of the hearth (crunch), intolerable putrid odor, gray skin and dry wounds;
  • sepsis (blood poisoning) - high hyperthermia, alternating then with low temperature, rapid development of the process and septic shock, often resulting in death.

Treatment of pressure sores depending on the stage

Treatment of bedsores stage 1-2 in bedridden patients can be carried out at home. Purulent and deep necrotic foci most often require surgical intervention and hospitalization of the patient.

Treatment of bedsore 1 stage

Argocrem in the treatment of bedsores at home

If the patient is in the hospital, it is possible to use dosed ultraviolet irradiation and electrostatic showers.

The hyperemic areas are treated twice - three times a day:

  • 2% camphor alcohol;
  • 1% salicylic alcohol;
  • 0.5% ammonia;
  • 1-2% alcohol solution of tannin;
  • Argocrem containing silver.

Treatment of bedsores stage 2 and open wounds at home

When microdamages on the skin and maceration appear, the main goal is to prevent suppuration. For this use:

  • Chlorhexidine antiseptics;
  • antimicrobial ointment Levomekol;
  • gel Solcoseryl, Bepanten (activate skin regeneration);
  • silver containing Argogel and ointment with Methyluracil (stimulate local immunity);
  • dressings with Himotrypsin, drugs Multiferm, Hydrosorb, Comfil.

Treatment of bedsores 3-4 stage

Treatment-bedsore-3-and-4-stage

The only effective treatment tactic is partial surgical excision of necrotic tissue with further local anti-inflammatory treatment of the resulting wounds and general therapy, including the use of hormonal preparations Dexamethasone, Hydrocortisone and immunostimulants, intravenous infusion of 0.5% Metronidazole.

Features of treatment of the location of bedsores

The therapeutic result is enhanced if the following treatment rules are observed, taking into account the localization of the necrotic process.

The bedsores on the heels are wedge-shaped pads, skin protection with a colloid dressing with Comifil for 2-5 days.

Pressure ulcers on the buttocks - treatment and prevention includes the use and regular change of diapers, special gluteal circles. Preventive massage of the gluteal zone in the absence of signs of necrosis may be more profound, since this area has a fairly pronounced muscle layer.

Pressure ulcers on the coccyx - the minimal muscle layer causes a rapid spread of necrosis to the bone tissue, so this area is treated with antiseptics in the first place.

Home Treatment

At home, it is permissible to conduct passive drainage. To do this, the wound is filled with sterile wipes, abundantly moistened with the above antiseptic solutions and anti-inflammatory ointments.

In the extreme case, you can use bandages with a treated, non-disintegrating edge. However, such a tactic will not ensure the cure of purulent deep wounds, but only prevent the growth of necrosis into the tissues.

йод, марганцовку, зеленку, перекись водорода, борную кислоту! Do not use: iodine, potassium permanganate, brilliant green, hydrogen peroxide, boric acid! When purulent processes are ineffective: Vishnevsky liniment , Sintomitsinovaya and other antibacterial ointment with petroleum jelly in the composition.

Measures for the prevention of bedsores

Bedsore prevention

The measures listed below will not only prevent the appearance of areas of soft tissue necrosis even in patients who are bedridden for a long time, but also increase the effectiveness of the algorithm for processing bedsores at home.

  • The best option is the use of an anti-decubitus mattress and a functional bed.
  • Changing the position of the patient every 2 hours.
  • Gentle rubbing of the skin on the buttocks, back, legs and other places of tight contact with the bed.
  • Bed and underwear is only natural, smooth texture (without embroidery, transverse seams and embossed patterns). Necessarily the absence of folds on the spread sheets and pillowcase.
  • Full hygiene - wiping the patient with a soft cloth dipped in warm water with further thorough drying, frequent change of body / bed linen, use of a duck / vessel.
  • A full-fledged diet with a sufficient amount of protein, if necessary - the introduction through the probe nutrient mixtures Nutrizon, Optimum, etc.
  • Compliance with the drinking regime - at least 1.5 liters of fluid per day.
  • Regular examination of the patient by the therapist while he is at home. When suppuration of bedsores - consult a surgeon.
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