Lecture 3b Flashcards
What are pressure sores/wounds?
A localized area of skin necrosis (dead skin) that occurs when soft tissues are subject to prolonged periods of pressure and lack of blood flow
Approximately 85% of people with SCI develop at least one sore at some point
- Usually right after injury since not sure how to deal with them, then become better at it
- As we age, natural muscle loss and thinning of skin causes them to become more common once again
- U-shape graph of getting pressure sores
What causes pressure sores?
- Seated or lying down for a long period of time
- Pressure concentrates on the skin between boy prominence and exterior surface
- Causes compression of capillaries supplying the skin
- Reduction of O2 delivery and metabolite (waste) removal
- Necrosis of tissue (Skin, and possibly muscle and bone)
Why are SCI individuals more susceptible? (9)
- Lack of sensation
- Lack of mobility
(Two largest factors)
- If we feel uncomfortable, we can adjust and reestablish blood flow to the area, those with SCI cannot - Susceptible skin
- Poor superficial circulation due to sympathetic dysfunction (most of the time with SCI/common), immobility, and edema
- Autonomic/sympathetic dysfunction such as blood pressure issues, issues constricting and dilating blood vessels - Loss of muscle mass
- Atrophy, especially in glutes has large effect since no longer protects the skin from pinching as much (Not cushioned) - Weight gain
- Gain fat, and more weight presses onto the specific area - Depression and resulting inactivity
- Previous pressure sores
- Will always be more susceptible even if years later - Dry skin
- Cannot sweat below the injury - Overly moist skin
- Bladder and bowel accidents (No control)
What are 4 ways pressure sores can be prevented?
- Reduction of pressure (30/30 rule, change position every 2-3 hrs when lying down)
- Still not sufficient, most say 200 seconds is what is needed, too difficult to prop up for 200 in a chair though - Hygiene and frequent skin inspection (Twice daily)
- Avoid tight clothing
- Diet high in protein and vitamin C (Skin elasticity)
How are pressure sores classified?
Stages 1-4
- 1 being the most mild, skin irritations
- 4 being the most severe, life threating wound
What are the characteristics and treatment options for Stage 1 sores?
Characteristics:
- Skin intact, but warm and firm
- Well-defined red area that persists at least 30 mins after the pressure has been removed
- Swelling (Edema), possible induration (Callus)
Treatment (Over several days)
- Remove pressure (Limit amount of time in chair for a few days
- Increase protein intake
- Consult a doctor if redness doesn’t resolve after 24 hours
What are the characteristics and treatment options for Stage 2 sores?
Characteristics:
- Formation of a wound, blister or shallow crater (Skin breaks through) on:
1. a red spot
2. along the rim of an induration
- Skin loss involving epidermis, dermis (Hair follicles, nerve endings, etc) , or both
- Redness and edema
Treatment (Approx. 2 weeks):
- Same as stage 1 (Pressure off for weeks whenever possible, mostly on the one area, but don’t want to form a new one so keep moving)
- Apply a dressing (Several depending on type of sore), but keep sore clean, moist and fill dead spaces with it
What are the characteristics and treatment options for Stage 3 sores?
Characteristics:
- Deep crater, destruction of subcutaneous tissue with possible penetration to muscle
- Possible infection, and necrotic (Dead, black) tissue
Treatment (Months or surgery):
- Same as stage 2
- Possible surgery (Last resort
- Dressings and debridement (scraping dead tissue off)
- Lifestyle changes (Diet, activity, etc)
- Antibiotics
What are the characteristics and treatment options for Stage 4 sores?
Characteristics:
- Deep crater, penetration to muscle, bone, joints, tendons
- Odor
- Necrotic tissue and high probability of infection
Treatment (Months or surgery):
- Same as stage 2
- Possible surgery (Last resort
- Dressings and debridement (scraping dead tissue off)
- Lifestyle changes (Diet, activity, etc)
- Antibiotics
What are the negatives of resorting to surgery for pressure sores?
- High rate of recurrence
- 79% recurrence within 10.9 months of surgery - Utilizes healthy tissue
- Graft of myocutaneous flap over sore (fills wound and it well vascularized - usually from thigh)
What is the largest resulting complication of pressure sores and how is it formed?
Septicemia (Blood poisoning)
- developed since sores became so bad, they were infected in blood
- Usually due to a number of things not just the wound
- Rapid multiplication of bacteria in blood (Works way into bloodstream and then bacteria is circulated)
- Arises from escape of bacteria from a focus of infection somewhere in the body (The pressure sore)
What other complications can septicemia lead to?
Septic shock
Leads to
Tissue damage and decreased BP
Leads to
- Bacteria promoting blood clotting and inability to vasoconstrict
AND/OR
- Kidney and heart failure
Leads to
Death (50% despite treatment if at this stage)
Do pressure sores have to start on the skin?
NO
- Might start within the muscle and break through when necrotic
- What you see might only be 10%, might spread further deeper into the tissue
How can electrical stimulation be used as treatment of pressure sores?
Can speed up healing process, with electrode directly onto the wound itself
Treatment done in study:
- 1 hr a day for 20 days straight
- 200 V, no muscle contractions, no discomfort
- Measured wound surface area (not a perfect measure since doesn’t show deep or infection level)
Results:
- Stage 2 wounds had healed (Mostly due to time)
- Stage 3 down 72% in Stim group, 52% in placebo
- Stage 4 down 67% in stim group, 15% in placebo
How?
- Inflammatory response, bactericidal effects (Kills bacteria) , increased blood flow
What are two counter measures that can be done to prevent pressure sore build up?
- BRADEN risk test
- Measures how at risk individuals are at developing pressure sores
- Low (0-2) Moderate (3-5) High (6-8) Very high (9-25) - Wheelchair characteristics/design chart
- Based on: Seat dimensions, footrest height, armrests, seat and back construction
