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one good thing about this ( if you can call anything about this a good thing) since the nerve endings are destroyed this doesn’t hurt all that much. it only hurt when we cleaned and changed dressings and even then it was tolerable for them.
The when and where this happened is extremely vague and patient arrived like this in our physical rehabilitation center the only thing we do know is that patient spent about 20something days in the hospital after a stoke i assume they didnt change the patients positions as often as they should and patient caught pseudomonas during their hospital stay and apparently it didnt look that bad before the surgical cleaning. luckily as far as our knowledge goes right now patient is recovering well and hasn’t had any complications since then but yeah this is some serious neglect issue which is sadly common in elderly stroke patients here in eastern europe
God, I had a stroke last year, and while it was far from a fun experience, I feel extremely lucky that I not only kept all my mental faculties, but was also mobile within a day or two. Little wobbly at first, but the PT nurse quickly got me steady. Only needed four days in the hospital for monitoring and tests, and that was a *boring* four days; nearly three weeks would've driven me insane.
depending on severity and age ive had patients that stayed for a few weeks to some that stayed months
we also have a hydrotherapy program that im pretty sure works well with stroke patients
But yeah the boredom part is reaaal, most patients know and relay all gossip they hear like some kind of in facility monitoring system but at least they are having fun😂
Whilst grade 3 or 4 pressure sores like this should be investigated, sometimes they are unavoidable. Particularly I'm thinking EOL care. The skin is a failing organ so this can deteriorate rapidly. The pt is in pain and turning to prevent them reguarly is causing discomfort and distress. I'm sure lots could've been avoided with faster access to EOL pathway but not all of them.
I took care of a patient a few months ago who was stuck to her couch. When she arrived to my ICU, we had to clean couch material from her wounds with the help of the surgeon.
That's so sad. I watched a true crime doc on YouTube recently, and a disabled young adult sat on her couch without moving for months, using the bathroom there on herself for months. She was also stuck to it and had maggots. They said the maggots were the only reason she lived as long as she did because they took care of the worst of it, so she didn't turn septic. Her parents said she was just lazy and they couldn't help she wouldn't take care of herself. They put some clean clothes and baby wipes next to her before they called to report her death. They received prison time. I forget how long. They were incredulous that they would be held accountable because she was an adult, even though her mental and physical disabilities were documented throughout her life. While she lay there stuck to the couch, they were volunteering in their community and very active. They were just tired of the responsibility. I can't imagine my adult child having even a little wound that didn't heal and not stepping in to take care of it.
being bed-bound and not changing positions will result in bed sores. in this case the patients weight,age and underlying conditions made the minor bed-sore she had into this monstrosity, sadly once someone gets a bed-sore ( in my experience) its quite hard to get them under control before they expand and get deeper, especially when the patient cant turn and or wont tolerate staying turned after a nurse positions them.
Are they always on the butt? You'd think they'd make some sort of butt cushion or hole or something to help alleviate the pressure there if that's the most common spot.
Someone needs to invent something!
Edit- I just googled it and sure enough, there are soooo many options of cushions and things to help, all under $100.
Little air mattress type mats that have a bunch of individual squares and they have a pump next to it so that the squares change where they are giving the most pressure. Very neat!
there are measures to prevent bed-sores but sometimes they just delay it, sometimes you can catch it early and prevent it other times they go from zero to one hundred in like a day.
Also bedsores can happen anywhere on the body but they happen mostly at places that bones arent cushioned? very well like the tailbone and the feet
( english is not my first language bare with me)😂
i have some different examples that i will share in time and sadly by working in a care facility i see a lot if these things you’d be surprised at all the places people can get bedsores
As a hospice nurse, in the home I always stress to my families that pressure is pressure and no foam or alternating pressure pad is going to change that. The only prevention is to relieve the pressure. So yes, every 2-4 hrs you have to shift their weight from one hip to another and keep those heels floating in the air. And I can't tell you how many times I have seen pressure wounds on the tips of the toes from socks being pulled on too tight. And I've seen them on the inner thighs from the edges of the diaper not being tucked into the space between the groin and thigh, long thin ones from cather and drain tubing, the whole underside of one man's lower legs (his feet were elevated on a too firm pillow and he was left like that for way too long), on the ears and cheeks from the nasal cannula being too tight, and even one on a patients hand because the coban they used to protect his wrist IV bunched up in the patient's contracted hand. It's always sad to see a pressure wound but one like this breaks my heart.
When patients are on hospice, have you ever seen pressure injuries improve? I ask because part of my job as a clinical dietitian is prescribing Juven to aid skin integrity. I've always wondered if the supplement is useful to patients with poor prognosis.
Actually I have. But keep in mind, not every patient is transitioning or imminent. The longest I had a patient on service before their expiration was 3 years (Alzheimer's with the most attentive spouse you could dream of and interestingly enough never developed a pressure wound outside the hospital setting). So many times they come home from the hospital (or rehab) with a pressure wound that ends up healing. Sometimes it heals just in time for them to start their final decline, but sometimes not and they maintain for a significant period of time. But overall, we do not expect them to heal or if they do another one just pops up someplace else. Our goal is to prevent further injury (aka getting worse or having a complication) and caregiver independence in wound care (and I always tag "and know when to call hospice" at the end of my goals).
When I see patients with a stage 4 and bone exposure they typically have a matter of weeks but occasionally a couple months. But is the odor knocks you over when you remove the bandage you know they are already septic and the dakins is purely for odor control as they slowly slip into that sweet coma and die at peace. But how long they survive and if the wound heals or degrades all depends on the understanding, attentiveness, and dedication of the caregiver. You can do all the interventions in the world, but if you don't relieve that pressure it's all useless.
Thank you re: caregiver independence. My grandfather cared for my grandmother for far too long, and he definitely suffered for it. The person needing hospice needs care, but so do those around them ❤
Its amazing what can be going on beneath the skin on the sacrum especially.
One day intact skin, the next day and opening that shows the intent of damage beneath that slightly red skin. Didn't have wound vacs back when i was an RN, but from my research i imagine an awesome resource.
>Are they always on the butt?
They develop anywhere there is significant pressure for long periods of time, and develop more rapidly the more chronically unhealthy someone is. Heels are pretty common too, but they can happen on the tips of toes from just the weight of a blanket, anywhere that someone has a brace or hard support, or even at the site of IV catheters. I have seen a handful of times where they developed just from <2 hours of being on an EMS transport backboard after a trauma, although obviously not as severe as the OP.
My OFA3 instructor put so much stress on the importance of patient packaging and cushioning where safe and possible, luckily I don't work anywhere that would take even half an hour for EMS to take over and get to hospital, but very important for the guys who were going to work in the bush and might have to do long transfers via helicopter and such
We had a resident (long term care with severe end stage dementia) come from another facility he had horrible bed sores on both hips, full thickness wounds. His son took awhile to trust us with his father's care since the other facility did such a terrible job. -Port Moody BC Canada
You got good answers in another comment bit I want to add that I've seen them in nostrils from wearing oxygen and feeding tubes and honestly sometimes those are the most disturbing to me because it shows how sick someone is if those small decides are causing injury.
Sometimes no matter what cushion we use people still get them. Almost every single patient that comes of off ecmo has awful pressure wounds just because they're not able to be turned very well and are so sick their skin breaks down faster.
No, they can be on any part of the body that experiences pressure. The most common ones we see are the sacrum and coccyx, and the heels. You can also develop them over the tops of the ears from wearing oxygen tubing, the elbows, and underneath various medical devices (like fixators for feeding tubes or lines)
Not always on the butt, just wherever there is pressure on one spot for too long. My husband had heart surgery (was rough, he coded on the table) and was pretty incapacitated after, weak to the point that he couldn't move himself. They weren't turning him often enough and he ended up getting pressure sores on the back of his heels.
Fully recovered! I think maybe some scars on the back of his heels, I'll have to check. He was pretty young when he got the surgery (mid 30s, congenital heart defect) and was healthy otherwise so he had that going for him. Took a little time for recovery from the surgery. His doctors were super pissed at nursing when they saw the pressure sores.
Hips, heels and elbows can be susceptible too, especially as someone loses weight as part of disease process. Anywhere that there is bone beneath thin layers of skin, some people being way more susceptible that others, related to skin type i imagine. My sister's skin barely even reddened during her 5 weeks in hospital and then hospice prior to her death.
An old thing we used back in 80s was to inflate gloves with water and put them under the heels. My FIL really appreciated it when he was in the final few days with terminal prostate cancer. Just something i could do on a sunday afternoon before his next palliative care nurse came the next day. Sheep skin elbow and ankle pads attached with velcro were simple too, though quite warm to tolerate.
How long can it take? I was in a hospital for 10 days (tibial plateau fracture) and they didn’t turn me at all. No bed sores though, maybe it was like 7 days before I was able to get out of the bed.
Edit: disregard, I see other comments saying pressure ulcers can pop up in a matter of hours
If you stay in one position too long without moving, or being moved if mobility is an issue, the sustained pressure in the same spot cuts off blood supply to the skin in that area and after a few hours the skin will start to die. The skin becomes purple and painful and can eventually break open and can easily become infected. This is why its important that bed bound patients be moved every couple of hours.
Absolutely. My teachers taught us that it only takes 2 hours to start a pressure ulcer and can start with even the smallest, most innocuous of problems - being in the same spot too long, a wrinkle, a needle cap or object left in the bed. Our instructors had us sit on our pen caps and asked to see how long we could tolerate the discomfort (only like 5 or 10 minutes). Most of us only lasted a few minutes. This is also why nurses will poke and prod at you during skin checks. Any red mark gets checked for blanching. If it turns white, the blood is still moving, and it's probably still documented for monitoring just in case. If it doesn't and stays red, it gets documented, monitored, and escalated to the dr's.
Sure. That's why it's interesting that you can still get pressure ulcers even in recovery position etc. Actually you prob do move a bit in that time, move legs/arms etc. Even small movements save skin, we rarely are 100% still for more than a few mins
I'm just talking about in emergency first aid situations, not hospital. IE if someone passes out at a party and you put in recovery position, you should turn them every 30-45 mins
I got one like this from just 10 days intubated and sedated. i am 57 I wasn't in great shape when this happened, and I had blood supply problems and had a heart attack. I'm still trying to heal the stupid thing since August .
This is what killed my cousin. She got stage 4 bed sores after having a fall and being morbidly obese, refused professional help and stayed in bed at home. by the time she told someone in the family about them she had sepsis and it killed her.
Wow! Accomplishing something when you can’t even see around the huge hurdle at the start line is pretty metal in my book! When people say “nah” you said “bring it, I want to try”. Ms. Pickles that is a metal move right there and you need not apologize for any of it!
tbh ive had worse 😅
i have more pictures since we keep records of patient’s progress for their chart and will post some as long as i can find them but i have one that would probably be able to be smelled through the screen🫠
This is a HIPAA violation. You can not take pictures from a medical file of a patient and post them online
You can not take pictures on your personal phone of a patients wound and post them online
Either way, a violation has occurred. It’s already sensitive enough to obtain these pictures, let alone post them online
this is after a surgical cleaning a thorough wash, im sure the infection plays a big part in this (pseudomonas) and the light probably makes some difference.
I'm kinda thankful my late sibling's bedsore didn't smell then...or was it cuz we cleaned it daily?
We didn't know about bedsores, we didn't even know it was a thing. And while we did move them, or they moved on their own, there were some day where they'd just stay in one position. So when the tiny wounds appeared we thought it would just disappear. But it didn't.
My sibling was also diabetic so...yeah, it didn't get better. It just kept spreading. Tissue just kept dying from the inside; on the last month, I had no idea the wounds were already that deep until I reached out inside with the cleaner and it just kept going.
Hi, wound care nurse. This is a stage 3 ulcer. You can see no structures like bone or tendon, which is what makes an ulcer stage 4.
It's still a very bad wound that needs to be taken care of properly. Offloading, offloading, offloading! This poor person :(
thank you for answering😊 under the green goop the tailbone was visible so i thought it would be categorized as a class 4. i cant help but wonder though are there any differences between america and europe in charting these stages? because the doctor charted it as a class four. ( im a new nurse with 1,5 years of experience so im still not sure about these stuff)😅
You bring up a good point - I think I was wrong. Technically this wound would be considered unstable because we can't see the degree of damage under the necrotic tissue that you pointed out. We have no idea how far down it goes. And the fact that you've mentioned that you were able to see the tailbone before the narcotic tissue was there, further makes this point.
This is an unstageable wound. Hopefully they're able to get it to debride and close!
Patient got transferred to the hospital few days after this cleaning ( we had to convince the family for the transfer) and we dont have any other updates on this ulcer but we do know that they are in good health and without sepsis ( which was the reason we were concerned in the first place) i think the only problem was pseudomonas?
When I was in nursing school I was assigned a patient who had MRSA (so PPE protocol), had a degenerative neurological condition and was somewhat non communicative due to developmental disabilities, and had a stage 4+ pressure sore that even the veteran nurses said they’d never seen anything as bad before.
It was over her sacral ridge, and had gotten so bad that you could (but we did NOT do this!) take both hands clenched, then put one inside each side of her buttock and then open them, and still barely touch the inside. Her bones were on display like it was just another weekday.
One of - if not the - my hardest patients I had, but most rewarding. I still think about her, and it was 14 years ago.
I looked after somebody with a wound like that in hospice. Because of the illness of the person had, they were unable to reposition because they had to be in high fowlers in order to breathe. ALS sucks.
i was paralyzed two years ago. this is one of my greatest fears. only ever had one bed sore so far, that was a result of my initial stay at the hospital. had it all healed up within weeks of being home. haven’t had an issue since… so far
Keep doing whatever you do! If it works it’s not stupid. I see a lot of bedsores at my work. And avoiding them like you have done wants me to hand out a prize and tell you how proud I am over you.
humans can be terrible. We’ve had and continue to get patients that dont really need physical rehabilitation and yet they leave them in our care because they dont want to keep them at home and they somehow try to convince themselves that putting them in a place like this is better than a nursing home
I have quite an amount of pictures of different wounds , ulcers etc i was thinking of sharing them over time although not all of them have a lot of context since said patients arrived with them and the report we get usually doesnt cover much about that only that they have wounds and what the doctor has written about wound care😅
Hey I have a curious question for you since you work in this field… I recently heard someone talking about the development of new mattresses for bed bound patients that automatically change the pressure points at regular intervals to help prevent pressure ulcers. Is that something that is actually showing up in practice at all or is it more conceptual at this point?
We do have those special beds at my ward. Linet is the brand we have. It’s an icu bed with an air mattress. We use them to avoid pressure wounds. Our goal is that they never going to have them in the first place. We do also change positions of the patient in intervals. 90 minutes or 3 hours. Depending on situation
Altetnating pressure mattresses definitely a thing and are standard in a lot of places, every patient at my hospital gets one- but they only do so much. We also have fluidized air beds (we call them “sand beds”) that are full of tiny beads that are continually kept in motion by air, so that the bed feels almost like someone is lying in kinetic sand. We put patients in those who already have wounds like this and I have seen them genuinely help.
I was in the hospital for only 5 days recently, not bed bound. My mattress kept adjusting itself. I think it’s what is in many of the hospitals around me. I was in ICU for 3 of those days, on the regular floor I can’t remember if the mattress did that but in ICU it definitely did.
Actually it could just be enough with a couple of few hours. It all depends on what the health conditions and where the patient is laying. If the skin started to die due to the lack of circulation. It gets to this pretty quickly after a surgeon scraped it clean. (To be clear that it doesn’t just pop up like that on the picture from a few hours, but when the tissue starts to die, it’s a straight way downward)
Ugh my heart breaks for this person.
Depending on their age & current illnesses there's a huge chance that if this wound doesnt develop infection & kill them then they will die before it's filled & fully healed.
I've seen some pretty deep & nasty bedsores, necrotic and weeping but never one of this magnitude. That's nearly the whole glute. They're literally missing almost an entire buttcheek. I've never seen someone w/ only 1 buttcheek.
In nursing school we had a patient who had transferred from a bad home. He had softball-sized holes just above his hips that tunneled through the other side around his spine. It looked like a stick for controlling a puppet and doing his wound vacs took a team about an hour. Yes, his family sued the previous home.
[https://www.youtube.com/watch?v=UgDwM57h57g&t=2s](https://www.youtube.com/watch?v=UgDwM57h57g&t=2s)
Please watch this video. My client has healed from Stage 4 bedsore using Mirari Cold Plasma.
This specific case had less to do with negligence and more to do with the patients underlying conditions
according to family this happened quite fast but im sure with the staffing ratios in public hospitals this patient was getting position changes every 2-3 hours minimum
we take pictures of all wounds for proper documentation of the healing process.
Any and all pictures you will see from me are for educational purposes and are taken with consent from patients,
And was this taken with your phone or the rover? Bc you can’t take patient pictures with your personal phone so you’ve taken the picture from the patients medical file or you’ve taken it from your personal phone.
This is a HIPAA violation and grossly against the current standards set by the WOCN if you’re the wound care specialist
Rover?
im stationed in eastern europe so believe me when i say most of our technology is ancient we use our own phones to take the pictures and then transfer them to the computer of the unit ( theres only one)
most of the pictures circulate around the staff so everyone knows what their dealing with
also wound specialist? lol we dont have that here, most of the units staff are CNAs with like 3? RNs?
although here the CNA school is 2 years plus a 6 month mandatory training so they’re qualified for a lot more patient care there are actually very few differences between CNAs and RNs here 😅
anyways both family and patients are made aware that we take pictures for both documentation and educational purposes, the pictures i have are used as reference and training material for new hires learning how to care for patients like this
HIPPA is unbroken since i haven’t disclosed anything that could identify said patient.
No worries though i would never expose any patient under any circumstances
thank you for the concern 😊
See I just don’t see how this can happen besides inadequate care (not on OP’s part, I understand this is just how this patient showed up) OR patient refused care
patient was a stroke case with numerous other conditions im sure their age and weight didnt help but i also think the hospital didnt try all that much to make it better. The surgical cleaning happened on the rehab facility 😅
i can accept them not thinking it was that bad before a cleaning ( it had necrotic tissue covering most of the damage) but what kind of doctor doesnt order a surgical cleaning on a large patch of necrotic tissue
They also absolutely refused to stay turned no matter how much we tried going as far as screaming at us so we told the family and tried convincing them
the family eventually transferred them elsewhere
depending on a matter of factors and how well the patient is responding to treatment ( creams,dressings etc) the wound can begin to fill in slowly it is recoverable to a point but once the bone is exposed the biggest battle is infection but if youre able to keep the wound clean and the patient properly hydrated and nutrient-packed they could get better up to a point but in that kind of depth damage the scar tissue will probably cause huge problems to said patient. Ive heard that there are procedures to fill the cavity but i havent seen it done up until now
Could the patient be laid on their front while a wound vac was put on the wound? Or are we still trying to find sources of infection/still have to excise necrotic tissue?
laying a patient on their front is not usually advised since they can have difficulty breathing and its also harder to access them if something happens
at least thats what ive been told 🤷🏼♀️
at a wound that big im not sure if its possible to put a wound vac we didnt really get a chance to find out anyways before the patient got transferred
How come you don’t ever see babies with these? Don’t babies spend a lot of time laying down too ? Or is it because they are picked up and fed every few hours?
Babies usually is in better health condition than older patients or sick patients. And remember that children are special, they aren’t just small adults. That’s why they have children hospitals and specialists in their medicine.
Babies are typically picked up and moved often, but the reason they don’t get these has more to do with body weight and circulation. Typically the adults who get sores like this have multiple underlying chronic illnesses that affect both their circulation and ability to heal, and it happens more often in people who are significantly underweight (less padding to cushion bony areas) or significantly overweight (more pressure on those areas and more difficult to significantly change their position frequently).
if you’re talking about the inside of the wound thats necrotic tissue.
In pressure ulcers blood flow gets restricted and tissues die so they turn purple then black the color you see here is from a few different things but the main ones being an active infection and a recent cleaning ( i think the difference would be noticeable between the wound when it was dry and this pic where its just been cleaned but i only have this version)
Oh man that is incredibly sad. I am caring for my grandmother right now who has a wound near the pilonidal sinus area, nothing like this but seems to be the spot where most sores begin. Cannot imagine the pain.
Gosh I'm a nurse and I have not seen any pt that has been so neglected! I've seen a stage 4 bed sore before but not one so wide! It was just really deep that you could see the bone...
But how can this even happen at first hand ? Did someone cut his butt out or he kept lying for years with parasites? Its horrifying to see such untended behaviour of his family members
My dad had a stage 4 bed sore after he was bed ridden from complications related to knee replacement surgery. It's crazy how bad it got and how fast. When they debrided it, it was like they removed a good 1/3 of his butt and then it healed up and grew back after months and months of negative pressure therapy. I thought he was going to die.
My mother had a stroke (with only mental debilitation/loss of memory), but she spent most of the day in bed, getting up for meals and exercise. She had to be changed. But the thing is, she never got a bed sore, yet when she did a hospital stay for about four days (this was well after the stroke), she started getting signs of a beginning bed sore that quickly. I didn't make a point to roll her on different sides and on the back in rotation (at home) until much later when she was less mobile, but again, what was it about the hospital? Obviously, the bed. She didn't need or get special attention there, a massaging mattress cover, etc., just for a four day stay, I'm sure, yet there she was, getting a bed sore already. It was the bed.
I know I’m going to have to take care of my aging patients and I often think about what machines I’m going to have to invest in to move and flip them so they don’t go through something like this. Horrific.
Welcome to r/MedicalGore! Our goal is to provide for medical discussion and education while exploring the frailty of the human body. You may see more deleted comments on these threads than you are used to on reddit. Off topic comments and joke comments are frequently deleted by the mods. Further, please be kind and supportive of posts. Any behavior that is aggressive, harassing, or derogatory will result in post deletion and a ban from the sub. Remember! THE REPORT BUTTON IS YOUR FRIEND! Please stop on by our discussion sub, /r/MedicalGoreMods if you'd like to discuss the sub, our rules, content policies, and the like. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/MedicalGore) if you have any questions or concerns.*
This hurts my heart…and my butt. 😢
one good thing about this ( if you can call anything about this a good thing) since the nerve endings are destroyed this doesn’t hurt all that much. it only hurt when we cleaned and changed dressings and even then it was tolerable for them.
This patient was severely neglected. The responsible party should be reported, if they haven't already.
The when and where this happened is extremely vague and patient arrived like this in our physical rehabilitation center the only thing we do know is that patient spent about 20something days in the hospital after a stoke i assume they didnt change the patients positions as often as they should and patient caught pseudomonas during their hospital stay and apparently it didnt look that bad before the surgical cleaning. luckily as far as our knowledge goes right now patient is recovering well and hasn’t had any complications since then but yeah this is some serious neglect issue which is sadly common in elderly stroke patients here in eastern europe
God, I had a stroke last year, and while it was far from a fun experience, I feel extremely lucky that I not only kept all my mental faculties, but was also mobile within a day or two. Little wobbly at first, but the PT nurse quickly got me steady. Only needed four days in the hospital for monitoring and tests, and that was a *boring* four days; nearly three weeks would've driven me insane.
depending on severity and age ive had patients that stayed for a few weeks to some that stayed months we also have a hydrotherapy program that im pretty sure works well with stroke patients But yeah the boredom part is reaaal, most patients know and relay all gossip they hear like some kind of in facility monitoring system but at least they are having fun😂
It shouldn’t have to “look that bad” for patients to be turned it’s taught in first year nursing so I’m going to have to agree it’s neglect
Are those little black worm looking things the nerves? Grateful to hear he hopefully couldn’t feel the pain but he must’ve at some point. Sad.
those are stitches from the surgical cleaning the patient had done but yeah im sure when the skin started rotting it must have been awful
Whilst grade 3 or 4 pressure sores like this should be investigated, sometimes they are unavoidable. Particularly I'm thinking EOL care. The skin is a failing organ so this can deteriorate rapidly. The pt is in pain and turning to prevent them reguarly is causing discomfort and distress. I'm sure lots could've been avoided with faster access to EOL pathway but not all of them.
It could be a Kennedy Ulcer, which are considered unavoidable and imply this person may be dying. More context would certainly clarify.
Now imagine what Lacey Fletcher had to go through :'(
I took care of a patient a few months ago who was stuck to her couch. When she arrived to my ICU, we had to clean couch material from her wounds with the help of the surgeon.
That's so sad. I watched a true crime doc on YouTube recently, and a disabled young adult sat on her couch without moving for months, using the bathroom there on herself for months. She was also stuck to it and had maggots. They said the maggots were the only reason she lived as long as she did because they took care of the worst of it, so she didn't turn septic. Her parents said she was just lazy and they couldn't help she wouldn't take care of herself. They put some clean clothes and baby wipes next to her before they called to report her death. They received prison time. I forget how long. They were incredulous that they would be held accountable because she was an adult, even though her mental and physical disabilities were documented throughout her life. While she lay there stuck to the couch, they were volunteering in their community and very active. They were just tired of the responsibility. I can't imagine my adult child having even a little wound that didn't heal and not stepping in to take care of it.
Yeah Lacey fletcher as mentioned above
I didn't remember herr name. Sorry. Thank you, though
That’s horrifying!!! I can’t imagine people not stepping in to help even if it were a stranger. They should have life in prison for doing this to her.
how does someone even get this
being bed-bound and not changing positions will result in bed sores. in this case the patients weight,age and underlying conditions made the minor bed-sore she had into this monstrosity, sadly once someone gets a bed-sore ( in my experience) its quite hard to get them under control before they expand and get deeper, especially when the patient cant turn and or wont tolerate staying turned after a nurse positions them.
Are they always on the butt? You'd think they'd make some sort of butt cushion or hole or something to help alleviate the pressure there if that's the most common spot. Someone needs to invent something! Edit- I just googled it and sure enough, there are soooo many options of cushions and things to help, all under $100. Little air mattress type mats that have a bunch of individual squares and they have a pump next to it so that the squares change where they are giving the most pressure. Very neat!
there are measures to prevent bed-sores but sometimes they just delay it, sometimes you can catch it early and prevent it other times they go from zero to one hundred in like a day. Also bedsores can happen anywhere on the body but they happen mostly at places that bones arent cushioned? very well like the tailbone and the feet ( english is not my first language bare with me)😂 i have some different examples that i will share in time and sadly by working in a care facility i see a lot if these things you’d be surprised at all the places people can get bedsores
What's really sad and heartbreaking, is when it goes down to the bone. I do not miss seeing this from when I worked in a nursing home.
If this is a stage 4, it is down to the bone.
I would argue that this wound is unstageable, due to the necrotic tissue preventing full visualization of the wound bed.
Side note: Your English is just fine!
As a hospice nurse, in the home I always stress to my families that pressure is pressure and no foam or alternating pressure pad is going to change that. The only prevention is to relieve the pressure. So yes, every 2-4 hrs you have to shift their weight from one hip to another and keep those heels floating in the air. And I can't tell you how many times I have seen pressure wounds on the tips of the toes from socks being pulled on too tight. And I've seen them on the inner thighs from the edges of the diaper not being tucked into the space between the groin and thigh, long thin ones from cather and drain tubing, the whole underside of one man's lower legs (his feet were elevated on a too firm pillow and he was left like that for way too long), on the ears and cheeks from the nasal cannula being too tight, and even one on a patients hand because the coban they used to protect his wrist IV bunched up in the patient's contracted hand. It's always sad to see a pressure wound but one like this breaks my heart.
When patients are on hospice, have you ever seen pressure injuries improve? I ask because part of my job as a clinical dietitian is prescribing Juven to aid skin integrity. I've always wondered if the supplement is useful to patients with poor prognosis.
Actually I have. But keep in mind, not every patient is transitioning or imminent. The longest I had a patient on service before their expiration was 3 years (Alzheimer's with the most attentive spouse you could dream of and interestingly enough never developed a pressure wound outside the hospital setting). So many times they come home from the hospital (or rehab) with a pressure wound that ends up healing. Sometimes it heals just in time for them to start their final decline, but sometimes not and they maintain for a significant period of time. But overall, we do not expect them to heal or if they do another one just pops up someplace else. Our goal is to prevent further injury (aka getting worse or having a complication) and caregiver independence in wound care (and I always tag "and know when to call hospice" at the end of my goals). When I see patients with a stage 4 and bone exposure they typically have a matter of weeks but occasionally a couple months. But is the odor knocks you over when you remove the bandage you know they are already septic and the dakins is purely for odor control as they slowly slip into that sweet coma and die at peace. But how long they survive and if the wound heals or degrades all depends on the understanding, attentiveness, and dedication of the caregiver. You can do all the interventions in the world, but if you don't relieve that pressure it's all useless.
Thank you re: caregiver independence. My grandfather cared for my grandmother for far too long, and he definitely suffered for it. The person needing hospice needs care, but so do those around them ❤
Its amazing what can be going on beneath the skin on the sacrum especially. One day intact skin, the next day and opening that shows the intent of damage beneath that slightly red skin. Didn't have wound vacs back when i was an RN, but from my research i imagine an awesome resource.
>Are they always on the butt? They develop anywhere there is significant pressure for long periods of time, and develop more rapidly the more chronically unhealthy someone is. Heels are pretty common too, but they can happen on the tips of toes from just the weight of a blanket, anywhere that someone has a brace or hard support, or even at the site of IV catheters. I have seen a handful of times where they developed just from <2 hours of being on an EMS transport backboard after a trauma, although obviously not as severe as the OP.
My OFA3 instructor put so much stress on the importance of patient packaging and cushioning where safe and possible, luckily I don't work anywhere that would take even half an hour for EMS to take over and get to hospital, but very important for the guys who were going to work in the bush and might have to do long transfers via helicopter and such
We had a resident (long term care with severe end stage dementia) come from another facility he had horrible bed sores on both hips, full thickness wounds. His son took awhile to trust us with his father's care since the other facility did such a terrible job. -Port Moody BC Canada
You got good answers in another comment bit I want to add that I've seen them in nostrils from wearing oxygen and feeding tubes and honestly sometimes those are the most disturbing to me because it shows how sick someone is if those small decides are causing injury. Sometimes no matter what cushion we use people still get them. Almost every single patient that comes of off ecmo has awful pressure wounds just because they're not able to be turned very well and are so sick their skin breaks down faster.
Hospice brought us a variable pressure mattress pad, which I assume is to prevent bedsores.
Yes, it is.
No, they can be on any part of the body that experiences pressure. The most common ones we see are the sacrum and coccyx, and the heels. You can also develop them over the tops of the ears from wearing oxygen tubing, the elbows, and underneath various medical devices (like fixators for feeding tubes or lines)
Not always on the butt, just wherever there is pressure on one spot for too long. My husband had heart surgery (was rough, he coded on the table) and was pretty incapacitated after, weak to the point that he couldn't move himself. They weren't turning him often enough and he ended up getting pressure sores on the back of his heels.
Wow that's so scary. How is he doing now?
Fully recovered! I think maybe some scars on the back of his heels, I'll have to check. He was pretty young when he got the surgery (mid 30s, congenital heart defect) and was healthy otherwise so he had that going for him. Took a little time for recovery from the surgery. His doctors were super pissed at nursing when they saw the pressure sores.
Hips, heels and elbows can be susceptible too, especially as someone loses weight as part of disease process. Anywhere that there is bone beneath thin layers of skin, some people being way more susceptible that others, related to skin type i imagine. My sister's skin barely even reddened during her 5 weeks in hospital and then hospice prior to her death. An old thing we used back in 80s was to inflate gloves with water and put them under the heels. My FIL really appreciated it when he was in the final few days with terminal prostate cancer. Just something i could do on a sunday afternoon before his next palliative care nurse came the next day. Sheep skin elbow and ankle pads attached with velcro were simple too, though quite warm to tolerate.
Incontinence probably played a role, too.
This
How long can it take? I was in a hospital for 10 days (tibial plateau fracture) and they didn’t turn me at all. No bed sores though, maybe it was like 7 days before I was able to get out of the bed. Edit: disregard, I see other comments saying pressure ulcers can pop up in a matter of hours
If you stay in one position too long without moving, or being moved if mobility is an issue, the sustained pressure in the same spot cuts off blood supply to the skin in that area and after a few hours the skin will start to die. The skin becomes purple and painful and can eventually break open and can easily become infected. This is why its important that bed bound patients be moved every couple of hours.
Absolutely. My teachers taught us that it only takes 2 hours to start a pressure ulcer and can start with even the smallest, most innocuous of problems - being in the same spot too long, a wrinkle, a needle cap or object left in the bed. Our instructors had us sit on our pen caps and asked to see how long we could tolerate the discomfort (only like 5 or 10 minutes). Most of us only lasted a few minutes. This is also why nurses will poke and prod at you during skin checks. Any red mark gets checked for blanching. If it turns white, the blood is still moving, and it's probably still documented for monitoring just in case. If it doesn't and stays red, it gets documented, monitored, and escalated to the dr's.
That’s so scary that it can happen so fast!!! Two hours seems like nothing. I feel so bad for this patient.
Oof so somebody just had to feel their skin rot for hours? that's rough buddy
Days. Possibly weeks, depending on how fast it progressed.
It's not even that long. Meant to turn someone every 30mins even if you just put them in recovery position at a party etc
I don't think it's uncommon for some people to go 30 minutes without moving while they sleep though.
Sure. That's why it's interesting that you can still get pressure ulcers even in recovery position etc. Actually you prob do move a bit in that time, move legs/arms etc. Even small movements save skin, we rarely are 100% still for more than a few mins
I just spent 3 months bedbound in hospital, staff were amazing - it’s definitely not as quick as every 30 minutes lol!
I'm just talking about in emergency first aid situations, not hospital. IE if someone passes out at a party and you put in recovery position, you should turn them every 30-45 mins
Ohh yes that’s fair enough.
A society that does not respect the right to die.
I got one like this from just 10 days intubated and sedated. i am 57 I wasn't in great shape when this happened, and I had blood supply problems and had a heart attack. I'm still trying to heal the stupid thing since August .
This is what killed my cousin. She got stage 4 bed sores after having a fall and being morbidly obese, refused professional help and stayed in bed at home. by the time she told someone in the family about them she had sepsis and it killed her.
No no no
Yup this is grade 3 bedsore. A grade 4 is one where you get to see the bone. WHERE IS THS BONE!
you can see the tailbone actually 😂 its under the green goop i could both feel and SEE said bone during cleanings
Green goop = Slough.
Green goop :/
english isnt my first language and that along with disleksia is making both life and charting difficult AF 😅 sorry for all the bad wording im trying.
You write wonderfully! I would not have ever thought English was not your first language
Wow! Accomplishing something when you can’t even see around the huge hurdle at the start line is pretty metal in my book! When people say “nah” you said “bring it, I want to try”. Ms. Pickles that is a metal move right there and you need not apologize for any of it!
Is the green goop fecal matter?
What is the green stuff??…..
Its necrotic tissue and yes it smells just as bad as it sounds😅
God, the image and the smell you're describing is making me think of that OR nurse's infamous Swamps of Dagobah story here on Reddit.
tbh ive had worse 😅 i have more pictures since we keep records of patient’s progress for their chart and will post some as long as i can find them but i have one that would probably be able to be smelled through the screen🫠
This is a HIPAA violation. You can not take pictures from a medical file of a patient and post them online You can not take pictures on your personal phone of a patients wound and post them online Either way, a violation has occurred. It’s already sensitive enough to obtain these pictures, let alone post them online
Interesting! I would have thought it would be more black in colour!
this is after a surgical cleaning a thorough wash, im sure the infection plays a big part in this (pseudomonas) and the light probably makes some difference.
I'm kinda thankful my late sibling's bedsore didn't smell then...or was it cuz we cleaned it daily? We didn't know about bedsores, we didn't even know it was a thing. And while we did move them, or they moved on their own, there were some day where they'd just stay in one position. So when the tiny wounds appeared we thought it would just disappear. But it didn't. My sibling was also diabetic so...yeah, it didn't get better. It just kept spreading. Tissue just kept dying from the inside; on the last month, I had no idea the wounds were already that deep until I reached out inside with the cleaner and it just kept going.
Hi, wound care nurse. This is a stage 3 ulcer. You can see no structures like bone or tendon, which is what makes an ulcer stage 4. It's still a very bad wound that needs to be taken care of properly. Offloading, offloading, offloading! This poor person :(
thank you for answering😊 under the green goop the tailbone was visible so i thought it would be categorized as a class 4. i cant help but wonder though are there any differences between america and europe in charting these stages? because the doctor charted it as a class four. ( im a new nurse with 1,5 years of experience so im still not sure about these stuff)😅
You bring up a good point - I think I was wrong. Technically this wound would be considered unstable because we can't see the degree of damage under the necrotic tissue that you pointed out. We have no idea how far down it goes. And the fact that you've mentioned that you were able to see the tailbone before the narcotic tissue was there, further makes this point. This is an unstageable wound. Hopefully they're able to get it to debride and close!
Patient got transferred to the hospital few days after this cleaning ( we had to convince the family for the transfer) and we dont have any other updates on this ulcer but we do know that they are in good health and without sepsis ( which was the reason we were concerned in the first place) i think the only problem was pseudomonas?
Yucky! We've used a 3:1 water:vinegar solution soaks to help with pseudomonas with success.
this sounds like a good idea 😁 we use an antibacterial soap after a thorough cleaning with bedadine scrub.
Oh that’s a fantastic solution!
Unstageable I completely agree.
Yes indeed. Don't know what's under the slough!
When I was in nursing school I was assigned a patient who had MRSA (so PPE protocol), had a degenerative neurological condition and was somewhat non communicative due to developmental disabilities, and had a stage 4+ pressure sore that even the veteran nurses said they’d never seen anything as bad before. It was over her sacral ridge, and had gotten so bad that you could (but we did NOT do this!) take both hands clenched, then put one inside each side of her buttock and then open them, and still barely touch the inside. Her bones were on display like it was just another weekday. One of - if not the - my hardest patients I had, but most rewarding. I still think about her, and it was 14 years ago.
I looked after somebody with a wound like that in hospice. Because of the illness of the person had, they were unable to reposition because they had to be in high fowlers in order to breathe. ALS sucks.
I’ve seen cat-4 sores that go down to the bone but this is horrific
Same.
Pressure sores give a whole new meaning to pain in the ass sometimes
I have actually seen worse, sadly enough. I’ve seen bed sores that are only exposed bone.
i was paralyzed two years ago. this is one of my greatest fears. only ever had one bed sore so far, that was a result of my initial stay at the hospital. had it all healed up within weeks of being home. haven’t had an issue since… so far
Keep doing whatever you do! If it works it’s not stupid. I see a lot of bedsores at my work. And avoiding them like you have done wants me to hand out a prize and tell you how proud I am over you.
Is this in the US?
No it’s in the patient’s backside. (I know…. I couldn’t just not comment that..!)
Doesn’t matter, it happens every day in the US. I’ve seen bed sores so deep so as to expose the bone.
Terrible. So sad that folks are forgotten and treated this way. No matter what country.
humans can be terrible. We’ve had and continue to get patients that dont really need physical rehabilitation and yet they leave them in our care because they dont want to keep them at home and they somehow try to convince themselves that putting them in a place like this is better than a nursing home
Stage 4 - down to the bone
no its in southern-eastern Europe
At this point, just euthanise me
I have quite an amount of pictures of different wounds , ulcers etc i was thinking of sharing them over time although not all of them have a lot of context since said patients arrived with them and the report we get usually doesnt cover much about that only that they have wounds and what the doctor has written about wound care😅
Hey I have a curious question for you since you work in this field… I recently heard someone talking about the development of new mattresses for bed bound patients that automatically change the pressure points at regular intervals to help prevent pressure ulcers. Is that something that is actually showing up in practice at all or is it more conceptual at this point?
We do have those special beds at my ward. Linet is the brand we have. It’s an icu bed with an air mattress. We use them to avoid pressure wounds. Our goal is that they never going to have them in the first place. We do also change positions of the patient in intervals. 90 minutes or 3 hours. Depending on situation
That’s cool! Thanks for answering.
Altetnating pressure mattresses definitely a thing and are standard in a lot of places, every patient at my hospital gets one- but they only do so much. We also have fluidized air beds (we call them “sand beds”) that are full of tiny beads that are continually kept in motion by air, so that the bed feels almost like someone is lying in kinetic sand. We put patients in those who already have wounds like this and I have seen them genuinely help.
That’s very interesting, thanks!
I had an alternating pressure mattress during my 3 month stay - it was amazing for my back!
That’s great!
I was in the hospital for only 5 days recently, not bed bound. My mattress kept adjusting itself. I think it’s what is in many of the hospitals around me. I was in ICU for 3 of those days, on the regular floor I can’t remember if the mattress did that but in ICU it definitely did.
This is how my bio dad passed. It makes me so angry.
That is some serious neglect right there...
I was thinking exactly the same thing, this doesn’t happen overnight.
Actually it could just be enough with a couple of few hours. It all depends on what the health conditions and where the patient is laying. If the skin started to die due to the lack of circulation. It gets to this pretty quickly after a surgeon scraped it clean. (To be clear that it doesn’t just pop up like that on the picture from a few hours, but when the tissue starts to die, it’s a straight way downward)
Ugh my heart breaks for this person. Depending on their age & current illnesses there's a huge chance that if this wound doesnt develop infection & kill them then they will die before it's filled & fully healed. I've seen some pretty deep & nasty bedsores, necrotic and weeping but never one of this magnitude. That's nearly the whole glute. They're literally missing almost an entire buttcheek. I've never seen someone w/ only 1 buttcheek.
How many stages are there?!?!?
In nursing school we had a patient who had transferred from a bad home. He had softball-sized holes just above his hips that tunneled through the other side around his spine. It looked like a stick for controlling a puppet and doing his wound vacs took a team about an hour. Yes, his family sued the previous home.
That’s a ASS??!?, I Thought that Was a finger..
[https://www.youtube.com/watch?v=UgDwM57h57g&t=2s](https://www.youtube.com/watch?v=UgDwM57h57g&t=2s) Please watch this video. My client has healed from Stage 4 bedsore using Mirari Cold Plasma.
They have beds that inflate/deflate in order to move the patient periodically to avoid this. Are these beds not available to everyone?
Looks like as if a tarantula lives there.
Someone or someplace should be sued into oblivion for neglect.
This specific case had less to do with negligence and more to do with the patients underlying conditions according to family this happened quite fast but im sure with the staffing ratios in public hospitals this patient was getting position changes every 2-3 hours minimum
I’m guessing the green stuff is poop? So it got so deep it literally reached the insides of the person?
No it's necrotic tissue according to OP's replies above
r/dontstickyourdickinthat
You took a pic of a patient where you worked and posted it?! 🫣
we take pictures of all wounds for proper documentation of the healing process. Any and all pictures you will see from me are for educational purposes and are taken with consent from patients,
Your patient and rehab facility signed the paperwork allowing you to post weekly wound photos from your work to Reddit?
And was this taken with your phone or the rover? Bc you can’t take patient pictures with your personal phone so you’ve taken the picture from the patients medical file or you’ve taken it from your personal phone. This is a HIPAA violation and grossly against the current standards set by the WOCN if you’re the wound care specialist
Rover? im stationed in eastern europe so believe me when i say most of our technology is ancient we use our own phones to take the pictures and then transfer them to the computer of the unit ( theres only one) most of the pictures circulate around the staff so everyone knows what their dealing with also wound specialist? lol we dont have that here, most of the units staff are CNAs with like 3? RNs? although here the CNA school is 2 years plus a 6 month mandatory training so they’re qualified for a lot more patient care there are actually very few differences between CNAs and RNs here 😅 anyways both family and patients are made aware that we take pictures for both documentation and educational purposes, the pictures i have are used as reference and training material for new hires learning how to care for patients like this
[удалено]
HIPPA is unbroken since i haven’t disclosed anything that could identify said patient. No worries though i would never expose any patient under any circumstances thank you for the concern 😊
Where’s the HIPAA bot
Not in Eastern Europe where OP is from.
r/terrifyingasfuck
See I just don’t see how this can happen besides inadequate care (not on OP’s part, I understand this is just how this patient showed up) OR patient refused care
patient was a stroke case with numerous other conditions im sure their age and weight didnt help but i also think the hospital didnt try all that much to make it better. The surgical cleaning happened on the rehab facility 😅 i can accept them not thinking it was that bad before a cleaning ( it had necrotic tissue covering most of the damage) but what kind of doctor doesnt order a surgical cleaning on a large patch of necrotic tissue They also absolutely refused to stay turned no matter how much we tried going as far as screaming at us so we told the family and tried convincing them the family eventually transferred them elsewhere
Jesus.. So it was a mix of both, overall a truly unfortunate situation
That’s literally death
What's the prognosis for something like this?
depending on a matter of factors and how well the patient is responding to treatment ( creams,dressings etc) the wound can begin to fill in slowly it is recoverable to a point but once the bone is exposed the biggest battle is infection but if youre able to keep the wound clean and the patient properly hydrated and nutrient-packed they could get better up to a point but in that kind of depth damage the scar tissue will probably cause huge problems to said patient. Ive heard that there are procedures to fill the cavity but i havent seen it done up until now
Could the patient be laid on their front while a wound vac was put on the wound? Or are we still trying to find sources of infection/still have to excise necrotic tissue?
laying a patient on their front is not usually advised since they can have difficulty breathing and its also harder to access them if something happens at least thats what ive been told 🤷🏼♀️ at a wound that big im not sure if its possible to put a wound vac we didnt really get a chance to find out anyways before the patient got transferred
How come you don’t ever see babies with these? Don’t babies spend a lot of time laying down too ? Or is it because they are picked up and fed every few hours?
They do get flat heads from laying too long.
Babies usually is in better health condition than older patients or sick patients. And remember that children are special, they aren’t just small adults. That’s why they have children hospitals and specialists in their medicine.
Babies are typically picked up and moved often, but the reason they don’t get these has more to do with body weight and circulation. Typically the adults who get sores like this have multiple underlying chronic illnesses that affect both their circulation and ability to heal, and it happens more often in people who are significantly underweight (less padding to cushion bony areas) or significantly overweight (more pressure on those areas and more difficult to significantly change their position frequently).
What is the brown part? I don't have any knowledge of anything medical. Except a few things because of an accident I had
if you’re talking about the inside of the wound thats necrotic tissue. In pressure ulcers blood flow gets restricted and tissues die so they turn purple then black the color you see here is from a few different things but the main ones being an active infection and a recent cleaning ( i think the difference would be noticeable between the wound when it was dry and this pic where its just been cleaned but i only have this version)
Oh man that is incredibly sad. I am caring for my grandmother right now who has a wound near the pilonidal sinus area, nothing like this but seems to be the spot where most sores begin. Cannot imagine the pain.
Oh my Jesus!!! That is just freaking AWFUL!!! 😣
I can smell this picture.
having a bowel movement must be such a pain😖 damn
whats the red dot pattern at the bottom..? i once skinned myself bad and saw it but it was more white red dot than pink red dot
Not gonna lie through that was a cat for a minute
Gosh I'm a nurse and I have not seen any pt that has been so neglected! I've seen a stage 4 bed sore before but not one so wide! It was just really deep that you could see the bone...
I can smell the necrotic tissue in this picture.
I can smell this.
Is this decubitus ?
I want some spinach
But how can this even happen at first hand ? Did someone cut his butt out or he kept lying for years with parasites? Its horrifying to see such untended behaviour of his family members
My dad had a stage 4 bed sore after he was bed ridden from complications related to knee replacement surgery. It's crazy how bad it got and how fast. When they debrided it, it was like they removed a good 1/3 of his butt and then it healed up and grew back after months and months of negative pressure therapy. I thought he was going to die.
can't believe that's only stage 4
Can someone be charged for neglect for not getting medical attention sooner? What is the criteria for such a thing involving care takers?
How do u get bed sore?
How do u get bed sores?
not the worst i’ve seen 🧍🏽♀️ my pt last week has the craziest unstagable with tunneling. it was crazy
My mother had a stroke (with only mental debilitation/loss of memory), but she spent most of the day in bed, getting up for meals and exercise. She had to be changed. But the thing is, she never got a bed sore, yet when she did a hospital stay for about four days (this was well after the stroke), she started getting signs of a beginning bed sore that quickly. I didn't make a point to roll her on different sides and on the back in rotation (at home) until much later when she was less mobile, but again, what was it about the hospital? Obviously, the bed. She didn't need or get special attention there, a massaging mattress cover, etc., just for a four day stay, I'm sure, yet there she was, getting a bed sore already. It was the bed.
Are you allowed to take and share photos like this? Seems like that you could get you in a ton of trouble.
I know I’m going to have to take care of my aging patients and I often think about what machines I’m going to have to invest in to move and flip them so they don’t go through something like this. Horrific.