Bed sores, also known as pressure ulcers, are wounds that develop on the body due to prolonged pressure on the skin and underlying tissues, often caused by lying in the same position on a bed for an extended period. These sores typically occur when the body is unable to move due to various underlying conditions, such as paralysis, trauma, fractures, or old age.
People who are admitted to the hospital for extended periods, especially in intensive care units (ICUs) or when on ventilators, are at a higher risk of developing bed sores. Hospitalized patients, in general, can develop pressure sores, with an estimated occurrence of 3-14% among hospitalized individuals. Any ailment that immobilizes a patient and requires prolonged bed rest or confinement to a wheelchair can make them prone to developing bed sores.
The location of a bed sore depends on the position in which the patient is primarily confined:
In addition to these common locations, bed sores can also develop on the heel, elbow, malleolus, knee, scapula, and occiput (back of the head).
Several factors contribute to the development of pressure ulcers, including:
Pressure ulcers are categorized based on the extent of damage:
Dr. Amit Agarwal conducts a thorough evaluation to determine the patient’s primary ailment and the exact stage of the wound. If there is a neurological issue, a neurologist is consulted, and for diabetes management, a physician optimizes treatment. Nutritional status is optimized, with a target of keeping serum albumin levels above 2.8 g/dL. Any pus discharge is cultured and sent for sensitivity, and appropriate antibiotics are initiated. If there is suspicion of osteomyelitis (bone infection), digital X-rays of the affected area are performed. Surgical management is recommended for deep bed sores.
The goals of managing pressure sores are:
Treatment at Kayakriti
For Category I and II bed sores, patients may not require admission if other factors are well controlled. They are educated about wound management and may be sent home with oral antibiotics and specific dressings. For Category III and IV bed sores, patients need hospital admission, and surgical correction is planned according to the site of the body involved.
The three main areas that are commonly affected are sacral, ischial, and trochanteric pressure sores.
For Category I and II bed sores, patients are educated about wound management. If other comorbidities are under control, they may not require admission. They are provided with oral antibiotics and advised on specific wound dressings. Follow-up appointments are scheduled, with frequent visits in the initial weeks and less frequent visits after the wound has healed.
For Category III and IV bed sores, patients definitely require admission to the hospital. Various investigations are conducted to assess the patient’s nutritional status and surgical fitness. This includes a pre-anesthetic checkup, and consultations with neurologists, cardiologists, and physicians to ensure the patient’s overall health is optimized.
Surgical correction is planned based on the patient’s vital stability and overall health. The three primary areas that are commonly affected are:
Sacral Pressure Sores: These are located in the lower back area.
Ischial Pressure Sores: These occur on the seat bones.
Trochanteric Pressure Sores: These develop on the hip or side bone areas.
Surgical correction involves various stages:
Care instructions are provided for home care, including the use of air mattresses, hygiene, and the importance of regular side-to-side turning. Follow-up appointments are scheduled for one-week post-discharge and then monthly for the next three months.
The primary focus is on optimizing overall health, including addressing the underlying medical conditions, nutritional status, and wound management to promote wound healing and prevent complications.
For any category of bed sore, it’s important to consult a healthcare professional, such as Dr. Amit Agarwal, for a thorough assessment and personalized treatment plan tailored to the specific condition and individual patient needs.
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