Pressure sore with non-blanching erythema and superficial erosions - USMLE Forums
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Old 12-07-2011
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Skin Pressure sore with non-blanching erythema and superficial erosions

While you are making rounds at a local nursing home, one of the nurses asks you to evaluate a patient about whom she is concerned. The patient is an elderly wheelchair-bound woman. On her right buttock is an area of nonblanching erythema that involves the dermis. Some small superficial erosions of the skin appear to be forming, but subcutaneous and deeper structures do not appear to be involved and the skin is for the most part intact, if markedly erythematous. Concerned about a developing pressure ulcer, you advise increased mobility as well as techniques and devices to relieve pressure. Which of the following is an appropriate additional therapy for this wound?

A. Dry gauze dressings, changed regularly
B. Empiric antibiotics, applied topically to the wound
C. Surgical consultation for debridement and “vac-pack”
D. Wet dressings, changed when still moist
E. Wet to dry dressings, changed regularly
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Old 12-07-2011
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the ans is D.....
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Old 12-07-2011
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D. Wet dressings, changed when still moist
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Old 12-08-2011
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E. Wet to dry dressings, changed regularly
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Old 12-08-2011
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D. Wet dressings, changed when still moist
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Old 12-08-2011
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The correct answer is D. Immobile patients, particularly the elderly, are at risk for pressure ulcer formation. Stages I and II pressure ulcers, which do not involve subcutaneous tissue, are best treated with relief of pressure, good nutrition and hygiene, and wound care. In general, the wound should be kept clean and moist with wet saline dressings, which should be changed when still moist. Wet to dry dressings (choice E), which are often used for wounds requiring microdebridement, are not as useful as keeping the pressure site moist. Likewise, dry gauze (choice A) will further dry and macerate the area and may delay healing.
Empiric topical antibiotics (choice B) should be started if the wound has not healed in 2 weeks or if the site appears grossly infected (pus). However, routine use of empiric antibiotics is not necessary, and has not been proven to improve outcomes.
Surgical debridement (choice C) and wound management may be necessary for stage III and IV pressure ulcers, which involve subcutaneous tissue and bone. Stage I and II pressure sores, by definition, do not have a large amount of necrotic tissue that would benefit from debridement.
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The above post was thanked by:
Adamentium (12-11-2011), jahn77 (12-11-2011), yarasara77 (07-22-2012)



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