Bed sores, also known as pressure sores, are chronic open sores that develop in patients so ill that they can’t roll over in bed. They’re a common problem now in hospitals with advanced, dedicated, professional care. They’ll be at least as common in an austere situation, and with limited medical resources available, it will be family members providing this care to their loved ones and doing their best to prevent bed sores from developing in their ill relatives.
Bed sores are most common in sick elderly individuals who are also very thin and weak. They develop above the bony parts of the body where the skin presses against the bedding, i.e., the hips, buttocks, base of the spine, heels, and shoulder blades. Pressure sores also occur in those who use wheelchairs and para- and quadriplegics. Even children with severe chronic illnesses are at risk.
These sores develop when pressure on the tissues increases to the point that circulation to the region is impaired. The resulting lack of oxygenation causes tissues in the region to die.
Bed sores are categorized by severity from stage 1 to stage 4.
Stage 1. A pressure ulcer is just starting to develop. It is characterized by a reddened area on the skin that does not turn white when pressed.[1]
Stage 2. The skin blisters or forms an open sore. The skin around the sore may be red and irritated.[2]
Stage 3. A crater forms, indicating tissue damage below the skin surface.[3]
Stage 4. The pressure sore has deeply damaged underlying tissues, including muscle, bone, tendons, and joints.[4]
As soon as a bed sore has been identified, treatment must begin immediately to prevent any further damage. (See below.)
Preventive measures
Turn the patient every 1-2 hours—face up, face down, side to side.[5] [6]
Bathe the patient daily and apply oil to the skin.[7]
Change the bed sheets and padding at least daily and any time the bedding gets soiled.[8] Incontinent patients will need extra attention to limit moisture.[9]
Use items to reduce the pressure—pillows, foam padding, air mattresses (though never permit the patient’s skin to directly contact a vinyl mattress).[10] Position cushions and pillows to reduce the rubbing of bony parts against the bed. [11]
Exercise daily, including range of motion exercises for immobile individuals.[12]
Feed the patient as well as possible. Supplement with vitamins and iron if available.[13]
Children with severe chronic illness and bed sores should be held often by caregivers.[14]
Treatment
Do all of the above. [15]
Wash the sores with cool, boiled water and mild soap. Very gently remove any dead flesh. Rinse well with cool, boiled water. Do this three times each day. [16]
Fill the cleaned sore with honey, sugar, or sugardyne. [17]
Moisture barrier ointments will benefit stage 1 and 2 sores only. Dust the surface of the sore with talcum powder, baby powder, or cornstarch before applying the cream or ointment. This will help dry the skin and permit the ointment to be cleaned off easier. Vegetable shortening or lard may be used if medical creams are not available. Petroleum jelly should not be used. This ointment/cream should be applied 2-4 times per day.[18]
[1] Survival and Austere Medicine, 3rd Edition, 2017, 433.
[2] Survival and Austere Medicine, 3rd Edition, 2017, 433.
[3] Survival and Austere Medicine, 3rd Edition, 2017, 433.
[4] Survival and Austere Medicine, 3rd Edition, 2017, 433.
[5] David Werner, Where There Is No Doctor, 1992, 214.
[6] Survival and Austere Medicine, 3rd Edition, 2017, 433.
[7] David Werner, Where There Is No Doctor, 1992, 214.
[8] David Werner, Where There Is No Doctor, 1992, 214.
[9] Survival and Austere Medicine, 3rd Edition, 2017, 433.
[10] Survival and Austere Medicine, 3rd Edition, 2017, 433.
[11] David Werner, Where There Is No Doctor, 1992, 214.
[12] Survival and Austere Medicine, 3rd Edition, 2017, 433.
[13] David Werner, Where There Is No Doctor, 1992, 214.
[14] David Werner, Where There Is No Doctor, 1992, 214.
[15] David Werner, Where There Is No Doctor, 1992, 214.
[16] David Werner, Where There Is No Doctor, 1992, 214.
[17] David Werner, Where There Is No Doctor, 1992, 214.
[18] Survival and Austere Medicine, 3rd Edition, 2017, 433.
19 october 2021
The stages of injury don’t occur in order. You can go from stage I to stage IV with no shallow open area in between.
ReplyDeletePLEASE think twice about adding powder under ointment! It gets gunky! Look for diaper cream, such as destin, for drying out/protecting skin, especially with mixed episodes of continence. If someone has dry fragile skin, think twice about soap for some areas.
Check your loved ones skin!!!! People that walk get pressure injuries! Check under glasses, the sides of the head, behind the ears, and anywhere that equipment rests! Slings, braces, and compression socks can do it. Don’t wait until a disaster scenario to do so! Check for infections, rashes, etc.
Pay the same attention when family members are hospitalized. Staff are busy, and competent people refuse repositioning because it’s uncomfortable. Pay attention and try to help.