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Thread: HELP PLEASE - Suspected Stage I Pressure Ulcer

  1. #1

    HELP PLEASE - Suspected Stage I Pressure Ulcer

    My son, 18 yrs. old, t-12, 3 months post.

    Yesterday morning, I noticed a red area on his bottom where the bone is prominent about the size of a quarter. Checked it again 2 hours later, still there. After reviewing the stages of ulcers on this sie, I suspect it's the onset of a pressure ulcer,. I put him in bed where he stayed all afternoon and evening. This morning, it's still there, not worse, but not better either. Now there's one one the other butt cheek.

    Is there anything else we should be doing? How long should he stay off it?

  2. #2
    It sure sounds like a pressure sore. Do whatever you can so there is absolutely no pressure on the affected areas until the skin has healed. This may take a week, maybe more, depending on how severe the damage is. That it doesn't look worse today is a good sign, you caught it early.
    You should review his chair cushion setup with his physiatrist; something isn't right there.
    Download and read "Pressure Ulcer Prevention and Treatment" from the PVA; their publication catalog page is here. They have other very useful publications there; the one on bowel management helped us a lot.
    - Richard

  3. #3
    Keep him OFF the areas. Increase water, protein and vitamins.

    He should be doing weight shifts while up in his chair every 15-30 minutes, even if he has a cushion. You should have pressure mapping on his cushion when he is sitting-once these areas are no longer red. Once no longer red, he needs to get this checked but start sitting for minimal amount of time and slowly build up time i.e. start with 30 minutes, check for any redness, then increase by 15 minutes. After each time check for redness.

    CWO

  4. #4
    Senior Member goat's Avatar
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    I have experienced great relief from pressure sores & sitting discomfort by using an alternating pressure cushion *under* my Stimulite Classic. (about $150 from http://www.flowcushion.com/flow/)
    I have NO financial interest in this company.

    OK... For all those Purists:
    This is NOT a Medical Device. It probably has not been studied on people with paralysis. It may not have been shown to be any more effective in prevention of pressure sores in those with paralysis than placebos. Send flames to /dev/null

    A reasonably handy person can tap into the electrical system of most power chairs to install a 12 volt cigarette lighter.
    "Let your food be your medicine" - Hippocrates

  5. #5

    Thank you, but still confused!

    Thank you so much! He's not had a pressure mapping and I'm not sure what type cushion he has except it cost $700, still in the rental chair though. He sat up playing an online game and Friday, he was in his chair playing for over 12 hours. We tell him when it's time for a lift, but get the "hold on" response and unless we stand over him, we don't know for sure he's doing his lifts. (We were instructed to do lifts every hour for one minute)

    Now, it's one quarter size red area on each butt cheek with what looks like mosquito bites in the middle (2-3 each). Actually it's more like fire ant bites in the middle ( for those of you not from the south, they look like mosquito bites with a pimple in the center).

    He's been in bed since I noticed early yesterday afternoon. The size nor the redness has grown, but...it doesn't look pretty. Each are on the butt cheek where the bone is prominent.......
    His Home PT lapsed this week because of change in insurance, but has since been resolved. Will this be something to further delay PT? Also, this is so frustrating because we were hoping to be released for Phase II therapy this week. Will this be a set back?

  6. #6
    Keep him off the areas and hopefully it will heal soon.PT will figure something out.
    cWO

  7. #7
    OK, had to get a new home health company since change in insurance. The nurse came out today for paperwork and initial exam. I had her look at this bottom and she confirmed the very early onset of pressure sores on both butt cheeks. HOWEVER, she was not sure what the pimple like things are in the middle. He also has a pimple on his front inner thigh... Any idea what these things are?

  8. #8
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    Quote Originally Posted by akeleshian View Post
    We tell him when it's time for a lift, but get the "hold on" response and unless we stand over him, we don't know for sure he's doing his lifts. (We were instructed to do lifts every hour for one minute)
    Well, hopefully, the good thing that will come out of this, is the time stuck on bedrest healing this, will teach him the need to do the pressure reliefs. Because you can't follow him around forever! (Some people find a timer, or setting a digital watch to beep is handy, especially if they are they type to really get caught up in something)

    While he is in bed .... be careful there is no pressure on the areas. Just getting in bed isn;t enough. He probably needs to be on his side or stomach as well.

    Good luck with this!
    T7-8 since Feb 2005

  9. #9
    Senior Member Mona~on~wheels's Avatar
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    Pressure sores often resemble pimples.
    They open from the inside out.
    I don't want to be doom but look for those pimples to open up.
    No pressure on them at all. Stay on his sides. Flipping back & forth.
    What treatment for them did she order?
    Do not put peroxide or betadine on them.
    They will eat healthy tissue and make things worse.
    She should have had an idea what the pimples were.
    Does she have any sci experience?
    Saying prayers here. Keep us updated.

  10. #10
    Thanks Mona. I wondered about that. She actually told us to clean the area with alcohol and when I asked about the alcohol drying out the area that is starting to break down, she said to use peroxide which I still questioned. She recommneded putting a lotion on (one that we got in the hospital) for dry skin.

    This still doesn't explain the pimple on his thigh (in the frront) where there is no pressure at all.. She's a home health nurse, not experienced in SCI. His pediatrician has been great but my son is his first SCI.

    I've had him on side since they first appeared Saturday afternoon. We quickly found out that we had to be diligent about rolling him while in the hospital it's just frustrating that he sat at his computer so long Friday night while we were sleep and this is now something else to deal with.

    What happens if/when those pimples open up? And how long can we expect him to remain in bed before they go away? He has an appointment with the surgeon Thursday, will the visit and ride back & forth (probably 4 hours) be a concern?

    Sjean - You are right and we've since had long discussions about "his" responsibilities, I've shown him pictures of what these could lead to e.g., stage 3, 4 and although they were graphic, he needs to understand the severity and the consequences for not lifting.

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