SCI Nurse, pressure sore advice please!

JenJen · 07-06-2007, 06:01 PM

Last Friday during my latest anti-gravity experiment, I flew outta my chair and ended up in the ER where I was pumped full of morphine and left to sleep it off flat on a backboard for 7 hours before I came to my senses and asked for help turning over. My IV had also run dry and backed up pretty good with blood and they d/ced me with a 102 fever, but i digress...

It left me with 2 sores on my sacrum that merged into 1. A home health nurse finally visited yesterday and placed a duoderm. The sore is a stage 2 measuring 3cmX2cmx.04cm with a lot of slough per the nurse. She hopes to have orders and approval early next week for a debriding agent but says it will take weeks to debride before it can begin to heal.

I have been down in bed for a week now, staying well hydrated and getting lots of protein through drink supplements.

Can I get up in my chair at all? I sit on a ROHO Quattro. If I can get up, for how long? my puppy needs to be fed and pottied through out the day and I dn't have support to count on. Plus I need to eat too.

What sort of treatment plan should I ask for?

lynnifer · 07-06-2007, 07:08 PM

What ever happened to that leg of yours? Did it heal?

SCI-Nurse · 07-06-2007, 07:47 PM

JenJen, I am so sorry. You need to follow up with that hospital as it is unacceptable to leave someone with a SCI on a backboard without turning or padding for that long, esp. if sedated. I believe they bear some responsibility for your breakdown. You may even have a legal case. At the very least, send a letter to the director of nurses, the hospital director, and their risk management department spelling out just what was done (and not done) for you, and the consequences this has caused for you personally.

I am afraid you do need to stay off of it. While sometimes you can bridge a sacral pressure ulcer for sitting, in my experience it is usually not a good idea. You would need some type of custom seating the be able to get away with this. Can a friend or family member help out with your dog? Sometimes there are volunteer groups (animal rescue, etc.) who will help with this when someone is ill.

Ask your physician about meals on wheels or other local program for meals if possible. Do you have a church group or any other community groups which could help you?

As far as treatment, you need to be on a low air loss mattress if you are not on one already, and stay side to side as much as possible (avoid being on your back, esp. with the head of the bed elevated). Debridement is needed. Otherwise the wound should be kept covered, and moist. You need to up your protein intake, and get on a good multivitamin with minerals if possible. Take zinc supplement too (although there is not good evidence for this, it will not hurt when you have a draining wound). You need to see a good wound care specialist as soon as you can. I am sure the homecare nurse is OK, but you may need more sophisticated treatments, such as VAC or Oasis, etc. and you really need a physician to help you evaluate these needs.

(KLD)

Antonio · 07-07-2007, 03:32 AM

Quote:

Originally Posted by SCI-Nurse

... I am afraid you do need to stay off of it. While sometimes you can bridge a sacral pressure ulcer for sitting, in my experience it is usually not a good idea...
(KLD)

KLD, why do you think is not advisable to sit in wheelchair with a sacral sore? I imagine you don't load sacrum when sitting, unless you are in an extreme posterior pelvic tilt or you are on a reclined/tilted back wheelchair. Is it the dependent that hastens healing?

Thanks!

Antonio

SCI-Nurse · 07-07-2007, 12:07 PM

Many people sit with a significant pelvic tilt that does put seat pressure on the sacrum, and the backrest applies pressure even when not in tilt or recline. Being dependent (which can cause sacral edema) and stretching the area (and possibly bumping it during transfers) can also be factors.

(KLD)

rybread · 07-08-2007, 04:04 AM

It's interesting that you say that. I've had 2 doctors tell me there's no pressure on my sacrum when I'm sitting up in my chair, even with some dump in it. I've recently gained a lot of feeling back in that area and I can definitely feel the pressure when I have my head up in bed to eat, but when I'm up in my chair I don't feel any pressure there.

07-06-2007, 06:01 PM	#1
JenJen Moderator Join Date: Dec 2006 Location: Arizona Posts: 2,401	SCI Nurse, pressure sore advice please! Last Friday during my latest anti-gravity experiment, I flew outta my chair and ended up in the ER where I was pumped full of morphine and left to sleep it off flat on a backboard for 7 hours before I came to my senses and asked for help turning over. My IV had also run dry and backed up pretty good with blood and they d/ced me with a 102 fever, but i digress... It left me with 2 sores on my sacrum that merged into 1. A home health nurse finally visited yesterday and placed a duoderm. The sore is a stage 2 measuring 3cmX2cmx.04cm with a lot of slough per the nurse. She hopes to have orders and approval early next week for a debriding agent but says it will take weeks to debride before it can begin to heal. I have been down in bed for a week now, staying well hydrated and getting lots of protein through drink supplements. Can I get up in my chair at all? I sit on a ROHO Quattro. If I can get up, for how long? my puppy needs to be fed and pottied through out the day and I dn't have support to count on. Plus I need to eat too. What sort of treatment plan should I ask for? __________________ My blog: Living Life at Butt Level Ignite Phoenix #9 - Wheelchairs and Wisdom: Living Life at Butt Level "I will not die an unlived life. I will not live in fear of falling or catching fire. I choose to inhabit my days, to allow my living to open me, to make me less afraid, more accessible, to loosen my heart until it becomes a wing, a torch, a promise. I choose to risk my significance; to live so that which comes to me as seed goes to the next as blossom and that which comes to me as blossom, goes on as fruit." *Dawna Markova Author of Open Mind.*

07-06-2007, 07:08 PM	#2
lynnifer Senior Member Join Date: Aug 2002 Location: Windsor ON Canada Posts: 15,307	What ever happened to that leg of yours? Did it heal? __________________ I think over again my small adventures, My fears, Those small ones that seemed so big, For all the vital things I had to get and to reach; And yet there is only one great thing, The only thing, To live to see the great day that dawns And the light that fills the world. Anonymous (Inuit, 19th century) T-11 Flaccid Paraplegic due to TM July 1985 @ age 12

07-08-2007, 04:04 AM	#6
rybread Senior Member Join Date: Jul 2001 Location: Phoenix, Arizona Posts: 2,409	It's interesting that you say that. I've had 2 doctors tell me there's no pressure on my sacrum when I'm sitting up in my chair, even with some dump in it. I've recently gained a lot of feeling back in that area and I can definitely feel the pressure when I have my head up in bed to eat, but when I'm up in my chair I don't feel any pressure there. __________________ C-5/6, 7-9-2000 Scottsdale, AZ Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

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07-06-2007, 07:47 PM	#3
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,333	JenJen, I am so sorry. You need to follow up with that hospital as it is unacceptable to leave someone with a SCI on a backboard without turning or padding for that long, esp. if sedated. I believe they bear some responsibility for your breakdown. You may even have a legal case. At the very least, send a letter to the director of nurses, the hospital director, and their risk management department spelling out just what was done (and not done) for you, and the consequences this has caused for you personally. I am afraid you do need to stay off of it. While sometimes you can bridge a sacral pressure ulcer for sitting, in my experience it is usually not a good idea. You would need some type of custom seating the be able to get away with this. Can a friend or family member help out with your dog? Sometimes there are volunteer groups (animal rescue, etc.) who will help with this when someone is ill. Ask your physician about meals on wheels or other local program for meals if possible. Do you have a church group or any other community groups which could help you? As far as treatment, you need to be on a low air loss mattress if you are not on one already, and stay side to side as much as possible (avoid being on your back, esp. with the head of the bed elevated). Debridement is needed. Otherwise the wound should be kept covered, and moist. You need to up your protein intake, and get on a good multivitamin with minerals if possible. Take zinc supplement too (although there is not good evidence for this, it will not hurt when you have a draining wound). You need to see a good wound care specialist as soon as you can. I am sure the homecare nurse is OK, but you may need more sophisticated treatments, such as VAC or Oasis, etc. and you really need a physician to help you evaluate these needs. (KLD)

07-07-2007, 12:07 PM	#5
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 41,333	Many people sit with a significant pelvic tilt that does put seat pressure on the sacrum, and the backrest applies pressure even when not in tilt or recline. Being dependent (which can cause sacral edema) and stretching the area (and possibly bumping it during transfers) can also be factors. (KLD)