Decubituses

Description:

Decubituses are the sites of ischemia (desalination) and necrosis (necrosis) of fabrics resulting from a long prelum, shift or shift them between a skeleton of the person and a surface of a bed.

Risk factors of developing of decubituses:

    * reduced food and lack of drink;
    * excess weight and exhaustion;
    * smoking;
    * cardiovascular diseases;
    * diabetes mellitus;
    * incontience of urine and calla;
    * injuries and diseases back and brain;
    * sweating at the increased temperature;
    * dirty skin;
    * crumbs and small objects in a bed;
    * folds, seams, buttons on linen;
    * allergic reaction to care products for skin.

Symptoms of Decubituses:

All places over bone ledges on a body which are squeezed when lying or sitting can be potential places of formation of decubituses. The hypodermic fatty tissue is in these parts most weakly expressed, pressure of bone ledges is expressed most strongly. If the patient lies on spin - these places are the sacrum, heels, sciatic hillocks, elbows, shovels, a nape. If on one side - on a hip sideways (area of a big spit), on each side anklebones and knees. If the patient lies on a stomach - area of a pubis and a cheekbone.
Types of decubituses:
Degree of I: the integument is not broken. The steady hyperemia which is not passing after the termination of pressure.

Degree of II: superficial (superficial) disturbance of integrity of integuments with distribution on hypodermic cellulose. Resistant hyperemia. Epidermis amotio.

Degree of III: destruction of an integument up to a muscular layer with penetration into a muscle. Decubitus looks as a wound. There can be liquid allocations.

Degree of IV: defeat of all soft tissues. Existence of the cavity baring underlying fabrics (sinews, up to a bone).

At decubituses of the III-IV degree the main method of treatment — surgical.

Reasons of Decubituses:

It is well known that tissues of a human body function, receiving necessary nutrients from blood. Bring blood to all bodies and tissues of a human body blood vessels which in uncountable quantity penetrate all tissues of the person and represent soft elastic tubes. The smallest of them - capillaries - are especially important for a normal metabolism in fabrics. It is simple to slow down the movement of liquid on such tubes or to stop absolutely by their prelum. Any sedentary or lying person has a prelum of soft tissues and a prelum of blood vessels, insufficient inflow of blood to fabrics is a consequence of what. If this state lasts more than 2 hours, then there comes disturbance of food (ischemia), and then and necrosis (necrosis) of soft tissues. Decubitus develops. Therefore it is necessary to remember that long motionless lying or sitting - is unsafe!

The second reason because of which decubituses can be formed is, for example, when the patient is pulled on a bed, extend from under him wet linen, try to podpikhnut under it the vessel. At this time there is a considerable shift of blankets of soft tissues in relation to deeply located layers therefore small blood vessels are torn, and blood supply of these departments is broken. Similarly decubituses can be formed also at weak lying patients who, without having an emphasis in legs, begin to slip slowly on a chair or a bed from a sitting position or semi-sitting that hardly considerably to an eye, but is very notable for soft tissues.

Treatment of Decubituses:

You should not count on the help of ointments, powders and other drugs until you make the struck room from a prelum blood could arrive freely to the place of the formed decubitus.

Speaking about treatment of decubitus, it is necessary to tell, first of all, several words about wounds in general. How the wound appears and develops? In the beginning the damaging force (in case of decubituses this damaging force is presented by a prelum), which causes disturbance of food and then necrosis of fabrics acts on fabric. The damaging force works changeably. If its action to weaken or stop, blood circulation in the place of damage will be recovered. It will lead to rejection of the formed necrosis (decubitus) and a gradual wound repair through granulation and epithelization. Treatment of decubituses, thus, comes down to three principles:

    * as much as possible to recover blood circulation in the place of damage;
    * to promote sloughing (the decubitus);
    * to promote bystreyshy healing of the cleared wound.

For rejection of a necrosis use:

    * mechanical removal of necrotic masses in the surgical way;
    * use of the drugs accelerating independent rejection: Iruxolum ointment. As good house means it is possible to use water dressings with salt solution on cognac (30 g of table salt and 150 ml of cognac). For rejection of a necrosis the bandage needs to be applied under compresseal paper and to change as required. Before imposing of a new bandage it is obligatory to wash out a wound in order to avoid increase in concentration of salt.

Treatment of the cleared wound

It is necessary to create wet conditions of keeping of a wound, using, for example, alginates (in the form of napkins and powder for filling of wounds), the hydrocolloid bandages (Hydrocoll, Duoderm, Hydrosorb, etc.) promoting clarification and closing of a wound. Bandages these rather expensive. For a wound repair it is possible to use the most various healing means: ointments "Levosin", "Levomikol", "Aktovegin", "Solkoseril", sea-buckthorn oil and many others. Quite often decubituses are complicated by accession of consecutive infection, and then use of antiseptic and antibacterial agents, such as boric acid, white streptocide in powder, 3% hydrogen peroxide solution, solution of Furacilin 1:5000, ointments "Levomikol", "Levosin" is necessary. In hard cases, at the weakened and elderly patients use of antibacterial drugs inside is shown.

Big on the areas and difficult healing decubituses sometimes it is possible to cure only in the surgical way - change of fabrics.

At treatment of decubituses it is necessary to apply bandages. Where it is possible, apply bandage to fixing of bandages, in other cases use a plaster. Not any plaster is good for this purpose. Decubituses it is necessary to treat long, and it means, as a plaster it is necessary to apply a long time. What at the same time there can be problems? The plaster interferes with normal functioning of skin (to breath, allocation, etc.). At removal of a plaster the blanket of cells of skin comes off because of what in the place of prolonged use of a plaster there can be additional wounds. To avoid such complications, use a plaster on a paper basis - skin under it well breathes, and glue well fixes a bandage, but does not tear off a cell from the surface of skin during removal of a plaster. Plastering, do not pull it strongly to avoid formation of small skin folds, and also consider the fact that at change of position of the patient soft tissues will be displaced and stretch that can lead to formation of undesirable folds of skin.

Behind skin around decubitus the most careful leaving is necessary. It needs to be washed with soap. It is not necessary to be afraid that soapsuds will get to a wound - it will not worsen a condition of decubitus. During washing it is impossible to rub skin but only to promakivat. After washing it is necessary to achieve or independent dehumidification of skin, or it is possible to use one of the following drugs: 1% the potassium permanganate solution, diamond greens, ointments containing zinc. The last resort is more preferable than others as at its use gauze bandages do not stick to edges of a wound and, respectively, do not injure again formed epithelium and granulations at removal of a bandage.

Applying bandages deep decubituses, wounds need to be tamponed all the way down (to close) a bandage, but not hardly, and рыхло.