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Complications From Bed Sores
Bedsores are a common problem for those who have limited mobility. The elderly and the infirmed are at a higher risk of developing bedsores and those with diabetes or poor circulation. If you're worried that your loved one might be at risk, the personal injury attorneys at Nursing Home Law Center, LLC can help!
Call our bedsore injury lawyers at (800) 926-7565 (toll-free phone number) or use the contact form today to schedule a free consultation. All confidential or sensitive information you share with our legal team remains private through an attorney-client relationship.What are Bedsores?
Bedsores (also called pressure ulcers and decubitus ulcers) are injuries to the skin and underlying tissue usually caused by prolonged pressure on the skin.
The pressure wounds often develop over bony areas of your body because those areas do not have much fat or muscle to absorb pressure from being placed against a surface for a long time.
The tissue damage from bedsores can go deep into your body and lead to serious complications, such as septic infections (infections that begin in the bloodstream and spread to other parts of your body).
Areas of your body that commonly put pressure on the skin and cause injury include your:
- Back, buttocks, or hip bones
- Shoulder blades
- Elbows, ankles, or heels
- Back to the head
If your skin is injured, any pressure on the injury can cause it to become worse. For example, areas covered by fat are less likely to develop bedsores since there is little support underneath the skin. However, these areas are also at risk because they have more nerves.Complications from Bed Sores
Any complication associated with developing pressure ulcers can create a prolonged hospital stay, lasting intense pain, and a diminished quality of life. Pressure sores usually occur on bony prominences, where blood flow circulation has been restricted for an extended period of two hours or more.
Without proper treatment, the localized affected area often has significant skin damage where the necrotic tissue creates an open wound. In addition, the elderly, critically ill individuals, diabetics, and those suffering from mobility issues are most likely to develop pressure ulcers with complications.
At an advanced stage, pressure ulcers can be exacerbated by friction, shear, and pressure. Without proper treatment, the patient can easily suffer:
- Severe cellulitis (deep tissue infection),
- Osteomyelitis (bone infection),
- Gangrene, sepsis (blood infection), and
- Necrotizing fasciitis (flesh-eating bacteria).
The infection caused by bedsore can easily spread to the deep layers of skin causing cellulitis. In addition to redness and extreme pain, significant swelling can occur on the patient's skin.
Without an effective course of antibiotics, the patient can suffer serious life-threatening infections that can easily spread to the joints, bones, and bloodstream.
If the cellulitis occurs on the sacrum or lower back, the infection can easily penetrate the spinal column and eventually the brain.Osteomyelitis
Infection to the bone (osteomyelitis) and joints (septic arthritis) can cause significant damage to the patient's bone, tissue, and cartilage. The only effective treatments are heavy doses of specific antibiotics or surgical removal of joint and bone tissue.Gangrene
Gangrene is a serious but rare life-threatening infection produced by the gas emitted from clostridium bacteria. This type of bacteria flourishes in damaged body areas with minimal or no oxygen at all. The bacteria produce harmful gases releasing dangerous toxins into surrounding tissue.
Usually, the victim suffers significant pain where the skin swells at a rapid pace. Without surgical debridement, where the dead and infected skin is removed, the patient will need to amputate every affected limb to prevent gangrene from spreading throughout the body.Sepsis
Sepsis is a common complication in patients suffering from pressure sores. This serious blood infection can rapidly progress throughout the body, causing organ failure and death.
Without proper management, the patient can suffer septic shock, with a 50-50 chance of survival. Common symptoms involve fever, lethargy, agitation, anxiousness, diminished awareness, and loss of appetite.Necrotizing Fasciitis
Group A Streptococci bacteria infecting a decubitus ulcer could result in necrotizing fasciitis. For most older men and women, necrotizing fasciitis is a life-threatening condition causing the rapid death of affected tissue.
Often referred to as "flesh-eating" bacteria, necrotizing fasciitis requires immediate medical treatment. A surgeon will likely recommend surgical debridement (removal of dead tissue) and specific antibiotics.
According to the National Pressure Ulcer Advisory Panel, cancer squamous cell carcinoma is a serious complication of non-healing, chronic wounds like an advanced stage pressure sore. Typically, the cancer is extremely aggressive, where effective treatment requires surgery.Specialized Treatment Necessary to Prevent the Progression of Wound Severity and Ultimately Death
The mortality rate is high for patients suffering serious complications associated with a pressure sore. Unfortunately, evaluating osteomyelitis and other serious conditions related to pressure ulcers is often inaccurate, even by trained medical staff at the nursing home, assisted living facility, or hospital.
When misdiagnosed, the patient can suffer additional serious complications or death. Because of that, it is essential to hire skilled medical professionals who specialize in treating pressure sores.
Without it, the patient can experience increased pain, reduced quality of life, or death.The Risk Factors Associated with Pressure Sore
Pressure sores are also known as bedsores, so named because they are most commonly found in the elderly population who have difficulty moving around for extended periods.
People with diabetes may also be at risk of developing pressure sores because there is less circulation in the tissues of their feet. These sores are caused by prolonged pressure over soft tissue. The risk factors associated with pressure sores include:
- Certain medications, including nonsteroidal anti-inflammatory drugs, anticoagulants, and dipyridamole
- Casts and braces
- Being over-weight
- Shoes without a good fit
- Failure to relieve constant pressure when lying or sitting
- Inadequate mobility
- Failing to use pressure-relieving cushions, mattresses, and other medical devices
- Poor nutrition
- Skin infections or dermatitis
These risk factors can be reduced through proper self-care, including exercising to keep the blood flowing and eating a nutrient-rich diet. Good nutrition helps the body stay healthy, whereas obesity or diabetes increases susceptibility to pressure sores.
Also, having shoes that fit properly is important because tight shoes could cut off circulation. Furthermore, it is imperative to keep one's skin clean and dry to prevent infections from developing.
In addition, at home, have a person reposition in bed about every two hours during the day and turn at least once per hour while sleeping. Also, get up at least once an hour during the night to avoid prolonged pressure on the buttocks or heels.
The best way you can prevent pressure sores is by wearing shoes that fit, keeping the skin clean and dry, exercising to keep blood flowing in the legs, eating a nutrient-rich diet, and repositioning oneself in bed every two hours. If these strategies are insufficient to alleviate the problem, it may be time to seek medical advice.Categorizing Pressure Sore Stages
Medical Science categorizes pressure sores in at least six stages that include:
- Stage I pressure ulcers: Redness / Intact Skin / No Fluid Collection
- Stage II pressure ulcers: Redness / Broken Skin / No Fluid Collection
- Stage III pressure ulcers: Redness/ Ulcer or Epithelial Defects covered by a thin, easily detached epithelial layer with no fluid collection
- Stage IV pressure ulcer: Slough / Ulceration / Fluid Collection
- Stage V pressure ulcer: Slough / Ulceration with exposed Bone, Muscle, and tendon, and ligaments covered by a thin epithelial layer of granulation tissue; no fluid collection
- Unstageable pressure ulcer: Typically, a pressure sore is unstageable from the build-up of debris, necrotic skin, and other particles blocking the diagnostician's view of how deep and widespread the open wound has become
- Deep Tissue Injury: occurs when a person's bone, muscle, or other tissue is damaged to the extent that it cannot heal properly
For medical science to accurately locate and classify pressure sores from one stage to another, healthcare providers must perform the following four steps:
- Assess signs and symptoms
- Assess the risk associated with patient positioning and support surfaces
- Evaluate skin condition to avoid complications of pressure wounds on all parts of the body
- Evaluate management of wound care daily and identify any signs of infection to skin, muscle, and bone
According to Medline Plus, a pressure sore is classified as being stage IV once the patient has suffered an underlying disease or injury and the pressure sore has not begun to heal.
A stage IV pressure score demonstrates a break in the skin, which penetrates down to the subcutaneous tissue (the layer of fatty tissue between the dermis and underlying muscle).
While different physicians may use varying terminology when defining this level of wound severity, the consensus is that a stage IV pressure sore has an open bedsore with deep tissue exposure.Who Should be Concerned about Stage IV Pressure Sores?
According to the National Council on Aging, those at risk for developing a stage IV pressure sore include:
- Those who have paralysis of the lower limbs
- Individuals with diabetes
- People who are very overweight and confined to a bed or wheelchair for an extended period
- Those with high levels of moisture (sweat, urine) on the skin for prolonged periods
- People with compromised immune systems due to chemotherapy, organ transplantation, radiation therapy, etc.
According to the CDC (Centers for Disease Control and Prevention), a stage IV pressure sore reveals a significant breakdown of the skin and underlying tissue, usually over a bony prominence due to pressure. In addition, a stage IV pressure wound exposes muscle, tissue, ligaments, tendons, and bone in its most advanced age.
Without immediate medical intervention, a stage IV pressure wound could claim the patient's life within hours or days if sepsis (blood poisoning) or osteomyelitis (bone infection) begins.
The chances of not surviving a stage IV pressure sore depend on the severity of the pressure wound and the patient's general health. Those bedridden and unable to take care of themselves are more likely to succumb to the pressure sore.
According to the US News, a study of 11 stage IV pressure sores revealed that nearly half of those afflicted died within 30 days due to sepsis. Additional studies report the following mortality rates for those with stage IV pressure sores:
- About 50% will die within two months without treatment
- Nearly 70% will die within three months without treatment
- Only 20% of those with stage IV pressure sores went on to survive, even after receiving medical intervention
According to the Centers for Medicare and Medicaid Services (CMS), nearly every type of advanced stage bedsore is preventable. The federal regulatory agency identifies bedsores as "never events" and restricts reimbursement payments to nursing homes and hospitals that allow advancing pressure ulcers to progress, placing the patient's health at risk.
When a patient acquires a pressure sore while staying at the facility, it is often an early warning sign of neglect. Without immediate legal intervention, the patient could die.
Because of that, many families will hire skilled attorneys to stop the neglect and hold those responsible accountable for their actions.How Doctors Diagnose Pressure Sores Using the Braden Scale
Many doctors, diagnosticians, and wound care specialists will categorize bed wounds using the Braden scale and other diagnostic tools. The Braden scale evaluates a patient's risk for pressure sores and other skin conditions, as well as the risks to those with compromised immune systems.
While many see the Braden Scale as a basic assessment tool, medical professionals often use it in every state. For example, the clinical health care administrator uses a six-point scale to determine a patient's risk for pressure ulcers.
There are six categories to the scale, which includes:
- Category 1: No risk of developing pressure sores
- Category 2: Minimal risk of developing pressure sores
- Category 3: Moderate risk of developing a stage IV pressure sore, but not likely without providing interventions
- Category 4: High risk of developing a stage IV pressure wound, but not likely without providing interventions
- Category 5: High risk of developing a stage IV pressure sore, and it is likely to develop with or without intervention
- Category 6: Imminent danger of developing a stage IV pressure ulcer and will likely result in the patient's death without immediate and effective medical treatment
The scale provides a valuable assessment of a patient's risk for developing pressure sores. Physicians often use the scale to assess patients with certain medical conditions such as:
- Infection including sepsis and osteomyelitis
A pressure ulcer is a type of wound caused by insufficient blood flow to the patient's skin. In some cases, a pressure ulcer can be treated without surgery.
Suppose the pressure sore has been categorized as a stage I through Stage III wound. In that case, a wound care specialist can treat the pressure ulcer by cleaning it, removing excess fluid or debris, applying pressure, and protecting it with a bandage.
However, a decubitus ulcer must be treated through surgical debridement after progressing to the most advanced age. During this procedure, the surgeon removes necrotic tissue using surgical tools to allow the wound to heal completely.Body Repositioning and Pressure-Relieving Devices
The patient's healthcare team will do everything to prevent pressure ulcers (bedsores) from developing on patients by turning the person every two hours or more frequently, depending on their condition.
Should an individual be unable to move independently due to illness or injury, the nursing home staff must ensure that they are turned regularly. The routine includes readjusting the body at least once every two hours around the clock when lying down and every fifteen minutes when sitting.
They may also use special devices like inflatable mattresses and beds with alternating air currents, which help keep patients cool and make them less likely to develop a pressure ulcer after surgery. Pressure relief devices are usually used for people who cannot be turned because of paralysis, restricted mobility, or obesity.
When a patient is housed at a nursing home, they will have access to pressure-relieving devices such as pillows, water beds, and air mattresses.
After being diagnosed with a severe pressure ulcer in the hospital, patients may be sent home with the necessary equipment to self-treat their ulceration. If a person does not have access to specialty medical supplies at home, they can speak to their health care provider about providing them with this equipment.
In rare cases, when a patient's condition worsens and becomes life-threatening, they may need surgery immediately instead of waiting for the wound to heal on its own before undergoing an operation. While no one likes surgery, these ulcers can progress to a life-threatening level if they are not treated immediately.
A doctor may need to cut away dead tissue when the wound is so severe that healing cannot begin without surgery. This procedure may be done with an electrosurgical knife, which cauterizes and kills diseased tissue and speeds up the healing process (see picture below).
After cutting away the dead tissue, a doctor will clean and debride (or remove) any remaining infected or damaged skin folds around the lesion before closing it back up with stitches. The doctor might also use antibiotic ointment or powder on top of the closed wound.Pressure Ulcers: Nursing Home Abuse & Neglect
Individuals, including the elderly, disabled, and mobility impaired, are most vulnerable to developing bed wounds. In addition, if the individual is receiving care from the nursing staff, hospital professionals, or at-home technicians, they could quickly develop pressure ulcers through negligence or abuse.
Deprivation of food and water, lack of turning or repositioning, poor hygiene care, and cuts or scratches from bed rails can all lead to pressure ulcers. In addition, should the patient receive medical treatment from a doctor at a hospital, they could develop a pressure ulcer if their doctor does not order them to be turned regularly or fails to remove surgical staples at the right time.
In many cases, patients take preventative measures such as constantly adjusting themselves in the bed to avoid getting pressure sores during their hospital stay. However, doctors may neglect to take necessary precautions when removing surgical staples after an operation which causes the patient's skin to turn gray or black.
This condition results from "hemorrhagic deconvoluting of the skin and subcutaneous tissue, after a chemical reaction between hemoglobin and silver in the staples. As a result, the patient's tissues turn black as they die."
The individual turns black as their tissues die after being exposed to the chemicals from the surgical staples.Pressure Ulcers: Nursing Home Abuse & Neglect: Legal Cases
One family dealing with the consequences of having an elderly family member subjected to neglect at a nursing home has recently filed suit against those responsible for failing to provide proper care. Their loved one died due to advanced stages of bedsores.
However, this case is just one example of many cases where elderly individuals are mistreated and abused due to neglect. Other cases involve:
- In one civil lawsuit, the document revealed that the plaintiff (nursing home resident) developed life-threatening bedsores when staff at a nursing facility did not provide adequate care. In addition, the elderly resident had been diagnosed with sepsis as a result of the neglect.
- A separate case involved a patient who developed bedsores while in a nursing home, causing serious infection and necessitating surgery to treat the wounds. In that particular case, those named as defendants may be held financially liable for negligent infliction of emotional distress.
- One nursing home abuse case involved neglect when an older man suffered from malnutrition and numerous bedsores. Although he was incontinent, staff would only come every four hours to change his diaper or help him to use the restroom when necessary.
- In this case, the staff failed to address his inability to eat independently or live without assistance despite regular pleas from the patient's family members. As a result, a jury found that neglect had been a substantial factor in his death and awarded $5 million to the man's estate.
The final category that is used when reviewing nursing home neglect cases is through what is known as common law compensatory schemes, referring that individuals will be able to file suit to collect economic and non-economic damages.
The types of non-economic losses that may be collected include pain and suffering, emotional distress, loss of consortium (which is the loss of support, service, relationship, or society), diminished quality of life, and punitive damages.Who is Financially Responsible for the Damage When Negligence & Abuse is Involved?
It is important to understand how these types of cases are handled in nursing home abuse or neglect. For example, when negligence leads to injuries or death in nursing homes, three categories may be used to determine who is financially responsible for damages.
The medical malpractice liability insurance system will typically only cover payouts up to $250,000 even if an individual's loved one has suffered much greater harm than that amount. As a result, some individuals choose not to rely on the resources within the medical malpractice liability insurance system when they need financial support for their losses related to a medical injury.Hiring Nursing Home Abuse Attorneys to Resolve Compensation Claims
Is your loved one the victim of nursing home neglect or abuse and developed preventable facility-acquired bedsores? Are you ready to hold those responsible for causing the damage legally and financially accountable?
At Nursing Home Law Center, LLC, our abuse injury attorneys understand it is always imperative to take immediate action to stop progressing bedsores to save the life of a loved one. Call our legal team today at (800) 920-600-7565 (toll-free phone number) for a free case evaluation.
Our law offices accept all personal injury cases and wrongful death lawsuits through contingency fee agreements. This promise ensures you pay nothing until your case is resolved through a negotiated settlement or jury award.Resources: