A bed sore diagnosis will have multiple ways in which the physician classifies the wound. Bed sores can be wide, deep, and have varying amounts of dead or necrotic tissue within the wound. These factors can determine how well the wound will heal, as well as the odds of infection or other complications. Learning the medical terms a physician may use when describing bed sores can help you or a loved one understand what a recent diagnosis might mean for the future. Eschar is a term one may hear during bed sore wound documentation.
Eschar refers to the dead tissue component of a bed sore or other wound, such as a burn injury. It appears as a patch of dead skin covering the bed sore. Eschar may be black, brown, or tan in appearance. It may also be crusty, or fluid-filled. Dead skin is often thicker than surrounding skin. If a loved one is exhibiting eschar, it will be hard for the physician to fully evaluate the wound without removing the dead tissue.
It is difficult to see what is underneath a layer of eschar on a bed sore wound. This makes bed sores with eschar impossible to classify. In cases without eschar, a physician will classify a bed sore as one of four stages. The first stage is minor, affecting the upper layer of skin and causing discoloration. A stage two pressure sore goes deeper, and may blister. Stage three affects the fatty tissues and can cause a crater in the skin. Stage four may affect the muscles and expose bone. The skin may turn black in a stage four bed sore, and show signs of infection.
The feet are most susceptible to developing eschar, but it can cover any area of the body. The layer of eschar may appear at the bottom or top of the sore. Skin around the eschar may be red, swollen, or tender. If a bed sore has eschar, a physician may need to remove the dead tissue to classify the wound. However, since eschar is a natural part of the healing process, not all physicians will opt to remove the tissues. Most bed sores that have eschar are at least stage three or four.
Although eschar can look alarming for victims and loved ones, it is a healthy and normal part of the healing process. The presence of eschar should be a red flag for a serious bed sore injury, but the eschar in and of itself is not dangerous for the patient. Eschar means a bed sore has advanced past the first stages and has broken skin, which could allow bacteria to enter and spread in the body. This could lead to infection and sepsis, a life-threatening blood infection.
If you see eschar in a loved one’s bed sore, it is cause for immediate medical action. A physician may make an official eschar diagnosis through a visual examination of the wound and surrounding skin. The doctor will then measure the length, width, and depth of the wound to create an appropriate treatment plan. Testing the pulse below the eschar can check to see if the dead tissue is inhibiting blood flow to nearby flesh.
Many physicians will opt to leave eschar as-is, allowing the natural healing process to continue. However, if the skin around the bed sore is moist, peeling off (sloughing), or red, the recommended course of action may be to debride the eschar, or remove dead tissue. Several debridement options exist depending on the patient and wound. After debridement of eschar, antibiotics, clean bandages, and pain medications are the most common bed sore treatments to facilitate skin healing.
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