🛏️ Pressure ulcers (bedsores/decubitus ulcers) can form within 1–2 hours of sustained pressure. ⚠️ Never leave patients on hard surfaces (e.g. A&E trolleys, X-ray tables) for long periods. Early detection & prevention are key to avoiding complications.

ℹ️ About

📈 Pressure sore development increases mortality risk almost 4-fold.
💡 Strongly associated with frailty, immobility, and poor nursing care.

📍 Common Sites

👣 Heels, lateral malleoli
🦴 Sacrum, ischial tuberosities
🦵 Greater trochanters (hips) and other bony prominences

⚠️ Causes (multifactorial)

♿ Immobility (e.g. post-stroke, prolonged bed rest)
🧠 Dementia or cognitive impairment
🧬 Neurological disease: MS, spinal cord injury, cauda equina
🩸 Comorbidities: diabetes, anaemia, malnutrition
💧 Incontinence → skin maceration
⬇️ Peripheral neuropathy → unperceived pressure
💊 Medications: steroids, sedatives, analgesics, anticholinergics
⚡ Shear forces, moisture, friction

🩺 Clinical Assessment

🧠 Assess mental status & comorbidities
🥗 Review nutrition, BMI, hydration
🦵 Full neurological exam (motor & sensory)
🫃 Abdominal & bowel/bladder function (esp. if incontinent)

📊 Grading of Pressure Ulcers

Grade	Description
Grade 1	Intact skin, non-blanchable erythema over bony area. May feel warmer or firmer. In dark skin, redness may be harder to spot.
Grade 2	Partial-thickness dermis loss → shallow red-pink ulcer or blister.
Grade 3	Full-thickness skin loss → visible fat but no exposed bone/muscle. May have slough.
Grade 4	Full-thickness tissue loss with exposed bone, tendon, or muscle. Often undermining/tunnelling.
Unstageable	Depth obscured by slough/eschar (yellow, brown, black). True grade unclear until debridement.

🔎 Investigations

🩸 FBC → anaemia or ↑WCC (infection)
🧪 U&E → renal status, albumin (nutrition)
🍬 Glucose → screen for diabetes
🔥 CRP → infection/chronic inflammation
🧫 Wound swab → culture & sensitivity if infection suspected
🧪 Blood cultures if septic
🩻 X-ray/MRI → rule out osteomyelitis under chronic ulcers

⚠️ Complications

🦴 Osteomyelitis → infection of bone beneath ulcer
🧬 Sepsis → systemic infection, life-threatening
➡️ Chronic non-healing ulcers → pain, poor QOL, repeated admissions

💊 Management

General Care: Debride necrotic tissue, regular repositioning, air/pressure-relief mattresses, meticulous wound care
Risk Assessment: Use Braden or Norton scale to identify high-risk patients; optimise diabetes, nutrition, anaemia
Pressure Relief: 2-hourly turns, heel protectors, special cushions, bed cradles
Debridement: Remove slough/eschar to promote granulation and accurate staging
Infection Control: Target organisms: Proteus, Strep D, E. coli, Staph, Pseudomonas. Treat cellulitis/sepsis promptly with systemic antibiotics
Nutrition: Optimise protein, vitamins (C, A), zinc, hydration
Dressings: Moisture-retentive, antimicrobial or proteolytic debriders depending on wound bed
Surgery: Stage III/IV may need grafts, flaps, or plastic surgical input

📌 Exam Pearl: – Grade 1 = erythema, intact skin. – Grade 4 = exposed bone/muscle. – Always reposition immobile patients every 2 hours to prevent sores. – Healing requires pressure relief + nutrition + infection control.

📚 References

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Pressure sores or ulcers