Dr. Lalit Kumar Bansal
General Surgery
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My mother, who is 84 years old, was admitted to the hospital for six days (discharge summary attached). In an intervening period of two days, she was admitted to another hospital (discharge card attached) for dialysis and brought back to the same hospital. She was shifted from the previous hospital to another hospital and was there for ten days. She complained of pain in the bottom side of the back; she, we, and sisters in the hospital thought she was hit at the pain site, and the pain would subside eventually. However, after coming home, ladies of the house observed the area of pain, and it was felt that it is alarming. Her BP was observed as 184/113, and after two hours or so, it was 176/101. She was administered Amlodipine 5 mg, and she had a fever of 100 F. She gave plain Paracetamol. Today her sugar level was 108, BP 138/89, and the temperature is 96.9. Please advice.
Hello,
Welcome to icliniq.com.
I have seen all reports (attachment removed to protect patient identity) and discharge summary.
She is a known CKD (Chronic kidney disease) with diabetes, hypertension, and bedsores.
As per investigation and report, blood pressure and diabetes are under control now. She has blood and urine infection in the past, but she is recovering well now.
The probable reason for back pain is degenerative changes in the spine due to age and other comorbid conditions. I have seen the treatment going on, and as per my view, it is all right. She needs Calcium and Vitamin D continuously. Also, bedsore dressing and care is required, which is possible only by visiting the nearby clinic.
We cannot give many painkillers as she is a CKD patient. Paracetamol is safe, but if she has severe pain, then Contramol (Tramadol) 50 mg tablet can be given if necessary.
I hope it helps.
Patient's Query
Hi doctor,
Thank you for your reply.
I was worried if the wound would be deep and having need some surgical intervention. Because as we sent the wound image to a sister who did dressing for her, she suggested that the surgeon's immediate intervention is required.
Regards.
Hi,
Welcome back to icliniq.com.
I can understand your concern.
As per the photograph (attachment removed to protect patient identity) you have sent me, it needs proper surgical debridement. You can see the black skin surrounded by a yellow line. Black skin is dead and needs removal with proper cleaning of the remaining floor. The yellow tinge and black skin should be wiped off, and only then new skin will take its place. A frequent position change and mobilization of the patient is a must to prevent further bedsore problem. For debridement, surgical intervention is required, and do not worry; it is not that deep. It will heal with proper dressing and wound care.
Patient's Query
Thank you, doctor, for your reply.
We have got surgical debridement done. They have asked us to do dressing daily at home and given us "Hydrocolloid dressing wound care." Kindly guide me on what solution should I use to clean and apply, as I am a skeptic to call any surgical technician or nurse or take her to any clinic due to the COVID-19 situation. The latest picture is attached herewith for your preview. Please advise.
Hello,
Welcome back to icliniq.com.
That is very good. I have seen the pictures (attachment removed to protect patient identity), now the wound looks better. But it would help if you cared for the wound properly. And yes, daily dressing is required until the yellow floor is completely wiped off and replaced by red granulation tissue. You can use some ointment for dressing. I will suggest you some brand name like Megaheal (Colloidal silver), Debridase (Papain and Urea) or Cadomer (Cadexomer iodine) ointment. These may be available in your town. You can purchase any one of these and do dressing at home only. Follow the previous advice also.
Please get back to me anytime.
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General Surgery
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