Bedsores / Decubitus Ulcers - Medical Negligence?

Bedsores

Located in South Florida, and serving all of Miami, Ft. Lauderdale, Boca Raton, and the entire state of Florida, the nursing home abuse and medical malpractice Florida private investigators at CTK INVESTIGATIONS, LLC have extensive experience in investigating bedsore, and medical malpractice claims. Our Florida private investigators work in conjunction with your Florida Nursing Home Negligence attorney or your South Florida Medical Malpractice attorneys to effectuate the best possible outcome for you.



Do I Have a Bedsore Lawsuit Claim?
Decubitus Ulcers or commonly known as pressure sores or bedsores, are a breakdown of skin and tissue resulting from a lack of blood flow or stress that deprives the skin or tissue of oxygen, thus killing the skin or surrounding tissue. If you or a family member has a bedsore, and you acquired this injury while under medical supervision, you may have a viable claim. Feel free to contact Cory T. Knight today to discuss your case, or click here to contact our Florida private investigators.

Frequency:

Two thirds of pressure sores occur in patients older than 70 years. The prevalence rate in nursing homes is estimated to be 17-28%. Our Florida private investigators can work in conjunction with your Florida malpractice attorney to properly document your injuries and investigate the negligent circumstances that led to you or your family member’s painful bed sores.

Among patients who are neurologically impaired, pressure sores occur with an annual incidence of 5-8%, with lifetime risk estimated to be 25-85%. Moreover, pressure sores are listed as the direct cause of death in 7-8% of all paraplegics. Proper nursing and medical care is needed to ensure that ulcers do not occur. Durable medical equipment such as air mattresses and daily skin inspections can minimize the potential for bedsores.

Research and investigation has proven that patients hospitalized with acute illness have an incidence rate of pressure sores of 3-11%. If you or a loved one has been hospitalized and acquired a bed sore, contact us today.

Disturbingly, even with current medical and surgical therapies, patients who achieve a healed wound have recurrence rates of as high as 90%.

Etiology:

Many factors contribute to the development of pressure sores, but pressure leading to ischemia (lack of blood flow), is the final common pathway. Tissues are capable of withstanding enormous pressures when brief in duration, but prolonged exposure to pressures slightly above capillary filling pressure initiates a downward spiral towards ulceration. That sounds fancy but the bottom line is, if you look at your fingernail, briefly press on the nail bed, you will see the brief change in color from pink to white and rapidly back to pink. This is an indicator of good blood flow. With the lack of mobility, and lack of proper medical care, patients that are not properly cared for can suffer from bedsores.

Impaired mobility is an important contributing factor. Patients who are neurologically impaired, heavily sedated, restrained, or demented are incapable of assuming the responsibility of altering their position to relieve pressure. Moreover, this paralysis leads to muscle and soft tissue atrophy, decreasing the bulk over which these bony prominences are supported.

The literature has proven that contractures and spasticity often contribute by repeatedly exposing tissues to pressure through flexion of a joint. Contractures rigidly hold a joint in flexion, while spasticity subjects tissues to considerable repeated friction and shear forces.
Sensory loss also contributes to ulceration by removing one of the most important warning signals, pain.

Paralysis and insensibility also lead to atrophy of the skin with thinning of this protective barrier. The skin becomes more susceptible to minor traumatic forces, such as friction and shear forces, exerted during the moving of a patient. Trauma causing deepithelialization leads to transdermal water loss, creating maceration and adherence of the skin to clothing and bedding, which raises the coefficient of friction for further insult.

Malnutrition, hypoproteinemia, and anemia reflect the overall status of the patient and can contribute to vulnerability of tissue and delays in wound healing. Poor nutritional status certainly contributes to the chronicity often observed with these lesions. Anemia indicates poor oxygen-carrying capacity of the blood. Vascular disease also may impair blood flow to the region of ulceration.

Bacterial contamination from improper skin care or urinary or fecal incontinence, while not truly an etiological factor, is an important factor to consider in the treatment of pressure sores and can delay wound healing.

Pathophysiology:

The inciting event is compression of the tissues by an external force such as a mattress, wheelchair pad, or bed rail. Other traumatic forces that may be present include shear forces and friction. These forces cause microcirculatory occlusion as pressures rise above capillary filling pressure, resulting in ischemia. Ischemia leads to inflammation and tissue anoxia. Tissue anoxia leads to cell death, necrosis, and ulceration.
Irreversible changes may occur after as little as 2 hours of uninterrupted pressure.



Clinical:

Clinical presentation of pressure sores can be quite deceiving to the inexperienced observer. Soft tissues, muscle, and skin have a differential resistance to the effects of pressure. Generally, muscle is the least resistant and will necrose prior to skin breakdown. Also, pressure is not equally distributed from the bony surface to the overlying skin. Pressure is greatest at the bony prominence, decreasing gradually towards the periphery. Once a small area of skin breakdown has occurred, one may be viewing only the tip of the iceberg, with a large cavity and extensive undermining of the skin edges.

Many classification systems for staging pressure ulcers have been presented in the literature. The most widely accepted system is that of Shea, which has been modified to represent the present National Pressure Ulcer Advisory Panel classification system. This system consists of 4 stages of ulceration but is not intended to imply that all pressure sores follow a standard progression from stage I to stage IV. Nor does it imply that healing pressure sores follow a standard regression from stage IV, to stage I, to healed wound. Rather, it is a system designed to describe the depth of a pressure sore at the specific time of examination, to facilitate communication among the various disciplines involved in the study and care of such patients.

Stage I represents intact skin with signs of impending ulceration. Initially this would consist of blanchable erythema from reactive hyperemia that should resolve within 24 hours of the relief of pressure. Warmth and induration also may be present. Continued pressure creates erythema that does not blanch with pressure. This may be the first outward sign of tissue destruction. Finally, the skin may appear white from ischemia.

Stage II represents a partial-thickness loss of skin involving epidermis and possibly dermis. This lesion may present as an abrasion, blister, or superficial ulceration.

Stage III represents a full-thickness loss of skin with extension into subcutaneous tissue but not through the underlying fascia. This lesion presents as a crater with or without undermining of adjacent tissue.

Stage IV represents full-thickness loss of skin and subcutaneous tissue and extension into muscle, bone, tendon, or joint capsule. Osteomyelitis with bone destruction, dislocations, or pathologic fractures may be present. Sinus tracts and severe undermining commonly are present.

Other important characteristics of the wound should be noted in addition to depth. One should note the presence or absence of foul odors, wound drainage, eschar, necrotic material, and soilage from urinary or fecal incontinence. This provides information regarding the level of bacterial contamination and the need for debridement or diversionary procedures.

The overall state of health, comorbidities, nutritional status, mental status, and smoking history also should be noted. Presence or absence of contractures and spasticity also are important in the formulation of a treatment plan. One should note where the patient normally resides and the extent of his or her support structure. Examining the support surfaces present on the patient's bed or wheelchair also is important.

Relevant Anatomy:

A frequency among anatomic sites exists in affected individuals. The hip and buttock regions account for 67% of all pressure sores, with ischial tuberosity, trochanteric, and sacral locations being most common. The lower extremities account for an additional 25% of all pressure sores, with malleolar, heel, patellar, and pretibial locations being most common.
The remaining 10% or so of pressure sores may occur in any location that experiences long periods of uninterrupted pressure. Nose, chin, forehead, occiput, chest, back, and elbow are among the more common of the infrequent sites for pressure ulceration. No surface of the body can be considered immune to the effects of pressure.

References:
• Barbenel JC, Jordon MM, Nicol SM: Incidence of pressure sores in the greater Glasgow Health Board area. Lancet 1977; 2: 548-550[Medline].
• Staas WE Jr, LaMantia JG: Decubitus ulcers and rehabilitation medicine. Int J Dermatol 1982; 21: 437-444[Medline].

Bedsores are caused from sustained pressure on certain parts of the body, usually from being bedridden as a result of a recovery or medical condition (such as paralysis, paraplegia, or quadriplegia).

Bedsores can result from a caretaker's negligence in failing to turn incapacitated patients. If you have a relative who has suffered bedsores while in the care of a nursing home or medical facility, please contact us for a free case evaluation to determine if you have a strong bedsore claim.

Am I at Risk for Bedsores?

If you are immobile due to injury or illness, then you are at risk for bedsores. Bedsores can occur within hours of pressure being applied to a particular location or body part, and can occur whether the pressure results from sitting in a wheelchair or lying in a bed. If you have nerve damage resulting in a loss of feeling in certain areas of your body, such as diabetes or stroke, you may be at a higher risk of bedsores because you cannot feel the pain to realize you need to turn or shift. In addition, the elderly have thinner skin, and are therefore at higher risk for bedsores.
For more information about bedsores, or to discuss your bedsore claim with an experienced Florida private investigator call Cory T. Knight today at (954) 652-0733. We will be able to discuss our bedsore investigation experience with you, and if you need a Florida personal injury attorney, or South Florida medical negligence attorney we can tell you who has successfully assisted our clients. Please feel free to contact Cory T. Knight or one of our South Florida private investigators at (954) 652-0733 to discuss your medical malpractice investigative needs. If you prefer, you can contact CTK INVESTIGATIONS, LLC via e-mail by clicking here.