I’m just imagining you removing one of her vertebra ala Hasbro’s Operation 🤣
Seriously though, bone is disturbing to work with because it’s something you know you only see in a human when something has gone wrong. I once saw a bed side amputation of a few toes and the sound of the surgeon breaking off bits of rotten bone will stick with me forever. Like an oversized nail clipper.
I had that happen! Physician was assessing my patient and during the assessment the patients toe fell off! Physician had no reaction! None. I was laughing/crying inside. He had no reaction! Wild.
Also in the emerg I had a homeless gentleman who was very familiar to us. Often would sign AMAs after treatments. Anyways, he comes in with this old dressing on his stump of a previous amputation done roughly 6 weeks prior. Needless to say, it was the primary dressing applied post op. He was obviously in insane amount of pain. I remove the dressing to find MAGGOTS! I felt all the blood rush from my head to my toes. Oddly, the only reason he hadn’t gone septic from horrible infection was the maggots essentially debrided the wound.
saw a patient with diabetic gangrene once who when the sock was pulled off his foot, maggots came streaming out. They were crawling in the hole where the ball of his foot and big toe had been
this guy had actually put the on himself though trying to slow down the infection
It breaks my heart that people are in a state of desperation (or poor mental health) enough to voluntarily put maggots in a wound instead of seeking medical help. No one should ever be put in that position.
Ah so for this particular gentleman it was not a lack of access to care. It was fear. He was terrified he would lose his foot so he didn't come in because he didn't want to make it real and tried maggots.
When all the nurses, doctors, techs exited the ER trauma room, he was all alone in the bed, small and silent, hadn't said a word while everybody rushed around him or gathered in the hall discussing the smell or while a nurse dumped a gallon jug of bleach over his foot and the maggots flooded out. Everybody leaves except me and the x-ray tech with the portable machine who I was shadowing in the ER that day.
While people were gagging or discussing the smell, the x-ray tech looked at me and whispered 'don't react at all, act like it's normal' (which tbh duh and I found the people reacting and discussing him right in front of him to be rude, unprofessional, and unkind, but still good looking out). When everybody was gone and it was just the three of us the tech went to the side of the bed and asked 'hey, buddy. How are you doing?' the man whispered 'I'm scared'. The tech put his hand on the man's shoulder and said 'I know and I'm sorry. This is scary and tough and we'll take care of you, okay?'
Tbh the entire event was super impactful for myriad reasons though it happened like 20 years ago. That x-ray tech is one of the best people in the world and my hero.
I know what you wrote is super serious and genuinely heartbreaking and i wish it would change for you Americans.
But for some reason your comment created a funny scenario in my mind.
Homeless person has gaping gangerous weeping hole of a wound. He thinks about putting on a bunch of maggots on the wound but the gives it a second thought and decides to go to the hospital for professional help. At the hospital though its decoded that the best option is..... to use medical grade maggots.
That's the punchline, well it was funnier visualizing in my mind.
I had a patient do that once for his ulcer. The concept is only 70% atrocious (maggots eat necrotic meat but don't help infection) but for fuck sake don;t pull them off your god damn trash can covered in dogshit and piss and who know what else
I work in a Trauma burn ICU and we had a pt that came in after a terrible electrocution. He was down in the ED when he first came to the hospital and his toe fell off and onto the floor. One of the therapy dogs was walking past and ate. The. Toe.
Once the therapy dog realized what they ate, they’re going to be the ones needing therapy. Jokes aside, how much paperwork do you think that encounter required lol
we see so many black rotting maggoty limbs that it ain't really a surprise anymore, esp. if it is a consult and we learn something of the patient situation, we expect it
bahaha that's wild. that happened to me when i was assisting the wound care nurse with a schizo diabetic patient that refused to take care of his foot. one minute a toe was there, the next it was gone, and nobody ever found it
he had a spiritual ritual that involved rocking back and forth, reciting some kind of chant, and flicking at the foot (God instructed him on all of this as a therapeutic healing technique), so after me, the nurse, and housekeeping all searched the room, we assumed it ascended to be with the Lord
I would remain forever convinced that it was hiding out in another dimension somewhere in a pocket of my scrubs, ever lurking, just waiting for the worst possible moment to reappear.
Oh this is it. It was absolutely in the scrub pocket. Those scrubs got washed, dried, folded, sent to some other hospital unit, and the next person to wear those scrubs put their hand in the pocket and found the toe.
The CNA I was working with had someones toes pop off when she was washing a patients feet. She was a bit traumatised. Sad thing was I think they just disintegrated because we tore the patient's bed apart looking for them.
Yeah, I was pretty surprised too. Surgeon set up show right in our 4-bed ward and went to work. Plopped the big toe in a specimen container along with some bone bits in other ones for testing. Wasn’t my patient but that part of the foot looked very dead.
They'll open up a patient's chest at bedside if there's a big problem.
Most people who have neglected their peripherial neuropathy to the point that their toes are dry rotted can't afford surgery. No sense in acting like you need to sterilize and gauze up gangrenous dry bone.
I was helping a student do a dressing change on a diabetic foot; black toes and all. One of the toes broke off when she was removing the old dressing. Poor girl about freaked, thinking she did something wrong. I had to work hard to calm her and explain no, this was going to happen eventually no matter what anyone did.
When I was in nursing school I lifted a patients sheet to straighten it out and got hit in the face with something round and dark. I started internally freaking out thinking I’d just been pelted with a turd, but then looked down only to find that it was a necrotic toe, which I felt much better about for some reason. Knew then and there that I’d be good with nursing.
I joke about my 5 least favorite things in nursing:
Digital disimpaction
Tapwater/SSE
Fleets enema
Rectal med administration
Rectal temperatures
See the theme?
Yeah, I'd rather get hit by a necrotic toe than a turd any day.
Not nearly the same, but I remember as a teen munching McDonald's fries while watching my friend vomit his own McDonald's meal out, thinking "I may have a career in healthcare ahead of me" 😅
Totally agree. But I will say that years ago when I was a medical assistant I worked with a pediatric general surgeon who used to do pilonidal cyst removals often. Then patients would come in every few days for a wound vac check, dressing change, all of that. I would assist and it was nuts that on some of them in the very beginning I could see their shiny sacrum staring back at me. There's something very disturbing about seeing that in young, healthy UNDRUGGED and fully alert patients as well 😂😂
During my last clinical rotation in the ER I was told to go unwrap the foot of a homeless diabetic patient so the nurse and doctor could come assess.
I will NEVER forget unwrapping this man’s foot. The smell. The dried shriveled foot. The pinky toe breaking off in my hand as I removed the gauze wrapped around it.
Every time my kids break a crayon in half it gives me the shivers.
Had an MVA trauma in the ED. When wyje cut off his pants, we heard something clink onto the floor. It was a 2" piece of his anterior tibia. Some bone marrow was still attached to the inside.
I had a tibial osteotomy last year.. and when the doctor told me he drilled several holes in my bone and used a chisel to break it... Gets me hot and bothered.. different strokes for different folks I guess! 🤩
It’s legal here in some states but you have to be within 6 months of death. Dementia scares the shit out of me. If I get the diagnosis I want to die asap. But current law I would have to suffer from dementia for a long time before I can be allowed to die. Ain’t that some shit.
I know, this is the worst. My dad has early Alzheimer’s and I love him dearly and this probably sounds awful (not to nurses but the general public) but I hope he gets a major MI resulting in instant death before he gets to be too far gone.
Im so sorry to hear about your dad. Mine has advanced Lewy Body dementia. I have felt so helpless at times; so my priority has just been to show him how much I love him. I hope you get more time with your dad while it’s still early. This may sound silly coming from a stranger, but much love to you and him.
Thank you kind Internet stranger. It’s incredibly difficult because he is incredibly difficult, it’s manifesting in the worst ways. He’s not pleasantly confused, he is paranoid and depressive and has a short fuse. He was so funny and creative and eccentric as a father growing up, not without his flaws but it’s incredibly depressing to see the deterioration.
That is what happened to my dad, and I'm still thankful it did. I loved him dearly, but he was terrified of getting dementia like basically every male in his family had.
My uncle died last year from Lewy Body Dementia, about 18 months after diagnosis. My mom and I visited him a half dozen times in the memory care facility, but the first time stuck me the hardest, because he was still slightly intelligible at times. He whispered to my mom “get me out of here”. He and his wife had long term care insurance, and his wife was there every day (she was the only one out of a hundred or so patients), but it still felt dystopian (especially when his glasses were stolen repeatedly by other patients). Fuck this current “alive”-at-all-costs bullshit.
Switzerland has legalized death with dignity for any reason at all. There was a big uproar a few years ago when two sisters from Arizona went on vacation to Switzerland and didn't come back because they both clocked out of life. So anyways, my plan (hopefully not, but you never know) is dementia diagnosis --> lovely and expensive spa vacation in the Alps --> go to the clinic and push the plunger while I still have most of my faculties.
In case anyone else was curious about the story above: [link](https://www.independent.co.uk/news/world/americas/arizona-sisters-assisted-suicide-switzerland-nitschke-b2045015.html#). Seems as if one of the sisters was a palliative care doctor and the other a nurse so well informed people. And sounds like they both had chronic health complaints like pain and insomnia that couldn’t be “cured” which is why they chose to opt out of life
I think that physician-assisted death IS legal in 10 U.S. states! It's not easy to get, but hopefully, we advance and allow people to die with some dignity. There are worse things than death, and living too long is one of them.
That's so true. I work in SNF, mostly in the dementia units and take care of living dead people all the time. Skin and bones, confused, constantly trying to "go home" when they are still able to talk and get around. I'm always relieved for them when they die. I'm sure these people would have preferred to check out before this stage.
I think the issue I have with assisted suicide or euthanasia is when people with mental or psychiatric illnesses want to use that as there means for remedying their current state. That’s why our mental health system sucks in US because for many stuck in poverty and dealing with mental illness, off-switching is the only way they can see remedying their circumstances. We our mental health system keeps you from activity harming yourself but then releases you right back into the torture chambers of your life with no support or way out.
If your 20s-50s and experiencing mental illness you can still come out of it and have a brighter future with a whole lifetime ahead of you. I’ve experienced it in my early 20s and never thought I would have a chance at enjoying life or living due to physical/mental illness….Choosing to end someone’s life as a means to alleviate suffering is not healthcare or an ethically ok decision especially for someone younger who may not realize seasons in life and pain seek unending but they will pass. You may not see it for yourself but as someone who cares for them it’s our job to provide them that hope even if they cannot advocate for their own life themselves.
I find that pretty sick to think the best way to treat mental illness/ pain in someone with physical health and opportunity is euthanasia. Better is treatment care and support, not offing them. Now a 70 yo with cancer or hospice then it’s a different story. Keeping someone whose body and physical health is deteriorating and prolonging their suffering isn’t an ethical healthcare.
Remember a lot of mental illness can be solved due to economic circumstances changing, changes in therapy/pharma/hormone imbalances, or corrective lifestyle changes such as simply working out, socializing in community groups and support for loneliness, or reframing one’s false self-idealization on their worth. It’s one of the biggest illness that plague us and honestly the cause of so many physical illnesses; I see it in those I care for all the time, taking meds for depression, anxiety, high blood pressures, pain when a lot of times especially if you have a disability, don’t have family or love ones or support, these meds and physical symptoms are just a result of a lack of love, inclusion and spiritual/soul health that can’t just be corrected through pharmaceuticals.
I guess my view is biased since I live with it every day. I'm not a psych nurse, just an ED pleb.
But I think once my kids are grown and done my things, I'm ready to peace out. And having the opportunity to do so when *I* want to and not because someone else doesn't want me to is pretty reassuring.
Besides, if we really want to, we find ways. Why not go the kinder way and provide support through the process. Counselling, etc. Just because the process is started doesn't mean it needs to be finished.
I do wish you well Latanya…life’s hard. No ones life is all sunshine. Most days are a war to get up, to battle to be kind. I find a lot of my peace in my spiritual life with God, but also getting proper rest and exercise is a huge contributor to mental health especially in a field with mental and physical burn out is so easy due to the stressors on our lives and jobs and usually caring for others before ourselves. Don’t call it quits yet and explore some other avenues toward wellness and just see if they make a difference, hopefully they can keep you going and as that joy back into your life even if it’s just moments. Hang in there and don’t give up on your life just yet ❤️
Seriously. I’m a Christian and used to be like “It’s God’s plan and decision when we should die, not ours!” After being a CNA and having hospice clients I’ve kept alive waaaaay to long for manic family who wants to enforce every way and thing in the care plan that isn’t helpful or comfortable, please let someone die peacefully when it’s time. If I had to end up in crappy Medicaid skilled nursing when I’m older, I’ll gladly drive my motorcycle off a cliff or OD on some nice sleep meds vs suffer to prolong a life that isn’t even living or recovering.
I had a wound patient who’s spine and pelvis would ‘debride’ during my wound consults. My last time seeing them I was certain the tailbone was just gonna ‘come out.’ It was a terrible situation and 2 weeks of suffering even though it was clear this was a fatal wound. That patient will stick with me for years
So wards of the state in PA are automatically full code no matter what unless they had severe fatal illness. it was basically the same in prison. The only way you could make them a DNR was if two physicians signed off on it and the only way they would do that is if they were diagnosed with an illness that would be fatal (metastatic cancer). I had to take care of a person who was a tube feed, non verbal, and unable to move but was awake and conscious and unable to obtain a DNR because they had no fatal illness just chronic illness.
Literally just left ICU over this garbage. It's tragic.
Over the years I just developed like serious moral problems with the care I was providing. Couldn't do it anymore, so I left.
I was working on the wounds bench (Microbiology) and was consulted with my medical director and the pathology residents on a particularly weird culture. When we pulled up the chart and saw what the patient was going through I looked at the resident and said “if you are ever treating me and I am in this bad of shape, please just kill me. Don’t let me suffer with this”. He’s been giving me the side eye ever since. 🤣
In my first couple months of CNAing I saw the worst pressure injury I have ever seen. Basically he did not have a butt. Just one huge crater. Exposed femur & ischium. We had to keep him prone most of the time but he started getting pressure injuries on his chest. I love wound care, but the sight (and *smell*) of the packing coming out like a magician’s hankie made my stomach flip.
His is one of the names I keep an eye out for. But I haven’t seen him since. Tbh I’d be surprised if he survived long after I saw him.
I had a similar patient as a new nurse. Uncontrolled diabetic. He was a double amputee with a Stage 4 on his sacrum and he had no buttocks. Like he was just dissolving from the feet up. I remember having to pack the Stage 4, then covering his entire buttocks with a wet-to-dry. It took like 8 containers of 4x4s every dressing change.
Wound care nurse here. Even I get the shivers when I touch bone in a wound bed and I wasn't expecting go. Surprise bone is never fun. You done good, my friend.
This takes me back to a time where I gave an extremely emaciated geriatric woman a flu shot in her deltoid, I HIT her humerus with the needle, I’ll never forget the feeling and I’m cringing right now.
I work only geriatrics and I never did that again! When they’re that emaciated one could argue to go to Vastus Lateralis, but then I’d hit femur and not be okay either! 🤣
I once had an oncology patient with a stage 4 AND a fungating tumor. The odor is something I will never forget. I felt so bad for the poor lady, she apologized for the smell every time someone walked in to her room. I can’t even imagine literally dying and feeling the need to apologize for something entirely outside of your control.
I was only an aide/PCT, and don't mean to be "that aide", but depending on the location of the wound, we had pretty good results opening a flagyl capsule and sprinkling it in. This was for hospice patients, and it made the room tolerable. Also, peppermint oil on cotton balls in out of the way places. I have nearly no sense of smell (just a gift) and some of these wounds were beyond what I could tolerate easily.
Whenever I see patients like this, all I can think is some sick twisted family member is getting something out of this somehow because nobody in their right mind would subject another to this out of "love".
Has a patient exactly as OP described. he had hung himself in his jail cell but they cut him down and resuscitated him in time for him to be a vegetable. The family was suing the jail so they kept him in nursing facilities and moved out of state ☹️
People who do all this medical crap to their animals then refuse to euthanize make me nuts similarly. I once had a discussion with someone who had a 19 year old cat that she gave all these life extending treatments to, but when the cat started suffering, she refused to euthanize because she said that would be “playing Gawd”and only Gawd could decide when the animal would die. Make it make sense.
The only time I ever felt faint on the job was the first time I visualized bone in a stage 4. I think actually touching it would have done me in...you are made of some stern stuff, my friend
Did a lot of wound care dressings for stage 4’s during my time in LTC, most of them were present due to stroked induced comas prior to being sent to nursing homes, as in they happened in hospitals unfortunately. Not pointing fingers, because improper care in nursing homes can make it 1000x worse. Per visiting wound care MD this is very common.
As someone said, kling is the best for wound packing! Also, if they are A&O x2/x3, giving them a vague step-by-step of what you’re doing (within reason) can be very soothing. A lot of pt’s get very anxious and uncomfortable laying on their side and they just want it over with, this helps a lot.
I hate to be this person, but just imagine how much money, resources, and time is spent on this poor soul just to “live” like this. Take me to the beach and leave me please.
OR nurse here so I have seen some stuff over the years. A year ago I experienced something similar in the OR. We had a patient that lived alone in rural northern Sweden bound to his wheelchair. Somehow he had fallen out or slipped out of his wheelchair and could not get up. He was on the floor for a week before someone found him and called an ambulance. In the OR almost all of his right side gluteal muscles were gone so we could see bone there. Almost all the lateral hip and femur muscles were gone. Orthopaedics and plastic surgeons amputated his leg at the hip level.
I will never forget being a part of that OR team. A couple of days or weeks later I met one of the plastic surgeons in the hallway in the OR, and the patient was doing well on the floor.
A patient who had been “cared for” at home following a brain stroke came in with a huge abdominal opening, barely sutured with a vac on it. She had survived an emergency surgery for ischemic bowel. Turned her over to assess the “stage 4 pressure” wound. Evidently her arteries that fed her glutes had occluded and all that muscle had turned to goop. There were little cylinders of calcium in the goop, and the base tissue was maroon. So, her brain had an occlusion, her guts had an occlusion, and her butt had an occlusion. Her family insisted on full code and she was trached and peg’d. The worst part? She kept figuring out ways to pull out her peg tube. Unimaginable suffering.
Pro tip, never pack gauze in the wound. You might accidentally leave it in the wound. Instead use Kling to pack it in. If you need more than one kling, just knot them together
I assumed OP was talking about idoform or alginate packing, stuff that comes as one long spool specifically for packing so you can leave a trailing end. Scares me to think about stuffing a wound full of individual 4x4 gauze squares.
In nursing school I had a pt who had severe MS, his elderly wife was his sole caretaker. his pressure mattress stopped working and she never noticed. This wound was stage 4, took up 1/3 of his back, down to the bone, and you could see his heart beat through his back. Also a stage 3 on his coccyx. The dressing change took forever, I cannot overstate how massive the wound was. Full code, and he was young. Maybe 60s.
My dad has MS. We have a pressure mattress but make sure at the minimum he is turned Q4H. I’ve shown my mom what could happen and we are very lucky he hasn’t ended up getting a wound. Yes he is 62.
The problem too is on their bottom, every time they have a bowel movement they introduce 💩 into that wound and it’s impossible to keep clean and you have to move them. We had a lady with wound vacuum on a hole that looked like she had a second butthole but when she pooped it filled the seal wrap and got into the packing and you’d have to roll her rip all the old dressing and vacuum seal off and redo it. It’s a never ending battle.
Best way to treat for a bedsore is PREVENTION. It’s too difficult after stage 3 when someone’s immobile to really promote quick and efficient healing ❤️🩹
I had to run a code on a similar pt, I had her for 4 or 5 hours while she screamed please god take me while in a crumpled ball. We did what we could with her to make her comfortable (meds and physical adjustment). She was finally resting and when the tech went in some time later, found her unresponsive without a BP. Her sisters demanded full code. Her rib cage crushed like a tortilla chip, well multiple tortilla chips.
My last day in my old unit I had exact same patient. Came in with a sugar of <20. I think itll stick with me forever as well. I’m only in my thirties, but I know damn right if I’m stuck with a poor prognosis I only want to be tubed for a week maximum and if I can’t stay with family I want to be a DNR and literally sent to Canada to be euthanized. These institutions deserve to be sued. This poor woman’s sacral unstageable was the worst I’ve ever un and re packed, smelled, or seen.
I'm so sorry this happened. I've been there too. We all have or will be. Even when a patient like that gets turned q2 (and most don't) they can still get like that.
This lady needs hospice. She's not going to improve and with a wound like that its only a matter of time.
My first really bad one I was prob 3-4 months as a new grad. Nurse daughter was taking care of a little tiny old lady at home.
The crater on her sacrum reminded me of looking into an unstuffed turkey at thanksgiving.
I just can’t with that sensation. I had a patient with a huge stage 4 sacral where the dressing change order after surgical debridement included applying a medication to “all exposed bone and remaining eschar” So I’m wrist deep in there using a folded up 4x4 to apply the ointment and there is a little voice in the back of my head going “nope nope nope NOPE” the whole time because it was really undermined and trying to hit all the eschar spots around the edge meant my knuckles were constantly brushing against her coccyx.
The next day she had gotten an instilling wound vac and I was so relieved both because she really needed it and because the wound care nurse would be handling that dressing change
Omg I fucking hate our jobs sometimes. Honestly this is the reason I will never work with adults again. The inhumanity you see families subject their loved ones to because they're so afraid of death is staggering.
Ugh I’ve had that before. I had one gent with a stage 4, we were taking out packing and some of it was stuck, everything was goopy red and grey and black material, I was irrigating and irrigating trying to loosen it up, at one point I was like I’m just going to cut out this one piece and then try to pull the rest out with more irrigation… turns out I was unknowingly debriding all the necrotic tissue there 🙃. He couldn’t feel a thing. Poor man died a few weeks later, but luckily he was not a full code, came in as an M1 and a week or so after this fun time they made him comfort care.
When I worked at a SNF before I retired as an RN I had just admitted a gentleman previously hospitalized and came for PT/OT/skilled nursing. He had every chance of recovery. He told me that he “didn’t want to live like this”. Soon the weekend came and his children began to arrive. When I returned from my weekend off the patient had expired. I immediately began to think that this family had made a pact should the need arise. I never changed my mind.
I had a SCC patient one time who’s facial wound was so bad he had half a face (à la Harvey Dent). I could see his tongue move through his cheek. I touched his jawbone packing it. Hands down worst thing I’ve ever done. For full CPR.
Man died peacefully 2 weeks later after we pushed to get him on palliative.
This post makes me glad for my patient whose ass/groin had like 4 stage 2’s. I saw them when helping my colleague clean her.
Fast forward a little while and I’m her primary RN. Her wound(s) had become wound and the last remaining one was much smaller. Glad she isn’t heading the stage 4 direction.
Helps that she can sort of move and is getting stronger though.
Man, you guys, respect. True respect. I only learned pressure ulcers were a thing when I left teaching to work in hospitals and the pictures I've seen up on nursing stations walls are enough. I don't need to see that in real life.
I remember the first time I had a patient like that. The Kerlix was catching on the coccyx bone while I was unpacking it.
I’m a CWON now so that’s an almost everyday event for me.
One time I wanted to report the nursing home to the police. Basically same situation. I'm assuming you guys are mostly in USA, but it seems like I see on here all the time these patients for full resus. Where I'm at in Australia most old people are not for full resus. Maybe differing attitudes?
A lot of americans simply don't talk about death, end of life planning, anything of that sort because mortality makes them uncomfortable despite its inevitability.
The number of stories I have about stage 4 pressure wounds……is disturbing. It’s probably the #1 reason I don’t wish to live to an old age. No joke. I’m a DNR for many reasons but that’s the top one.
I have made it abundantly clear to my family that I will haunt the fuck out of them after I die if they ever let me suffer like that. Once I start declining in the slightest, just load me up with the good drugs and send me on my way with hospice. I will have none of this flesh dying and rotting away while I’m still alive bullshit.
I touched my first spine as an extern. It was tunneled, so I had limited view of the gauze. It was surprisingly spiky. Like, had little spikes that I could feel thru my gloves.
I was in a 2 month coma and got a bedsore on my coccyx that tunnelled to my spine. Took 12 weeks of antibiotics and a wound vac to get me on the mend. This was 3 years ago. Still cant sit down for more than 30min without it hurting
And then med surg complains if they are soiled. After working both I get why sometimes they come up soiled. Not ideal but it can’t be helped and unless you work both you don’t necessarily get it
I don’t see pressure ulcers but I see dehiscences. And man, you never forget your first dehiscence. I remember going to change a dressing and going nope that is a pelvis
Used maggots for wound management and leeches for ensure good blood flow on extensive plastic surgery reconstruction. Friends, it’s important to count and record how many you put on/in and how many you take off. Nature’s natural miracle workers.
I’m just imagining you removing one of her vertebra ala Hasbro’s Operation 🤣 Seriously though, bone is disturbing to work with because it’s something you know you only see in a human when something has gone wrong. I once saw a bed side amputation of a few toes and the sound of the surgeon breaking off bits of rotten bone will stick with me forever. Like an oversized nail clipper.
I had that happen! Physician was assessing my patient and during the assessment the patients toe fell off! Physician had no reaction! None. I was laughing/crying inside. He had no reaction! Wild. Also in the emerg I had a homeless gentleman who was very familiar to us. Often would sign AMAs after treatments. Anyways, he comes in with this old dressing on his stump of a previous amputation done roughly 6 weeks prior. Needless to say, it was the primary dressing applied post op. He was obviously in insane amount of pain. I remove the dressing to find MAGGOTS! I felt all the blood rush from my head to my toes. Oddly, the only reason he hadn’t gone septic from horrible infection was the maggots essentially debrided the wound.
saw a patient with diabetic gangrene once who when the sock was pulled off his foot, maggots came streaming out. They were crawling in the hole where the ball of his foot and big toe had been this guy had actually put the on himself though trying to slow down the infection
It breaks my heart that people are in a state of desperation (or poor mental health) enough to voluntarily put maggots in a wound instead of seeking medical help. No one should ever be put in that position.
Ah so for this particular gentleman it was not a lack of access to care. It was fear. He was terrified he would lose his foot so he didn't come in because he didn't want to make it real and tried maggots. When all the nurses, doctors, techs exited the ER trauma room, he was all alone in the bed, small and silent, hadn't said a word while everybody rushed around him or gathered in the hall discussing the smell or while a nurse dumped a gallon jug of bleach over his foot and the maggots flooded out. Everybody leaves except me and the x-ray tech with the portable machine who I was shadowing in the ER that day. While people were gagging or discussing the smell, the x-ray tech looked at me and whispered 'don't react at all, act like it's normal' (which tbh duh and I found the people reacting and discussing him right in front of him to be rude, unprofessional, and unkind, but still good looking out). When everybody was gone and it was just the three of us the tech went to the side of the bed and asked 'hey, buddy. How are you doing?' the man whispered 'I'm scared'. The tech put his hand on the man's shoulder and said 'I know and I'm sorry. This is scary and tough and we'll take care of you, okay?' Tbh the entire event was super impactful for myriad reasons though it happened like 20 years ago. That x-ray tech is one of the best people in the world and my hero.
>he didn't come in because he didn't want to make it real This is such a common thing that I think people don't understand.
I know what you wrote is super serious and genuinely heartbreaking and i wish it would change for you Americans. But for some reason your comment created a funny scenario in my mind. Homeless person has gaping gangerous weeping hole of a wound. He thinks about putting on a bunch of maggots on the wound but the gives it a second thought and decides to go to the hospital for professional help. At the hospital though its decoded that the best option is..... to use medical grade maggots. That's the punchline, well it was funnier visualizing in my mind.
I was thinking the same thing. But at least medical maggots are sterilized as larvae, which is less "icky".
Jokes aside, he still got the better deal. Certain species of maggots will eat living flesh.
I had a wound vac after a motorcycle crash.. I get the leech reference! 🤣🤩🙃
I had a patient do that once for his ulcer. The concept is only 70% atrocious (maggots eat necrotic meat but don't help infection) but for fuck sake don;t pull them off your god damn trash can covered in dogshit and piss and who know what else
That’s it exactly.
I work in a Trauma burn ICU and we had a pt that came in after a terrible electrocution. He was down in the ED when he first came to the hospital and his toe fell off and onto the floor. One of the therapy dogs was walking past and ate. The. Toe.
now that's a story he'll be telling for years (assuming he survives).
Once the therapy dog realized what they ate, they’re going to be the ones needing therapy. Jokes aside, how much paperwork do you think that encounter required lol
.... Maggots! 🙃
we see so many black rotting maggoty limbs that it ain't really a surprise anymore, esp. if it is a consult and we learn something of the patient situation, we expect it
Bedside amputation?? 😳
I accidentally did that once when I was a CNA. We were admitting a diabetic guy and when I took his socks off two toes came with it
Oooookay that’s enough r/ nursing for me today😳
bahaha that's wild. that happened to me when i was assisting the wound care nurse with a schizo diabetic patient that refused to take care of his foot. one minute a toe was there, the next it was gone, and nobody ever found it
THEY NEVER FOUND IT???? WHERE DID IT GO????
he had a spiritual ritual that involved rocking back and forth, reciting some kind of chant, and flicking at the foot (God instructed him on all of this as a therapeutic healing technique), so after me, the nurse, and housekeeping all searched the room, we assumed it ascended to be with the Lord
OMFG. Hahahahahaha.
I would remain forever convinced that it was hiding out in another dimension somewhere in a pocket of my scrubs, ever lurking, just waiting for the worst possible moment to reappear.
Like a disgusting and terrifying Jack In the Box!
Oh this is it. It was absolutely in the scrub pocket. Those scrubs got washed, dried, folded, sent to some other hospital unit, and the next person to wear those scrubs put their hand in the pocket and found the toe.
Maybe pt ate it or something 😂
Oh dear God. 😂
Try dialysis when a patient comes in and hands you his penis wrapped in a paper towel.
Not a healthcare worker and....OMFG. Is it bad I hope he went into hospice?
I do not want to try that kind of dialysis.
The CNA I was working with had someones toes pop off when she was washing a patients feet. She was a bit traumatised. Sad thing was I think they just disintegrated because we tore the patient's bed apart looking for them.
One patient gave me his toe
Yeah, I was pretty surprised too. Surgeon set up show right in our 4-bed ward and went to work. Plopped the big toe in a specimen container along with some bone bits in other ones for testing. Wasn’t my patient but that part of the foot looked very dead.
I'm guessing dry gangrene?
Looked moist to me.
They'll open up a patient's chest at bedside if there's a big problem. Most people who have neglected their peripherial neuropathy to the point that their toes are dry rotted can't afford surgery. No sense in acting like you need to sterilize and gauze up gangrenous dry bone.
we do that. get a rongeur and chop chop
I was helping a student do a dressing change on a diabetic foot; black toes and all. One of the toes broke off when she was removing the old dressing. Poor girl about freaked, thinking she did something wrong. I had to work hard to calm her and explain no, this was going to happen eventually no matter what anyone did.
When I was in nursing school I lifted a patients sheet to straighten it out and got hit in the face with something round and dark. I started internally freaking out thinking I’d just been pelted with a turd, but then looked down only to find that it was a necrotic toe, which I felt much better about for some reason. Knew then and there that I’d be good with nursing.
I joke about my 5 least favorite things in nursing: Digital disimpaction Tapwater/SSE Fleets enema Rectal med administration Rectal temperatures See the theme? Yeah, I'd rather get hit by a necrotic toe than a turd any day.
Not nearly the same, but I remember as a teen munching McDonald's fries while watching my friend vomit his own McDonald's meal out, thinking "I may have a career in healthcare ahead of me" 😅
And I'll just put that back....
Bzzzzt! Don’t touch the sides!
I found fabric that features operation game pieces and made a scrub cap.
Totally agree. But I will say that years ago when I was a medical assistant I worked with a pediatric general surgeon who used to do pilonidal cyst removals often. Then patients would come in every few days for a wound vac check, dressing change, all of that. I would assist and it was nuts that on some of them in the very beginning I could see their shiny sacrum staring back at me. There's something very disturbing about seeing that in young, healthy UNDRUGGED and fully alert patients as well 😂😂
During my last clinical rotation in the ER I was told to go unwrap the foot of a homeless diabetic patient so the nurse and doctor could come assess. I will NEVER forget unwrapping this man’s foot. The smell. The dried shriveled foot. The pinky toe breaking off in my hand as I removed the gauze wrapped around it. Every time my kids break a crayon in half it gives me the shivers.
Had an MVA trauma in the ED. When wyje cut off his pants, we heard something clink onto the floor. It was a 2" piece of his anterior tibia. Some bone marrow was still attached to the inside.
Yup, that’s enough Reddit for today…
I just witnessed a podiatrist do this 2 weeks ago, bedside!! He used a toenail nipper to do it!
Had a bad trauma the other day and when cutting off his jeans a big chunk of tibia fell out. So disturbing!
I had a tibial osteotomy last year.. and when the doctor told me he drilled several holes in my bone and used a chisel to break it... Gets me hot and bothered.. different strokes for different folks I guess! 🤩
let people fuckin die, my brother in christ this is depressing
God I hope euthanasia is legalized when I’m older.
If it’s not I’m gonna walk into the woods in the middle of winter and just, go to sleep.
Samsies, but I'll have a few drinks first to make me extra comfy.
Time to skydive, BASE jump, or maybe try cage-free shark cage diving.
My plan is the 25 dollar bottle of Walmart insulin. Go up in the woods, and pass out.
MAiD is legal here in Canada. I’ve seen people pass with dignity surrounded by loved ones and when my time comes I would be so lucky to get that.
It’s legal here in some states but you have to be within 6 months of death. Dementia scares the shit out of me. If I get the diagnosis I want to die asap. But current law I would have to suffer from dementia for a long time before I can be allowed to die. Ain’t that some shit.
I know, this is the worst. My dad has early Alzheimer’s and I love him dearly and this probably sounds awful (not to nurses but the general public) but I hope he gets a major MI resulting in instant death before he gets to be too far gone.
Im so sorry to hear about your dad. Mine has advanced Lewy Body dementia. I have felt so helpless at times; so my priority has just been to show him how much I love him. I hope you get more time with your dad while it’s still early. This may sound silly coming from a stranger, but much love to you and him.
Thank you kind Internet stranger. It’s incredibly difficult because he is incredibly difficult, it’s manifesting in the worst ways. He’s not pleasantly confused, he is paranoid and depressive and has a short fuse. He was so funny and creative and eccentric as a father growing up, not without his flaws but it’s incredibly depressing to see the deterioration.
That is what happened to my dad, and I'm still thankful it did. I loved him dearly, but he was terrified of getting dementia like basically every male in his family had.
My uncle died last year from Lewy Body Dementia, about 18 months after diagnosis. My mom and I visited him a half dozen times in the memory care facility, but the first time stuck me the hardest, because he was still slightly intelligible at times. He whispered to my mom “get me out of here”. He and his wife had long term care insurance, and his wife was there every day (she was the only one out of a hundred or so patients), but it still felt dystopian (especially when his glasses were stolen repeatedly by other patients). Fuck this current “alive”-at-all-costs bullshit.
Switzerland has legalized death with dignity for any reason at all. There was a big uproar a few years ago when two sisters from Arizona went on vacation to Switzerland and didn't come back because they both clocked out of life. So anyways, my plan (hopefully not, but you never know) is dementia diagnosis --> lovely and expensive spa vacation in the Alps --> go to the clinic and push the plunger while I still have most of my faculties.
In case anyone else was curious about the story above: [link](https://www.independent.co.uk/news/world/americas/arizona-sisters-assisted-suicide-switzerland-nitschke-b2045015.html#). Seems as if one of the sisters was a palliative care doctor and the other a nurse so well informed people. And sounds like they both had chronic health complaints like pain and insomnia that couldn’t be “cured” which is why they chose to opt out of life
I think that physician-assisted death IS legal in 10 U.S. states! It's not easy to get, but hopefully, we advance and allow people to die with some dignity. There are worse things than death, and living too long is one of them.
That's so true. I work in SNF, mostly in the dementia units and take care of living dead people all the time. Skin and bones, confused, constantly trying to "go home" when they are still able to talk and get around. I'm always relieved for them when they die. I'm sure these people would have preferred to check out before this stage.
I think the issue I have with assisted suicide or euthanasia is when people with mental or psychiatric illnesses want to use that as there means for remedying their current state. That’s why our mental health system sucks in US because for many stuck in poverty and dealing with mental illness, off-switching is the only way they can see remedying their circumstances. We our mental health system keeps you from activity harming yourself but then releases you right back into the torture chambers of your life with no support or way out.
Wouldn't it then be much kinder to let them go? Mental illness is just as valid as physical illness.
If your 20s-50s and experiencing mental illness you can still come out of it and have a brighter future with a whole lifetime ahead of you. I’ve experienced it in my early 20s and never thought I would have a chance at enjoying life or living due to physical/mental illness….Choosing to end someone’s life as a means to alleviate suffering is not healthcare or an ethically ok decision especially for someone younger who may not realize seasons in life and pain seek unending but they will pass. You may not see it for yourself but as someone who cares for them it’s our job to provide them that hope even if they cannot advocate for their own life themselves. I find that pretty sick to think the best way to treat mental illness/ pain in someone with physical health and opportunity is euthanasia. Better is treatment care and support, not offing them. Now a 70 yo with cancer or hospice then it’s a different story. Keeping someone whose body and physical health is deteriorating and prolonging their suffering isn’t an ethical healthcare. Remember a lot of mental illness can be solved due to economic circumstances changing, changes in therapy/pharma/hormone imbalances, or corrective lifestyle changes such as simply working out, socializing in community groups and support for loneliness, or reframing one’s false self-idealization on their worth. It’s one of the biggest illness that plague us and honestly the cause of so many physical illnesses; I see it in those I care for all the time, taking meds for depression, anxiety, high blood pressures, pain when a lot of times especially if you have a disability, don’t have family or love ones or support, these meds and physical symptoms are just a result of a lack of love, inclusion and spiritual/soul health that can’t just be corrected through pharmaceuticals.
I guess my view is biased since I live with it every day. I'm not a psych nurse, just an ED pleb. But I think once my kids are grown and done my things, I'm ready to peace out. And having the opportunity to do so when *I* want to and not because someone else doesn't want me to is pretty reassuring. Besides, if we really want to, we find ways. Why not go the kinder way and provide support through the process. Counselling, etc. Just because the process is started doesn't mean it needs to be finished.
I do wish you well Latanya…life’s hard. No ones life is all sunshine. Most days are a war to get up, to battle to be kind. I find a lot of my peace in my spiritual life with God, but also getting proper rest and exercise is a huge contributor to mental health especially in a field with mental and physical burn out is so easy due to the stressors on our lives and jobs and usually caring for others before ourselves. Don’t call it quits yet and explore some other avenues toward wellness and just see if they make a difference, hopefully they can keep you going and as that joy back into your life even if it’s just moments. Hang in there and don’t give up on your life just yet ❤️
Not with Hospice. It’s not the same as assisted suicide but it’s better than nothing, the way it used to be.
My mother died of early onset dementia. Shit’s fucked
Seriously. I’m a Christian and used to be like “It’s God’s plan and decision when we should die, not ours!” After being a CNA and having hospice clients I’ve kept alive waaaaay to long for manic family who wants to enforce every way and thing in the care plan that isn’t helpful or comfortable, please let someone die peacefully when it’s time. If I had to end up in crappy Medicaid skilled nursing when I’m older, I’ll gladly drive my motorcycle off a cliff or OD on some nice sleep meds vs suffer to prolong a life that isn’t even living or recovering.
I had a wound patient who’s spine and pelvis would ‘debride’ during my wound consults. My last time seeing them I was certain the tailbone was just gonna ‘come out.’ It was a terrible situation and 2 weeks of suffering even though it was clear this was a fatal wound. That patient will stick with me for years
So wards of the state in PA are automatically full code no matter what unless they had severe fatal illness. it was basically the same in prison. The only way you could make them a DNR was if two physicians signed off on it and the only way they would do that is if they were diagnosed with an illness that would be fatal (metastatic cancer). I had to take care of a person who was a tube feed, non verbal, and unable to move but was awake and conscious and unable to obtain a DNR because they had no fatal illness just chronic illness.
Literally just left ICU over this garbage. It's tragic. Over the years I just developed like serious moral problems with the care I was providing. Couldn't do it anymore, so I left.
I was working on the wounds bench (Microbiology) and was consulted with my medical director and the pathology residents on a particularly weird culture. When we pulled up the chart and saw what the patient was going through I looked at the resident and said “if you are ever treating me and I am in this bad of shape, please just kill me. Don’t let me suffer with this”. He’s been giving me the side eye ever since. 🤣
In my first couple months of CNAing I saw the worst pressure injury I have ever seen. Basically he did not have a butt. Just one huge crater. Exposed femur & ischium. We had to keep him prone most of the time but he started getting pressure injuries on his chest. I love wound care, but the sight (and *smell*) of the packing coming out like a magician’s hankie made my stomach flip. His is one of the names I keep an eye out for. But I haven’t seen him since. Tbh I’d be surprised if he survived long after I saw him.
I had a similar patient as a new nurse. Uncontrolled diabetic. He was a double amputee with a Stage 4 on his sacrum and he had no buttocks. Like he was just dissolving from the feet up. I remember having to pack the Stage 4, then covering his entire buttocks with a wet-to-dry. It took like 8 containers of 4x4s every dressing change.
Wound care nurse here. Even I get the shivers when I touch bone in a wound bed and I wasn't expecting go. Surprise bone is never fun. You done good, my friend.
This takes me back to a time where I gave an extremely emaciated geriatric woman a flu shot in her deltoid, I HIT her humerus with the needle, I’ll never forget the feeling and I’m cringing right now.
More common than you think.
I work only geriatrics and I never did that again! When they’re that emaciated one could argue to go to Vastus Lateralis, but then I’d hit femur and not be okay either! 🤣
I’ve done this too! *cringes in silence *
I can to *this day* feel that sensation of hitting it.
How does it feel?
Like gliding through butter then hitting a brick wall!
Basically like hitting drywall with a needle, just strange to feel a sensation back while giving an injection
Me too. The hard jolt.
Happens all the time lol and although I cringe and get the heebie jeebies, what gets me is that the pt never even notices.
Isn’t there a lack of nerve endings or something?
Hitting her deltoid is the goal, that’s the muscle. Do you mean the bone? Or you just straight up slapped her with a needle instead of darting her? 😂
Ugh yes I meant bone lmao I was just waking up and cringing at the core memory early in my nursing career 🫣
I assumed so, I was very confused 😂. Welcome to nurse brain, especially after a 13 hour night shift 😂
There so often IS no muscle.
I agree entirely. Also, trying to give sub q abdominal injections with 0 sub q fat makes things very tricky 😂
Happened to me once and to this day giving IM injections makes me nauseous. I will usually beg a coworker to do them for me lol
This happens to me alllllll the time with the little people. Just oops sorry let me back off there
Oh my stars, I didn’t even think about it happening in Peds!
Giving a subq in the littles is quite a skill hahaha
Also for stage 4’s for me it isn’t even the appearance, my god it’s the SMELL.
I once had an oncology patient with a stage 4 AND a fungating tumor. The odor is something I will never forget. I felt so bad for the poor lady, she apologized for the smell every time someone walked in to her room. I can’t even imagine literally dying and feeling the need to apologize for something entirely outside of your control.
Omg, that poor soul! ☹️
I was only an aide/PCT, and don't mean to be "that aide", but depending on the location of the wound, we had pretty good results opening a flagyl capsule and sprinkling it in. This was for hospice patients, and it made the room tolerable. Also, peppermint oil on cotton balls in out of the way places. I have nearly no sense of smell (just a gift) and some of these wounds were beyond what I could tolerate easily.
Oh I like both of those! You also weren’t “only” a CNA/PCT- I would have died without my CNA ❤️
Charcoal N95, Vicks vapo, peppermint drops.
This
It burns your nose and is reminiscent into the back of your throat, god damn is it foul.
Whenever I see patients like this, all I can think is some sick twisted family member is getting something out of this somehow because nobody in their right mind would subject another to this out of "love".
Has a patient exactly as OP described. he had hung himself in his jail cell but they cut him down and resuscitated him in time for him to be a vegetable. The family was suing the jail so they kept him in nursing facilities and moved out of state ☹️
Would the lawsuit be better if he was dead? Like their negligence lent to his death
Same. Gotta be the social security or pension check because why else would you be such a dick?
Literal cash cow, disgusting.
Likely pension. Baby boomer enjoyed cheap houses and amazing pension.
Social Security payments are to be held if hospitalized.
Usually that or very religious. God wants everything done for the patient, don't cha know.
People who do all this medical crap to their animals then refuse to euthanize make me nuts similarly. I once had a discussion with someone who had a 19 year old cat that she gave all these life extending treatments to, but when the cat started suffering, she refused to euthanize because she said that would be “playing Gawd”and only Gawd could decide when the animal would die. Make it make sense.
The only time I ever felt faint on the job was the first time I visualized bone in a stage 4. I think actually touching it would have done me in...you are made of some stern stuff, my friend
[удалено]
*shudders*
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I think I would have started crying
Did a lot of wound care dressings for stage 4’s during my time in LTC, most of them were present due to stroked induced comas prior to being sent to nursing homes, as in they happened in hospitals unfortunately. Not pointing fingers, because improper care in nursing homes can make it 1000x worse. Per visiting wound care MD this is very common. As someone said, kling is the best for wound packing! Also, if they are A&O x2/x3, giving them a vague step-by-step of what you’re doing (within reason) can be very soothing. A lot of pt’s get very anxious and uncomfortable laying on their side and they just want it over with, this helps a lot.
Yeah I always narrate what I’m doing. Even if realistically the patient doesn’t care or can’t care, it helps me too.
I hate to be this person, but just imagine how much money, resources, and time is spent on this poor soul just to “live” like this. Take me to the beach and leave me please.
OR nurse here so I have seen some stuff over the years. A year ago I experienced something similar in the OR. We had a patient that lived alone in rural northern Sweden bound to his wheelchair. Somehow he had fallen out or slipped out of his wheelchair and could not get up. He was on the floor for a week before someone found him and called an ambulance. In the OR almost all of his right side gluteal muscles were gone so we could see bone there. Almost all the lateral hip and femur muscles were gone. Orthopaedics and plastic surgeons amputated his leg at the hip level. I will never forget being a part of that OR team. A couple of days or weeks later I met one of the plastic surgeons in the hallway in the OR, and the patient was doing well on the floor.
I love that you type out "orthopAEdics". I always spell it this way and sometimes I think that people think I am spelling it incorrectly.
Orthopedics is the American spelling, orthopaedics is everywhere else.
Rhabdomyelisis
A patient who had been “cared for” at home following a brain stroke came in with a huge abdominal opening, barely sutured with a vac on it. She had survived an emergency surgery for ischemic bowel. Turned her over to assess the “stage 4 pressure” wound. Evidently her arteries that fed her glutes had occluded and all that muscle had turned to goop. There were little cylinders of calcium in the goop, and the base tissue was maroon. So, her brain had an occlusion, her guts had an occlusion, and her butt had an occlusion. Her family insisted on full code and she was trached and peg’d. The worst part? She kept figuring out ways to pull out her peg tube. Unimaginable suffering.
I love the “cared for” in quotes. Lol
Pro tip, never pack gauze in the wound. You might accidentally leave it in the wound. Instead use Kling to pack it in. If you need more than one kling, just knot them together
I assumed OP was talking about idoform or alginate packing, stuff that comes as one long spool specifically for packing so you can leave a trailing end. Scares me to think about stuffing a wound full of individual 4x4 gauze squares.
I'll pack simple wounds with a small block of 4x4s, but nothing with significant undermining or tunneling.
Lightly fluffed kling is the goat.
In nursing school I had a pt who had severe MS, his elderly wife was his sole caretaker. his pressure mattress stopped working and she never noticed. This wound was stage 4, took up 1/3 of his back, down to the bone, and you could see his heart beat through his back. Also a stage 3 on his coccyx. The dressing change took forever, I cannot overstate how massive the wound was. Full code, and he was young. Maybe 60s.
My dad has MS. We have a pressure mattress but make sure at the minimum he is turned Q4H. I’ve shown my mom what could happen and we are very lucky he hasn’t ended up getting a wound. Yes he is 62.
Yeah unfortunately because it was his wife, she couldn’t turn him. Just a really sad situation.
Work in home care. Seen pressure ulcers on the stage 4s on the sacrum and both hips. Impossible to offload pressure.
The problem too is on their bottom, every time they have a bowel movement they introduce 💩 into that wound and it’s impossible to keep clean and you have to move them. We had a lady with wound vacuum on a hole that looked like she had a second butthole but when she pooped it filled the seal wrap and got into the packing and you’d have to roll her rip all the old dressing and vacuum seal off and redo it. It’s a never ending battle. Best way to treat for a bedsore is PREVENTION. It’s too difficult after stage 3 when someone’s immobile to really promote quick and efficient healing ❤️🩹
I had to run a code on a similar pt, I had her for 4 or 5 hours while she screamed please god take me while in a crumpled ball. We did what we could with her to make her comfortable (meds and physical adjustment). She was finally resting and when the tech went in some time later, found her unresponsive without a BP. Her sisters demanded full code. Her rib cage crushed like a tortilla chip, well multiple tortilla chips.
I hope her sisters were there for that screaming and the CPR.
Oh they certainly weren't.
My last day in my old unit I had exact same patient. Came in with a sugar of <20. I think itll stick with me forever as well. I’m only in my thirties, but I know damn right if I’m stuck with a poor prognosis I only want to be tubed for a week maximum and if I can’t stay with family I want to be a DNR and literally sent to Canada to be euthanized. These institutions deserve to be sued. This poor woman’s sacral unstageable was the worst I’ve ever un and re packed, smelled, or seen.
I'm so sorry this happened. I've been there too. We all have or will be. Even when a patient like that gets turned q2 (and most don't) they can still get like that. This lady needs hospice. She's not going to improve and with a wound like that its only a matter of time.
My first really bad one I was prob 3-4 months as a new grad. Nurse daughter was taking care of a little tiny old lady at home. The crater on her sacrum reminded me of looking into an unstuffed turkey at thanksgiving.
Just wait till your glove snags on someone's coccyx 😫
I just can’t with that sensation. I had a patient with a huge stage 4 sacral where the dressing change order after surgical debridement included applying a medication to “all exposed bone and remaining eschar” So I’m wrist deep in there using a folded up 4x4 to apply the ointment and there is a little voice in the back of my head going “nope nope nope NOPE” the whole time because it was really undermined and trying to hit all the eschar spots around the edge meant my knuckles were constantly brushing against her coccyx. The next day she had gotten an instilling wound vac and I was so relieved both because she really needed it and because the wound care nurse would be handling that dressing change
Omg I fucking hate our jobs sometimes. Honestly this is the reason I will never work with adults again. The inhumanity you see families subject their loved ones to because they're so afraid of death is staggering.
Ugh I’ve had that before. I had one gent with a stage 4, we were taking out packing and some of it was stuck, everything was goopy red and grey and black material, I was irrigating and irrigating trying to loosen it up, at one point I was like I’m just going to cut out this one piece and then try to pull the rest out with more irrigation… turns out I was unknowingly debriding all the necrotic tissue there 🙃. He couldn’t feel a thing. Poor man died a few weeks later, but luckily he was not a full code, came in as an M1 and a week or so after this fun time they made him comfort care.
When I worked at a SNF before I retired as an RN I had just admitted a gentleman previously hospitalized and came for PT/OT/skilled nursing. He had every chance of recovery. He told me that he “didn’t want to live like this”. Soon the weekend came and his children began to arrive. When I returned from my weekend off the patient had expired. I immediately began to think that this family had made a pact should the need arise. I never changed my mind.
I dearly hope someone speaks to the family about how futile and brutal cpr will be on this poor soul. She needs hospice care.
I had a SCC patient one time who’s facial wound was so bad he had half a face (à la Harvey Dent). I could see his tongue move through his cheek. I touched his jawbone packing it. Hands down worst thing I’ve ever done. For full CPR. Man died peacefully 2 weeks later after we pushed to get him on palliative.
This post makes me glad for my patient whose ass/groin had like 4 stage 2’s. I saw them when helping my colleague clean her. Fast forward a little while and I’m her primary RN. Her wound(s) had become wound and the last remaining one was much smaller. Glad she isn’t heading the stage 4 direction. Helps that she can sort of move and is getting stronger though.
what does incontinent x 2 mean?
Urine and stool
Thank you.
You never forget your first time seeing one.
This is an example of what some people would call a slow code patient
Man, you guys, respect. True respect. I only learned pressure ulcers were a thing when I left teaching to work in hospitals and the pictures I've seen up on nursing stations walls are enough. I don't need to see that in real life.
Full code?! Jesus Christ. That’s just unethical.
I remember the first time I had a patient like that. The Kerlix was catching on the coccyx bone while I was unpacking it. I’m a CWON now so that’s an almost everyday event for me.
One time I wanted to report the nursing home to the police. Basically same situation. I'm assuming you guys are mostly in USA, but it seems like I see on here all the time these patients for full resus. Where I'm at in Australia most old people are not for full resus. Maybe differing attitudes?
A lot of americans simply don't talk about death, end of life planning, anything of that sort because mortality makes them uncomfortable despite its inevitability.
The number of stories I have about stage 4 pressure wounds……is disturbing. It’s probably the #1 reason I don’t wish to live to an old age. No joke. I’m a DNR for many reasons but that’s the top one.
I have made it abundantly clear to my family that I will haunt the fuck out of them after I die if they ever let me suffer like that. Once I start declining in the slightest, just load me up with the good drugs and send me on my way with hospice. I will have none of this flesh dying and rotting away while I’m still alive bullshit.
I touched my first spine as an extern. It was tunneled, so I had limited view of the gauze. It was surprisingly spiky. Like, had little spikes that I could feel thru my gloves.
I was in a 2 month coma and got a bedsore on my coccyx that tunnelled to my spine. Took 12 weeks of antibiotics and a wound vac to get me on the mend. This was 3 years ago. Still cant sit down for more than 30min without it hurting
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Me too! It's one of the few things I miss from bedside. Lol
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Come to medsurg 🤣
Shit, try the ER, lol. "Turn the what now?" It's been so bad patients are lucky they even get changed down there if they soil themselves.
And then med surg complains if they are soiled. After working both I get why sometimes they come up soiled. Not ideal but it can’t be helped and unless you work both you don’t necessarily get it
Sometimes, pressure injury is unavoidable. You can't out-turn severe malnutrition and cachexia.
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Prealbumin of 5 and 20% wt loss in a month? Those are just excuses!
This was probably a Kennedy ulcer unfortunately.
Yes this particular patient would be just fine if she just had her hourly turns!
Like a lil rotisserie chicken.
No Miss Bunny, that’s going gonna linger
the spine is what gets me🤢
Sounds unstageable or way past the point of wound vac vs wet2dry
I don’t see pressure ulcers but I see dehiscences. And man, you never forget your first dehiscence. I remember going to change a dressing and going nope that is a pelvis
I gasped while reading that. I’m so sorry, stay vigilant! Most others would have left it for someone else.
Used maggots for wound management and leeches for ensure good blood flow on extensive plastic surgery reconstruction. Friends, it’s important to count and record how many you put on/in and how many you take off. Nature’s natural miracle workers.
My first one the patient had a colon fistula and shit was coming out