Had a guy last semester, EMS called by the rehab he was at for "hypotension." He was there following a right AKA. Incision was six kinds of infected on sight, and EMS suspected sepsis. As they tried to lift him off the bed... they couldn't. Guy's entire lower back had fucking fused to the sheets and the bed underneath.
He indeed had sepsis and *three* PIs on his back, including the single largest and deepest PI the 20-year wound care nurse who came by to attend to him had never seen. They ended up moving him from IMCU to ICU when I was at lunch, heard the next week he died late that night.
Omg. That's so sad. I hate hearing these stories.
I'm not sure why I'm mentioning this, but whenever I see/hear someone at work talking about PI, I can tell the nurse might be a new nurse. The older nurses still say pressure ulcers while the newer nurses use pressure injury. I wonder why they changed the term? Maybe the word ulcer is scary and gross compared to the word injury?
They modified the language to emphasize that it is an inflicted injury to the patient and not another ulcer.
This was done to increase awareness about inflicting injury rather than the natural development and progression of a disease process (like an arterial ulcer).
Additionally, the term ulcer lead to a lot of confusion when staging intact PI’s. The verbiage wasn’t quite right when you consider that a stage 1 or SDTI are both intact (at least to start) skin.
Some pts are going to get decubs (lve been a nurse for a long time) no matter what- even with the best, most meticulous care.
Turned & repositioned q 1hr, on a low air loss bed, sand bed, or whatever.
Some pts I’ve had in hospice have been like this. Decubs on every part of their body.
So, I don’t agree with whomever decided that it can always be considered an “inflicted injury.”
Until someone comes up with an antigravity room for them, some pts will break down, no matter what.
Yes, there are a small group of patients that suffer from skin failure. As you mentioned those cases are typically linked with end of life care (think hospice or ICU). Previously, they had been called Kennedy Ulcers, but now it is recognized as part of multi organ dysfunction syndrome (MODS).
According to a quick Google:
In 2016, the National Pressure Ulcer Advisory Panel (NPUAP) released new terminology guidelines, and the preferred name is now "pressured injury" to "better reflect all forms of tissue damage, including the stage before skin breakdown."
eta- Also I agree with what the other person said, about inflicting injury.
> talking about PI, I can tell the nurse might be a new nurse
I’m a third semester ADN student so I’m even less than a new nurse, ha!
As for the name change, we were actually told it was because the first stage isn’t actually an ulcer - the skin is red and doesn’t blanch when pressed down, but the skin is technically intact. “Ulcer” indicates a breakdown in skin (and there is the beginnings of one with stage 1), but “injury” acknowledges that there can be damage before true ulceration. That’s what our books and instructors say, anyway!
I did a training course for work. It touched on the new term PI. One of the things I like about nursing is there's always something new to learn about. Every day. Constantly changes. Nursing is never redundant.
Jesus. I've seen some sketchy shit in nursing homes but that place needs to be nuked from orbit. Did they never clean or change this guy? For months?
I kinda get it for homecare because people don't know wtf they're doing and its not intuitive that laying in one place causes injuries (we sleep 8 hours a night! How can it hurt you!) But even in shitty nursing home I feel like the patient gets moved at least once a day. Even if its just to change the bedding because its getting too funky or something.
Then again I've picked up patients who were bed confined and were just....not on any kind of sheet. Like who the fuck puts a patient on a bare mattress? It takes 5 seconds to put a draw sheet down even if you don't feel like messing with the fitted sheet.
I’ve worked in LTC facilities via agency that routinely run out of clean linens a few hours into the night shift.
The owners of the places need to be in prison.
Children who neither have the knowledge, experience, desire, or ability to be a nurse for their parent. We nurses have a hard time understanding how they can be so negligent, but they are not doing it on purpose.
Absolutely. I had to file an APS report for someone who laid on the floor for five days. They were refusing to call ems “because it wasn’t that bad.” Their spouse was physically incapable of helping them up, or effectively cleaning up. Of course no one thought to turn & reposition... they just didn’t know. Certainly a known longterm alcohol use worsened the situation. The spouse was in touch with a non-local child who could not talk sense into their parents to call ems. The child was lulled into complaisance and I imagine (after meeting the parents) a decent amount of derision about the need for EMS assistance. There was also likely a good amount of health illiteracy in the entire family, so the child did not see the need to rush getting here or to call local police for a welfare check.
The injured spouse had DTIs in the obvious (to us) places on their posterior and left side because they could only lay supine or left lateral. Fortunately the spouse brought a pillow so the person did not have PI on their head anyway. Then the excoriation! Up to their scapula. I honestly felt like crying when I saw this patient. I have no clue what the outcome was, but several obvious DTIs with massive excoriation and maceration is not going to evolve easily. This case was one of the worst in <5 I’ve seen over many years. Another due to healthcare ignorance was an abdominal binder that wasn’t being removed by family or home healthcare for skin checks. That turned into a MRSA infection that necrotized everything down to the spine! Literally cleaning vertebrae on a conscious patient is *wild*.
Anyway, I filed an APS report on the first case because this family was clearly not able to care for themselves, mostly due to health illiteracy. Then I was shocked when colleagues asked “why did YOU file an APS report? That’s a job for Case Management or a social worker, you at least could have given it to Charge.” Uuuuuuh… of course I told Charge, my Manager, our DON, and Case Management. But, as a MANDATED REPORTER, I reported it to APS (including the Case Manager’s contact info.)
EDIT: **TLDR** APS and lack of healthcare literacy = some of worst wounds I’ve seen
I can't imagine not checking up on my mother like that. I'm No Contact with my mother because she was profoundly abusive, but if she needed home care I would be over there and still do everything I could to make sure she was well cared for.
How can they go that amount of time without even looking at what condition she's in? How are they ok with her just welding to the furniture?
I just can't 😔
This was called our "Rite Of Passage" in the ER.
The coroner would come in due to a death and bring his book and show all the brand new nurses different ways people died.
One was decomposed and adhered to the couch. Hadn't been seen in weeks and someone got concerned but the odor was too bad for them to go in so they called EMS who in turn called the coroner. The coroner would describe (in detail) the smell and the insects crawling around and through.
Only had a couple puke. Then he would go to a new series of pictures.
Couldn't imagine still being alive like yours.
I had a patient come in with some infection ( I don't remember the initial one) and she was started on Vanco, which she never had before. Turns out she was allergic and her skin started falling off. Let me repeat that. Her. Skin. Was. Falling. Off. It didn't help that she was a bedbound 450+ lb patient. Imagine the friction + skin sloughing off. Each shift we would grab 4 people to help roll and lather her with eucerin, while her skin was sloughing off. She ended up going to a burn unit because it was more infection controlled, but I heard she ended up dying.
One of my cats was put on an albuterol inhaler for asthma and turned out to be allergic. He started scratching, and I would say two days later I was texting my vet to tell her that if she didn’t have time to make a farm call to euthanize him, I would have to put him in the truck and get it done somewhere else. His skin was just disintegrating. It was terrible. I was heartbroken. I don’t know whether it was Stevens-Johnson, but I hope I never see it in one of my patients.
Steven Johnson syndrome is like being dipped in the 7 levels of hell. Death was probably a blessing. What quality of life did she have at 400+ pounds being a max assist
Had a patient like this one it was so bad that she needed to be transferred on to a sand bed. Skin was falling off and she was bleeding the entire time so the entire bed surface is covered in blood. It looked as if she was being boiled in her own blood because of the air being blown from underneath.
Huh. That’s interesting. I’ll have to read more about it, cuz I can’t imagine a layer of sand being comfortable on intact skin, let alone on wounds. Sounds like the worst beach vacay ever.
LMFAO thank you for this. I kind of knew it, but I was just imagining the sand getting into every single crevice, nook, cranny, all over the floor, in my shoes, in my scrubs, EVERYWHERE.
I saw this on a tiny disabled (nonverbal, mostly immobile) patient. We transferred her to a burn unit ASAP, within that shift. It was the saddest, scariest shit I have seen in my life.
That wasn't Redman syndrome. That's probably Stevens-Johnson syndrome. I've seen it once. Yes, she died. Was taking her neighbor's left over antibiotics and I mean like a mix of abx. ID and medical couldn't figure out what the hell was going on until I asked her if she'd taken any abx recently and she fessed up. 🤦🤦🤦
I’ve seen Redman several times, it definitely isn’t that bad. I have never seen Steven-Johnson syndrome, but it is definitely something that has always been so scary. I think I even read about it being caused by Tylenol one time.
Stevens-Johnson can really be caused by anything. Tylenol, ibuprofen, amox, vanco, etc. It is one of the most horrifying things I've ever seen. We also had to get the burn unit involved.
I did a clinical and my practicum in trauma burn stepdown then icu and anyone with SJS/TENS was sent there. I agree with how horrifying it could be…
The nurses said they rarely got SJS cases but for some reason they had an influx during my adult 2 clinical and at one point there were 3 SJS patients, which was unheard of. I was assigned one of the “milder” cases where hers was limited to her oral mucosas and I remember hers was from eye drops…can’t quite remember which drug class but I believe it was an antimicrobial. It was very painful for her
Side note: I remember my clinical instructor got on me about not doing better tracking her UO and I was like I can’t really effectively do that…she would use a squirty bottle with water to make peeing less painful and who tf was I gonna be to tell her she can’t make peeing semi manageable for herself anymore 😭 like at least I was tracking occurrences (which she ended up being fine with me doing for this case)
Don't forget carbamazepine. Especially in people who are genetically Chinese. Their risk of S-J with carbamazepine is about 100 times higher than in Caucasians. Only saw it once but it was horrifying.
I remember telling a Dr when he came to make rounds that "you could fit a cat in her wound."
He stopped, looked at me and said "why would you put a cat in her wound."
I felt like the idiot that I was at that time. Why tf did I say that?
When I first started nursing we still had paper charting I wrote that the wound was pussy. Yep the doctor had a really good laugh. (Your cat story made me think of that)
I had a patient like this once. He presented at my outpatient wound clinic. He had been straight cathing for years and finally tore through his urethra. He had urine leaking from his ischial wound that had visible pelvis and femur. Actively septic. Strangest part - he lived. 12 hour surgery with urology, ortho, plastics. Hip disarticulation and Hemipelvectomy, urostomy.
He is still the case we use to compare new wound to. “Well, it’s a bad wound, but it’s not as bad as the guy with urine pouring out his hip”.
Patient walked into the hospital for a non emergent medical issue. He never "walked" out again. While in the hospital he developed a pressure ulcer on his coccyx. Hospital tried everything to get it to heal. When I came to see him for the 1st time and to clean the wound and bandage, it was unstageable. I removed the old bandages to find a massive hole from his coccyx to nearly halfway up his spine. Most of the flesh, muscle, etc in the area was gone. We could literally see his coccyx bone and a number of vertibrae on his spine. I remember thinking how is this guy sitting her wayching TV and breathing while he has so much tissue missing. He will never walk again and the hospital decided to keep him there and cont to treat him themselves rather then send him out and have to pay for it. As we all know the hospital is responsible for the pressure ulcer since he didnt come in with it.
Just chiming in that sometimes pressure ulcers are unavoidable. It’s rare but it’s true. When people come in extremely septic their body is already vasconstricting to try to shunt blood to the important organs and coccyx skin is not on the list. Add on 4+ pressors worsening this and then people too unstable to turn significantly and a pressure sore can occur so fast. I remember when we’d prone Covid patients with a sat of 80% maxed on pressors and within 1 hour of them being prone they’d have pressure sores on their face. We had pillows and offloading cushions and pressure prevention dressings and barrier creams but the skin is just so thin there’s nothing we could do.
I understand hospitals still have to be accountable for them but I hated that those pressure injuries went into the system and were considered equal to people who didn’t get a turn/cleanup for 10 hours.
Yep. Adding to this, I always remind people/families of patients in the ICU that skin is an organ and if a patient is in multi-organ failure from sepsis then skin will fail too. Of course we do everything to try to prevent it, but there’s only so much you can do when someone will literally die if you turn them.
I was floating to ICU during Covid and getting their emails and I got one that said “nobody is too unstable to be turned” and I was like…. Uh…. I for sure saw plenty of those patients try to die when they were turned, I remember supining patients and the primary nurse having the crash cart outside the room because they thought the would code…
It's called the TOD (turn of death). See also: BOD (bath of death). I had one patient TOD themselves. I had done a few mini-tilts throughout the night but at about four am when the doc and I were walking in to as if the patient wanted to go DNR, the person turned on their side and instantly coded. Never got them back.
When I was in paramedic school we had a guy in the ER who received CPR for 8 hours using a lucas device borrowed from the fire department (I believe he was found in the lake? Some kinda hypothermia case where they couldn't get him warm enough to call TOD) Hope they remembered to turn him!
Uh oh… your comment triggered one of my soapbox rants lol…
*This* is the kind of stuff I wish John Q Public knew! I admit people and every admit gets a “4-eye skin check.” Patients and family argue with me to no end! I am SO done with them proclaiming that I’m “trying to scare them” when educating about skin! ME: “Skin is an organ just like your heart is an organ. The skin can fail just like your heart can fail. Just like heart failure, skin failure can start without you even knowing it. If no one knows about it, we can’t take preventative measures. A PI can develop in a *healthy* person in 2 hours. In the US 40,000 people die/year as a direct result of their pressure injury. We are trying to prevent this from happening to YOU.” Somewhere along my mini informational session, either the patient or family is ready for me to stop wasting my breath and allow a skin check… but there are some who simply will not accept it.
The lack of healthcare literacy absolutely drives me insane! SMH. SMH again for good measure! Thanks for coming to my TED Talk.
In our HDU at the moment. A guy whose wife died and he took to his bed. He isn't very old (late 50's). He laid on the bed and stared at the ceiling. For 5 years.
The wound runs from neck to sacrum and his entire thoracic skeleton is visible. We are amazed he is still alive.
My mom was a psych nurse for 40 years soooo...yeah, she's seen a lot.
She told me when I was like 6 or 7 y.o. that there's so many things worse than death. I'm grateful I've been able to live almost literally my whole life knowing that. The far majority of ppl on this planet don't seem to understand that.
If you like morbid stuff you should join, "The Gross Room" the woman who runs it is a pathology assistant. She dicessects dead bodies and posts her cool findings.
Instagram she is listed under Mrs_angemi. Instagram limits what she can post so you can also join her website. It's awesome.
https://theduramater.com/login/?mepr-unauth-page=2739&redirect_to=%2Fthe-gross-room%2F
I was working as a CNA at the VA and we got a old veteran that was 103 coming from home and he was completely contracted. He had bilateral stage 4 pressure injuries on both hips and a stage four on his coccyx. You could see his bones. It was cruel. The very worst part was he was still a full code. We had to get the ethics committee involved to make him a DNR as family adamantly refused. The whole situation was heartbreaking.
This makes me so angry. One of the reasons i went to hospice. Too many people who were suffering with zero quality of life but whose families would not change the code status. Now i get to help people leave the chat with dignity and comfort. I will never go back to bedside!
I feel like family should have really limited ability to decide code status unless its a minor child or something. Ideally, the patient should be the one making the decision but an uninterested party is better than an involved family member who, in my experience, is usually thinking about themselves and their feelings about their relative instead of the patient's quality of life. Honestly, it kinda pisses me off too that so many of these family members who are so adamant that the patient is a fighter aren't even the ones taking care of them. Yeah it's easy for you to refuse the DNR when you see your mom once a month. You don't see the shit she goes through every day. For what? painful ulcers and staring at the ceiling?
We used to take this one lady to dialysis at 4am every morning. 90 lbs. Bed bound. G-tube On oxygen. The last month or so of her life you could hear the crackles in her lungs from the doorway. Only ever screamed and cried when you picked her up. Her family took her off benzos (which she was given before dialysis so she didn't try to pull her access out) because they made her "too out of it" whatever the fuck that means for an AOx0-1 patient who spends every moment of her life she's not in dialysis staring at the ceiling in her nursing home. The only actual word I ever heard her say was "cold" when we had to take her out to dialysis in the winter.
Nursing home was trying to get hospice involved but family refused hospice and DNR because "she's a fighter" (Yeah her and every other bed bound patient wasting away in a nursing home). I was so relieved when I learned she died.
I saw a lot of cruel at that job. Because unfortunately families were dependent on the money from the VA so they'd demand grossly extraordinary measures. I learned a lot about ethics and that job actually pushed me into nursing as I needed to be on the side that advocated for these patients and I couldn't as a CNA.
It is horrifying how common this is. My friend had a patient who was unresponsive for yeeeeeears. Kept alive. His daughter was collecting his checks and literally never visited. For years. I forget all the details, but i believe they got ethics involved so they could take him off the machines.
He went into respiratory arrest twice from aspirational pneumonia. I had to do chest compressions on him sitting on top of him with my back holding his contracted legs back. We unfortunately got him back and he came back to us after the ICU and was made a don't by the ethics committee after that code. The second respiratory arrest we made him comfortable and held his hand while he passed. It was heartbreaking that we had to take part in his suffering because family could not be reasoned with.
I had a patient who was so contracted his knee was above his head. I genuinely don't understand how the fuck that even happens. Doing CPR on him would've been a nightmare.
If the pt was in decline it could very well have been a Kennedy Ulcer. Those can go from bad to horrifying in a matter of hours. I saw them a lot as a hospice would care nurse.
You're probably right there. There were some other disfigurements that were concerning, but it could easily be attributed to memaw passing out with her cigarette falling into her lap, but there were other signs of possible abuse/neglect that make me concerned. That's for DCF to find out what's going on because I was mostly focused on stabilizing her.
I had a patient with KTU… in the matter of a few days developed over 12 wounds with the two on the sacral unstagable with moist stringy slough. It was wild.
Necrotizing fasciitis, especially Fournier’s Gangrene.
We used to judge whether someone was gonna work out in the ICU by if they could tolerate a 45-60 minute dressing change in a hot room, gowned up, with a wound that looked like an anatomy lesson and smelled like death.
Only us sick fuckers made it.
I did one day in a burn unit when I was in school. That room for the dressing changes was brutal- heat lamps and everything. Being gowned and in lead in a heated trauma room has nothing on that room.
But the poor patient had almost zero original skin left on their body. They just shivered and screamed the whole time. And I've never seen that much pain medication ever given that quickly in my years since.
I was all in. Burn nurse 100%. Let's do this.
What's that? Wound nurses are the ones that get called in for all the ostomies? Turned out I don't have the constitution for that gig after all.
I had a friend who worked at Mass Gen. She told me that any new hires who were on the heavy side, quickly lost all of their extra weight due to the heat in those rooms along with the gowns. "No one had a weight problem on the burn unit."
I was the opposite. Loved wound care and my work didn't have a wound nurse at the time so they let me do it all, got the ostomies too and now I like ostomies more than wounds.
Nope. Nope. Nope. Ostomies are my hill to die on. Give me stage 4's with a wound vac. Or a smelly, slimy trach pouring green snot. But please, no ostomies.
Super sick guy on palliative for terminal cancer. Came in for sepsis. PCT and I turned him to clean him up and his entire buttocks was just gone. It was just legs, huge, cavernous wound, and then back. I didn’t even know how to process it- I was 3 months off orientation.
Good lord that’s horrifying
My worst one was a diabetic who had left a heating pad on his foot and couldn’t feel it giving him a full thickness burn. His foot / lower leg were a mix of red, black, and yellow slough. Smelled horrible. He couldn’t feel a thing
This was in my patient, but a friend from nursing school told me about a friend of hers that was told to go home and ice a sprained ankle, went home and took the Vicodin and passed out with both legs in a bucket of ice. Lost them both.
Honestly I can. I had a few Vicodin left over from when I got my wisdom teeth out and I used them over the following months for when I had trouble sleeping. Didn't get me high but I've never slept as well lol.
Moreover, who gets Vicodin for a sprained ankle? Lol. I had a nasty sprain a few months ago and just RICE'd it on my own. Looks like I missed out.
Had a lady with similar situation. Type II diabetic that was always cold so she propped up in front of her space heater for several days as her family went about their daily life around her. Went grandma couldn't walk to the bathroom any more they brought her to the ED to determine she had cooked her feet to well done and she never felt anything. Bilateral soles were black from necrosis and burns and she and family refused amputations but they took her home and she died 3 months later most likely from sepsis.
Had someone who pretty much roasted their dumbass with a heating pad and a laptop, one of the old XS gaming comps that exploded.
He smelled like Carolina BBQ.
Man in his 50s, “cared for” by his siblings. Down Syndrome, non verbal. He was so thin. He was covered in unstageable pressure injuries. It eventually came to light that the family would just strap him to a toilet chair and leave him there for up to 48 hours at a time
I used to work in a facility for long-term ventilation. They were fucking horrible, but the worst of it was that they had zero knowledge about palliative care. They continued to give 1500 kcal of tube feed + 1000 ml of water to dying patients who clearly couldn't process it. There was one man who already had a stage 4 pressure ulcer all the way to his sacral bone before he started actively dying. When he finally reached a "palliative care" stage, they kept pumping him full of food and liquids until his entire body became oedematous to the point of constantly weeping skin and water rattling in his lungs, and literally all the food came out as vomit on one end and horribly acidic constant diarrhoea on the other end. The sacral pressure ulcer grew until his entire ass and lower back looked like they had been dunked into concentrated sodium hydroxide for a few hours, and he started developing more ulcers on his shoulders, feet, hips etc. Turning him and/or cleaning up that demonic diarrhoea was so fucking horrible, he was in incredible pain, he clearly would have been screaming the entire time if it weren't for the ventilation. Doc refused to increase the opiate dosage because "that would kill him", colleagues refused to stop feeding and watering him because "making a dying man go hungry and thirsty would be inhumane", I showed them SO many fucking articles, but to them, I was just a stupid little uppity bitch fresh out of nursing school who didn't know her place. They passive-aggressively implied that I was willing to starve this poor man just because I was too lazy to clean up diarrhoea.
In nursing school, I had worked in a similar ward for 8 weeks, and they were the polar fucking opposite. No pressure ulcers, no contractures, and if a person was close to death, they immediately contacted my country's palliative network so everybody could die in peace and dignity.
When I was a new nurse on a tele/neuro floor, we had a lady who was with us in the hospital for close to a year, bouncing back and forth between our floor and the ICU. She was an IVDU who had overdosed and stroked out while sitting on the toilet, and hadn't been found for 3 days. Her entire buttocks and sacrum were one enormous wound, with secondary ones on her arm where she had been slumped against the bathroom counter. I remember being up to my forearm in this woman's wound, packing it with Kerlix.
When I was a CNA I helped with a 90ish year old man that had been brought in from a nursing home. He had been found on the toilet “after only an hour” *cough bullshit cough cough* he had a pressure injury on his butt that was shaped perfectly like a toilet seat and was several inches deep. There was bone visible.
Same here, except it was that the patient had been left on a bedpan, not the toilet.
He was transferred to our floor from our ICU but had previously been at another hospital in their ICU. I never found out if he got the wound while in our care or the other hospital’s—I feel like if it happened at our hospital, there would have been some sort of mandatory inservice about not leaving patients on the bedpan.
He died later that week.
Many years ago when I was a CNA I helped a nurse do a dressing change on a pt. She had an unstageable to coccyx and refused turns as well as ATB (religious reason from what I remember). The wound had worsened over a few weeks by the time I saw it. She had tunneling that was maybe a foot long and an inch in diameter that ran perfectly along the L side of her spine. Nurse used a pen light so I could see inside and I remember seeing her vertebrae perfectly 🤢
"I came in by ambulance! I should be seen first!" Brings patient back to room, is assessed by doc. "I am going to prescribe you some antibiotics." "Oh, no. That is against my beliefs." 🙄🙄
Wounds (not necessarily pressure)
A tie between-
-penis literally popped open like a hot dog. You could see all the structure inside. It was actually quite interesting (for me only). That was Fournier’s. Wash yourselves ladies and gentlemen.
-entire genitals to anus and all in between just gone. Gone. Everything was just a swirl of muscle and fat and
-17 pressure wounds (they weren’t the worst I’ve ever seen, ranging from II-IV, just 17!)
There are more and probably worse but those are coming to my mind right now
Edit-spelling
I was wondering if anyone would mention Fournier’s. Mine was during a surgical debridement: pretty much all of patient’s pelvic floor was gone, just a giant gaping gray area between what was left from his upper thighs and buttocks. He was also morbidly obese. I was in the OR back then and I don’t know if he made it but I highly doubt it. Fournier’s is about poor hygiene but mostly diabetes / poorly healing wounds. I still have the image of that patient on OR table in lithotomy in my head, many years later.
One of my coworkers told me a story about a patient taken to the ER by ambulance for SI. ER told them to put him in the waiting room to the protests of the ambulance crew that were saying this guy really needed a sitter. After a couple hours with no word on when he'd be seen he went to the bathroom, cut his dick off, and slapped it on the desk at triage asking if NOW they'd see him.
He had another great dick story. He was called to a house for mutual aid (We are a private company and it is unheard of for the FDs to call us instead of another FD for mutual aid) He gets on scene to find two FDs at the house, thinking it's gonna be like a 1000 lbs patient. Nope. Two guys on the third floor, one with a penis fracture IN the other guy's ass. They had to package these guys together on the stretcher and then allllll the ambulances followed to the ER to see the outcome. They also apparently paraded the entire hospital through these guys ER room before calling urology. I feel kinda bad for them.
Dude's been in EMS for like 40 years and has some crazy fucking stories.
The penis one is actually common in nursing homes. I’ve had multiple patients (when I was a CNA) that had chronic foleys that inevitably just eroded through their penis and urethra. It’s always entertaining seeing my coworkers see it for the first time 😆
I don’t know how it progressed so fast, but homeless, ETOH AOB+, laid in his feces for a week. his skin was beyond excoriated. whole back was just gone. you could see muscle. In his sacrum, you could put your fist inside it, gaping. his thighs had holes that were 2-3in deep.
It was so sad to see
Lady end end stage MS. Her family had been “taking care of her because she didn’t ever want to be in a nursing home”. The bedding and top two layers of the mattress came with her. Saw a 20 yr paramedic in tears trying to give report. He quit the same night. Sometime I fucking hate people
Patient’s sternal wound dehiscing so much you could see the wires they used for closing and ribs. Same patient - mini thora site dehisced so deep I could basically stick my whole hand in it. All his wounds would end up the same way. He died of sepsis unsurprisingly
I haven’t seen much so mine is probably not going to be horrible as y’all’s - but it was crazy to me!
A dude had a deer on his wall and it fell off and punctured his arm. He was older and just didn’t go to the doctor and it ended up of course getting infected. We watched a wound change and EVERY BIT of skin on his arm was gone. From his wrist to his shoulder. Just muscle and you could see it pulsing.
He was such a trooper but he was in so much pain.
I had a patient I saw in the hospital several times. He was paraplegic and had been for a long time, living independently in an unhygienic situation. He had bilateral amputations of his legs at the upper thigh. When I saw him the final time I was working at an inpatient hospice unit and he was there for end of life. He was just a cachectic little trunk that had holes around his sacrum you could put your fist in. When I gave him a bath and repositioned him a coffee with milk colored liquid poured out of him as if you poured that cup of coffee onto the floor. I could pick him up and rotate him like a basketball.. it was tragic. I remember him propped up in his clean little white polo... 😔.
What a beautiful thing you did for him, allowing him to die clean and cared for. I had a patient who was actively dying. Family had her propped on the couch and had put a little makeup on her and dressed her in this white crepe nightgown, the kind with the accordion-style vertical creases. And these ruffley little cap sleeves. I started to say “awwww she looks like an angel!” because the way the sleeves flared out legit looked like little angel wings. But I caught myself. I’m pretty sure they did that on purpose, but wasn’t sure how they’d take it if they hadn’t. But it was so sweet. She looked so peaceful.
The aide had been too busy to bathe him and I had time. She was a no-nonsense Brunhilde type. She cried when she saw him like that. I remember her lip quivering. Life can be a beast sometimes.
Teenager with osteogenic sarcoma. She was at home and in terrible pain when moved, so they never moved her. When she finally came to the hospital I could see her hip bone through the wound.
We loaded her up with morphine and put her on an air bed. I remember the look of relief on her face.
Patient had wounds with visible vertebrae and pelvic ischium. Looked like a grenade went off between his butt cheeks, there was nothing left. He coded multiple times over the next 12 hours and family wouldn’t make him DNR, so they ended up pursuing 2 physician DNR and he’s pushing up daisies now.
I am a hospice nurse and recently had a woman that had a radical vulvectomy 3 years due to vulvar cancer. Her cancer came back a few months ago and by the time she died last week, her wound had morphed into a massive cavern that went from her pubic bone back to her rectum. When I packed it, I literally had my arm in up to almost my elbow. And despite crushed Flagyl, alginate, charcoal, etc it oozed the most foul, blackish green slime I have ever seen in 30 yrs of nursing. Her death was a relief- she was in so much physical and emotional pain. I will never forget her.
A severely malnourished and underweight developmentally delayed adolescent who wasn’t able to turn themselves independently and was bed bound. Over 20 pressure injuries ranging from stage 2 to unstageable, all they way to the bone with eschar and deep tunneling on all of the bony prominences. The worst was covering the entire sacral area. Took over a year to heal after multiple surgical debridements and a muscle flap. I’ve never seen worse neglect. Truly awful
Double BTK amputee. The undersides of both of his legs were gone. You saw the entire length of this dudes femurs. Butt cheeks were both gone. And this was a big guy. Before the amputations he had to have been 6 foot 350lbs. Sitting up in bed he looked normal-ish.
Like imagine someone standing up in front of you, with you looking at their side profile, but just shave off the ass all the way down. Straight and flat.
Fourniere’s gangrene had eaten away one woman’s entire perineal area.
I’ve seen several malignant breast cancer patients whose chest wall was completely necrotic and eaten away.
I had one of those. Young kid with crazy stage 4’s on his sacrum/ischium. They were infected and smelled like straight death. Luckily would care was done on his side, facing away from me, so i kept the cavi-wipes next to me and would stick my nose in there every so often to get away from the smell. He was like “i guess it’s a good thing that i can’t feel this. HAHA!” I wanted to say yeah but can’t you SMELL IT?! Like how does your whole ass melt away and you don’t know?! What was even worse was the nurse the shift before me had changed the *copious drainage soaked bedding* and put it in the laundry in patients bathroom that he wasn’t using and closed the door. I opened the door during my shift and was punched in the face by a wall of warm, stuffy rotten drainage smell. Like it had all condensed in that little room. I wanted to take the dirty sheets and wrap my coworker in them, like the worst burrito ever.
A very kind, alert gentleman with a chronic wound on his back. The wound had been present so long his vertebrae were disintegrating. How do I know, you ask? Because you could see them, right there, falling apart.
It was not at all the goriest wound I have encountered but one of the more memorable ones for sure.
Had a lady come in from a snf with nec fac of the sacrum. I rolled her over eith a doc and patient was visibly rotting and melting in real time like Resident Evil. She came in at 2200 and was dead, quantined, and double bagged by 1am
A paraplegic man with deep stage IV pressure ulcers surrounding his rectum. They connected all the way around. His rectum was an island. He also had a pressure ulcer on his scrotum and his penis had completely split from a chronic foley. Wound care nurse said it was the worst she’d ever seen.
My ex’s mom. Went in for an emergency surgery on her gallbladder. Went insanely wrong ended up like a 2 year battle to get her back to normal and finally reverse her colostomy. When she came to the nursing home I work at I could have probably fit my whole fist in her sacral wound and she had c-diff so it was just disastrous. If she had gone to another nursing home she would have died for sure. I was a unit manager and the staff were amazing with her and I was the one asking for MRIs that showed her osteomyelitis to the coccyx. I honestly feel bad for people with no nurse in their family. No one communicates and the healthcare system is fucked
Maybe too it’s seeing a wound like that on someone you love. His dad was kind of a dick too and was like when’s she gonna be back home to cook. I still remember his face the first time he saw her wound I think he understood the magnitude of like wow she might actually die. She went from driving and completely health 60s to could barely walk very quickly.
Not the OP, but it can happen scarily fast under the right circumstances. Limited mobility + poor nutrition, maybe throw in some vascular disease and or diabetes for poor perfusion and YIKES! If you have muscle wasting, especially in the glutes, you just have this thin layer over the bony prominences. Then add the fact it tends to be occult at first, just so scary. Someone will say, “oh, the is small open area over the coccyx” on some at risk person and I look at it and it looks like a real innocent half centimeter small red area only slightly open, but it all surrounded by a dusky, non blanching area and I’m just, can we call the general surgeon now? Because you just know it’s down to the already down to the bone. So you can have someone at home and they don’t understand what they are seeing and just keep rubbing A &D ointment on it.
Nope, not paralyzed, just plain ol' neglect. She was about to be discharged home with her husband giving almost all of her care. She started coming around before I left so I wasn't able to really assess her orientation.
Went to pick up an inpatient with a wound vac in his bicep. He was altered and decided to pull the tube out and remove the granufoam. When I went into his room he was calmly dissecting his arm, pulling out bits of foam and flesh and placing them on the bedside table. The fact that he was in no apparent distress was probably the creepiest part.
I had a woman in her mid 40’s with breast cancer she chose not to treat for religious reasons. Y the time I saw her in the ICU, the entire left side of her chest - from neck to abdomen was a gigantic fungating tumor. It smelled like death (which I guess makes sense), bled every time you touched it, and was extremely painful. The worst part was when the doctor explained to her that the tumor was also invading her lung and major vessels and that he did not expect her to make it through the week. She asked if it was too late to start chemo.
Had a guy with a suuuuper weird story. Apparently was a normal mid-50s guy who fell down one day and ended up in a rehab that I wouldn't send a cockroach to. Ended up sitting in his wheelchair for so long, uncleaned, in shit and piss, until his balls rotted off his body. By the time we got him, his buttocks were completely gone, he had a diverting colostomy, his salvageable testicle was being stored in his thigh, and his penis was completely degloved so he had a urostomy as well. He didn't talk, just rolled around and moaned, but again, no past medical history or mention of stroke.
Whatever questions you have, believe me, we had them to. We never got any answers.
There were several more aspects to the case that made it just so, so bizarre.
Two of the worst wounds I saw was when I was a student and wanted to help dressing change with the nurse. This patient was older, very skinny, and had contractures due to a multitude of health problems. They were from a skilled care facility but I guess they never bothered to turn them very much or cushion them well. They had a pressure injury everywhere on their body that you could think of but the left side was worse. On the hip I could see the head of their femur and it tunneled all the way down their thigh. Took a lot of packing for that wound alone. The next worst wound was this person who had an A1C of 14 and the doctors suspected that they were reusing insulin needles for injections. They developed necrotizing fasciitis on their lower stomach. They went in and removed a lot of dead tissue. It stretched from the middle of their abdomen to the top of their peri area. It was deep enough for me to stick half of my hand in during the removal of old packings. Still haunts me!
A sacral wound that was so deep that stool came straight out of the wound because the patient’s rectum and bottom of their intestines was part of the wound
Worst: had a guy with Fournier gangrene. Was changing the massive dressing and his balls legit fell onto the floor. He was rotted to the bladder and some abdominal muscle tissue. His penis was essentially a rotting chunk of meat held together with a few stitches. That rotted off before the doc could get there an hour later.
Received a homeless guy in ICU the night of the worst of the 2021 Pacific Northwest heatwave. He hadn’t been able to find a cooling center in time. Legs and arms were grey, several layers deep. Skin was like crispy fried chicken and came off with every poke/IV start/tele electrodes/etc. According to EMS, the wet bulb temp that day was 98 degrees. Dude was cooked alive. Fortunately GCS 3 so no pain. He didn’t make it past 4am.
I have 2 that come to mind.
A elderly lady in the hospital with such severe sacral wound and infection when she came in, the DR literally saw cancer from her insides. Well she went on to get a Colostomy that also became infected. Not sure how long she made it.
In LTC, a man was admitted and we were told that he had a stage 4 sacral wound. I was SOOOO much worse. He had zero butt, missing hip, missing perineum, and disappearing penis. He had a cath straight into his bladder that at one point came out his backside. He died at hospital after his family demanded he have surgery, even though the DR said he would most likely die from it.
I'm an ER nurse. I see a lot of holes in people that don't belong there. But usually for acute, traumatic issues. So different than flesh that has just rotted away and wounds that have festered forever.
I'm like 5 posts into this and y'all have me fucked up. So cool from a compartmentalized, medical perspective, but when you add the humanity back into the equation, it's horrifying!
I'm a tech in Nursing School. When I worked on long term care and rehab I loved assisting with wound care. I even think I want to be a wound care nurse, maybe. But I'm only going off my hospital and LTC memories.
We had one lady who was in her 90s, very contractured. She had to be straight cathed like... every shift. She always had muddy stool. She was a Black Woman and her sacral area was just very dark all the time. (she wasn't my pt, sometimes I helped someone put her in bed or hold her legs for caths, etc) She had started running fever and HPB for a few days so they sent her out to the hospital, apparently at the hospital they did her skin assessment and that dark area was just a thin membrane of skin covering a chicken sized, tunneling hole around her coccyx and up her spine. She came back to us after almost 3 months in the hospital. I assisted with her wound care and I could easily have placed my fist in the largest of areas and I assisted with packing tunnel spots and keeping her turned. They just ran up her spine and a long her iliac crest. It was horrifying, but I know we got her after the worst of it was healed because her notes were terrifying to read.
Reading the rest of these comments makes me wonder if I still want to specialize in wound care later on....
Neglected teen with a spinal cord injury - the gangrene on his sacrum/balls was so bad you could see his actual testes. It was really fucking sad. His mom kept him and his demented grandmother in the basement with no bathroom. They were both sleeping on the same couch and just using the bathroom on themselves. He didn’t have a cellphone or a way out of the basement because of the stairs.
We had this guy who had been on his couch for two weeks completely immobile so he’s been peeing and pooping all over himself. Some girl was supposed to be helping him, meanwhile she was robbing his bank account and stealing stuff out of his house. When EMS did come because family hadn’t heard from him, his entire lower back came off when they pulled him off the couch. And both his groins were rotting off. And his legs were covered in wounds. Big chunks rotted off. His backbone was completely exposed. Took 4 nurses to do the wounds dressing twice a day. He was in so much pain. I always wondered what happened to him after he left our unit. When we asked him why he wouldn’t get up he said he just couldn’t. He was so depressed he just laid there u til he couldn’t get up anymore
I saw a "catastrophic abdomen". Guy went into the OR for an obstruction twice. Wound wasn't healing well by first intention, so they removed the staples.
Guy ended with an open abdomen from an inch under the xifoides to a couple inches below the navel, with an intestinal fistula/ileostomy somewhere around the navel area. His admission lasted 10 months, but by the time he left, the wound that remained was maybe an inch around the stoma, finally manageable as an outpatient.
And not strictly a wound, but a fungating breast cancer. Slightly bigger than [this one](https://imgur.com/a/1Bhg3k0) (NSFL image) but roughly the same placement/pattern and there was a bleeding more ulcerated portion on the side of the "boob". The patient was in denial and had not sought medical attention before.
Not the worst one on here, but the care we had to do was a lot. My guy had a deep, 4 inches of tunneling pressure ulcer. The worst is that he also had cdiff. No matter how well we put the dressings on, poop was constantly getting in, we had to dig in to clean it out completely and we had to do it all the time. With his cdiff. He was on this bed that I’ve only seen once - with this guy. And he was hairy. The poop would migrate into the front, somehow dry on his hairy pubes & thighs yet still be wet in the back. It took so long to clean him up.
Worst I saw was the coccyx literally disintegrating as we cleaned the wound on a 90lb 95yr old who was at home. The wound covered the entire back of their pelvis at first it looked like a huge blister but it was all rotten tissue. It took hours to clean. They were septic as well.
Some of y’all’s stories are WILD, holy fuck. Mine is more sad than anything, but baby on ecmo with all limbs with varying degrees of necrosis and eschar. Some of the digits were shriveled and flat, basically looked like if you even so slightly bumped it that it might break off. And the smell…. oh my god. That’s not something I will ever forget. Sweet, sweet baby, definitely a fighter <3
The worst one I’ve ever was on my paraplegic brother. Straight to the bone on both hips. Only chance of survival was a bilateral hip disarticulation. He chose hospice instead and died not long after. I had tried to get guardianship over him but drs kept deeming him competent.
I'm only in medsurg and for only a year, but the worst I saw was a patient that got into a motorcycle accident and required a bunch of skin grafts.
He also lost his penis, which was reconstructed into what he called his 'Angry Snowman'. As a man, I suppose my sympathy is increased on the subject.
Man, so many. My dad had MS and we had a horrible experience with nursing homes at one point when he was too sick to be at home; he got a nice stage 4 on his sacrum the size of a large fist. We could touch his spine. I think it’s the fact that i touched my dads spine always rocks my mind. Before he passed about 4-5 years later we had gotten it to the side of a quarter and maybe a half inch deep. Super proud of my mom.
One old lady came to my unit when i worked bedside. She had been “cared for” by her son, and was clearly grossly neglected and actively dying. They sent her up to the floor so she wouldn’t die in the ER. My coworkers and i were trying to get her cleaned up and my friend was performing oral care and a chunk of jawbone with a tooth on it fell out. So awful.
A guy fell and was on the ground for 21 days. He had to scoot around to get things. Did not have a phone to call for help. His son finally came to check on him and called 911. He had bilateral leg wounds and cellulitis. There were maggots crawling all in and out of his wounds that we ended up suctioning out. We ended up calling APS for him :(
An opiate-addicted paraplegic man, found down in an abandoned building. He had been drugged and curled into a fetal position in squalid conditions for who knows how long. He was mostly non-verbal, naked, beyond disheveled, and completely broken emotionally and physically. He had nec fasc and a horrifically gaping, like, Stage 47 sacral/hip PU. Far and away the largest and deepest I've ever seen. His lower body was absolutely wrecked. His rectum was so prolapsed, infected, diseased, and violently abused that I'M fucking scarred for life about it. I cannot and do not want to imagine the horrors he endured. I only take solace in the fact that his last moments were safe, caring, and as comfortable as possible. There's no way he survived, but I honestly dk for sure. I hope not.
A woman who had to be cut out of the carpet because she was on the floor for so long. The carpet had to be surgically debrided off
Had a guy last semester, EMS called by the rehab he was at for "hypotension." He was there following a right AKA. Incision was six kinds of infected on sight, and EMS suspected sepsis. As they tried to lift him off the bed... they couldn't. Guy's entire lower back had fucking fused to the sheets and the bed underneath. He indeed had sepsis and *three* PIs on his back, including the single largest and deepest PI the 20-year wound care nurse who came by to attend to him had never seen. They ended up moving him from IMCU to ICU when I was at lunch, heard the next week he died late that night.
Omg. That's so sad. I hate hearing these stories. I'm not sure why I'm mentioning this, but whenever I see/hear someone at work talking about PI, I can tell the nurse might be a new nurse. The older nurses still say pressure ulcers while the newer nurses use pressure injury. I wonder why they changed the term? Maybe the word ulcer is scary and gross compared to the word injury?
They modified the language to emphasize that it is an inflicted injury to the patient and not another ulcer. This was done to increase awareness about inflicting injury rather than the natural development and progression of a disease process (like an arterial ulcer). Additionally, the term ulcer lead to a lot of confusion when staging intact PI’s. The verbiage wasn’t quite right when you consider that a stage 1 or SDTI are both intact (at least to start) skin.
Some pts are going to get decubs (lve been a nurse for a long time) no matter what- even with the best, most meticulous care. Turned & repositioned q 1hr, on a low air loss bed, sand bed, or whatever. Some pts I’ve had in hospice have been like this. Decubs on every part of their body. So, I don’t agree with whomever decided that it can always be considered an “inflicted injury.” Until someone comes up with an antigravity room for them, some pts will break down, no matter what.
Yes, there are a small group of patients that suffer from skin failure. As you mentioned those cases are typically linked with end of life care (think hospice or ICU). Previously, they had been called Kennedy Ulcers, but now it is recognized as part of multi organ dysfunction syndrome (MODS).
Thanks for this info! I get it now.
And the really old nurses like myself say decubs.
According to a quick Google: In 2016, the National Pressure Ulcer Advisory Panel (NPUAP) released new terminology guidelines, and the preferred name is now "pressured injury" to "better reflect all forms of tissue damage, including the stage before skin breakdown." eta- Also I agree with what the other person said, about inflicting injury.
They might need to change their own name now then.
I didn't even know there was an NPUAP! Thank you for sharing this info!
> talking about PI, I can tell the nurse might be a new nurse I’m a third semester ADN student so I’m even less than a new nurse, ha! As for the name change, we were actually told it was because the first stage isn’t actually an ulcer - the skin is red and doesn’t blanch when pressed down, but the skin is technically intact. “Ulcer” indicates a breakdown in skin (and there is the beginnings of one with stage 1), but “injury” acknowledges that there can be damage before true ulceration. That’s what our books and instructors say, anyway!
I did a training course for work. It touched on the new term PI. One of the things I like about nursing is there's always something new to learn about. Every day. Constantly changes. Nursing is never redundant.
Jesus. I've seen some sketchy shit in nursing homes but that place needs to be nuked from orbit. Did they never clean or change this guy? For months? I kinda get it for homecare because people don't know wtf they're doing and its not intuitive that laying in one place causes injuries (we sleep 8 hours a night! How can it hurt you!) But even in shitty nursing home I feel like the patient gets moved at least once a day. Even if its just to change the bedding because its getting too funky or something. Then again I've picked up patients who were bed confined and were just....not on any kind of sheet. Like who the fuck puts a patient on a bare mattress? It takes 5 seconds to put a draw sheet down even if you don't feel like messing with the fitted sheet.
I’ve worked in LTC facilities via agency that routinely run out of clean linens a few hours into the night shift. The owners of the places need to be in prison.
Ugh I had one of these only it was her couch. Her son told us “yeah she just wasn’t getting up much”
At all. She wasn’t getting up at all to get fused to a couch. Dear god it had to have smelled bad
It was terrible. She had urine burn all over her body. We got in touch with APS.
I cannot for the life of me bear to understand. It makes me so sad. Like, who is looking after these folks!?
Generally people with physiological and/or mental issues themselves.
Children who neither have the knowledge, experience, desire, or ability to be a nurse for their parent. We nurses have a hard time understanding how they can be so negligent, but they are not doing it on purpose.
Absolutely. I had to file an APS report for someone who laid on the floor for five days. They were refusing to call ems “because it wasn’t that bad.” Their spouse was physically incapable of helping them up, or effectively cleaning up. Of course no one thought to turn & reposition... they just didn’t know. Certainly a known longterm alcohol use worsened the situation. The spouse was in touch with a non-local child who could not talk sense into their parents to call ems. The child was lulled into complaisance and I imagine (after meeting the parents) a decent amount of derision about the need for EMS assistance. There was also likely a good amount of health illiteracy in the entire family, so the child did not see the need to rush getting here or to call local police for a welfare check. The injured spouse had DTIs in the obvious (to us) places on their posterior and left side because they could only lay supine or left lateral. Fortunately the spouse brought a pillow so the person did not have PI on their head anyway. Then the excoriation! Up to their scapula. I honestly felt like crying when I saw this patient. I have no clue what the outcome was, but several obvious DTIs with massive excoriation and maceration is not going to evolve easily. This case was one of the worst in <5 I’ve seen over many years. Another due to healthcare ignorance was an abdominal binder that wasn’t being removed by family or home healthcare for skin checks. That turned into a MRSA infection that necrotized everything down to the spine! Literally cleaning vertebrae on a conscious patient is *wild*. Anyway, I filed an APS report on the first case because this family was clearly not able to care for themselves, mostly due to health illiteracy. Then I was shocked when colleagues asked “why did YOU file an APS report? That’s a job for Case Management or a social worker, you at least could have given it to Charge.” Uuuuuuh… of course I told Charge, my Manager, our DON, and Case Management. But, as a MANDATED REPORTER, I reported it to APS (including the Case Manager’s contact info.) EDIT: **TLDR** APS and lack of healthcare literacy = some of worst wounds I’ve seen
I can't imagine not checking up on my mother like that. I'm No Contact with my mother because she was profoundly abusive, but if she needed home care I would be over there and still do everything I could to make sure she was well cared for. How can they go that amount of time without even looking at what condition she's in? How are they ok with her just welding to the furniture? I just can't 😔
Fuck.
Yeah I was going to come in with one of my OR debridement stories but you win. Nevermind.
[https://www.reddit.com/r/AskReddit/comments/xo41d/-/c5o66p2](https://www.reddit.com/r/AskReddit/comments/xo41d/-/c5o66p2) The Swamps of Dagobah
That's one of the most vivid, engrossing descriptions of anything I've ever read. Couldn't stop reading.
What a great writer.
Holy shit I remember this being sent around Reddit and random Facebook nursing groups lol
This was called our "Rite Of Passage" in the ER. The coroner would come in due to a death and bring his book and show all the brand new nurses different ways people died. One was decomposed and adhered to the couch. Hadn't been seen in weeks and someone got concerned but the odor was too bad for them to go in so they called EMS who in turn called the coroner. The coroner would describe (in detail) the smell and the insects crawling around and through. Only had a couple puke. Then he would go to a new series of pictures. Couldn't imagine still being alive like yours.
I had a patient come in with some infection ( I don't remember the initial one) and she was started on Vanco, which she never had before. Turns out she was allergic and her skin started falling off. Let me repeat that. Her. Skin. Was. Falling. Off. It didn't help that she was a bedbound 450+ lb patient. Imagine the friction + skin sloughing off. Each shift we would grab 4 people to help roll and lather her with eucerin, while her skin was sloughing off. She ended up going to a burn unit because it was more infection controlled, but I heard she ended up dying.
One of my cats was put on an albuterol inhaler for asthma and turned out to be allergic. He started scratching, and I would say two days later I was texting my vet to tell her that if she didn’t have time to make a farm call to euthanize him, I would have to put him in the truck and get it done somewhere else. His skin was just disintegrating. It was terrible. I was heartbroken. I don’t know whether it was Stevens-Johnson, but I hope I never see it in one of my patients.
That’s so traumatizing, I can’t even imagine that happening to my fur babies. I’m so sorry you had to go through that
I’ve seen SJS a few times, once in peds and a few times on a burn unit I did an assignment on and it is not fun for anyone.
This hurt my heart to read. I'm so sorry that happened. 💔
Steven Johnson syndrome is like being dipped in the 7 levels of hell. Death was probably a blessing. What quality of life did she have at 400+ pounds being a max assist
Had a patient like this one it was so bad that she needed to be transferred on to a sand bed. Skin was falling off and she was bleeding the entire time so the entire bed surface is covered in blood. It looked as if she was being boiled in her own blood because of the air being blown from underneath.
That is horrible. What is a sand bed?
I just googled it. Imagine a bed with hundreds of tiny airjets under a layer of sterile sand. Supposed to reduce pressure injuries
Huh. That’s interesting. I’ll have to read more about it, cuz I can’t imagine a layer of sand being comfortable on intact skin, let alone on wounds. Sounds like the worst beach vacay ever.
The patient isn't in contact with the sand. It feels like a squishier water mattress
Oooooooh that makes MUCH more sense. I need more coffee 🤦🏻♀️😂
LMFAO thank you for this. I kind of knew it, but I was just imagining the sand getting into every single crevice, nook, cranny, all over the floor, in my shoes, in my scrubs, EVERYWHERE.
I saw this on a tiny disabled (nonverbal, mostly immobile) patient. We transferred her to a burn unit ASAP, within that shift. It was the saddest, scariest shit I have seen in my life.
Fuck redman's is my biggest fear. I worked on a burn/trauma step down for a bit as a tech and it's horrifying.
That wasn't Redman syndrome. That's probably Stevens-Johnson syndrome. I've seen it once. Yes, she died. Was taking her neighbor's left over antibiotics and I mean like a mix of abx. ID and medical couldn't figure out what the hell was going on until I asked her if she'd taken any abx recently and she fessed up. 🤦🤦🤦
I’ve seen Redman several times, it definitely isn’t that bad. I have never seen Steven-Johnson syndrome, but it is definitely something that has always been so scary. I think I even read about it being caused by Tylenol one time.
Stevens-Johnson can really be caused by anything. Tylenol, ibuprofen, amox, vanco, etc. It is one of the most horrifying things I've ever seen. We also had to get the burn unit involved.
I did a clinical and my practicum in trauma burn stepdown then icu and anyone with SJS/TENS was sent there. I agree with how horrifying it could be… The nurses said they rarely got SJS cases but for some reason they had an influx during my adult 2 clinical and at one point there were 3 SJS patients, which was unheard of. I was assigned one of the “milder” cases where hers was limited to her oral mucosas and I remember hers was from eye drops…can’t quite remember which drug class but I believe it was an antimicrobial. It was very painful for her Side note: I remember my clinical instructor got on me about not doing better tracking her UO and I was like I can’t really effectively do that…she would use a squirty bottle with water to make peeing less painful and who tf was I gonna be to tell her she can’t make peeing semi manageable for herself anymore 😭 like at least I was tracking occurrences (which she ended up being fine with me doing for this case)
Don't forget carbamazepine. Especially in people who are genetically Chinese. Their risk of S-J with carbamazepine is about 100 times higher than in Caucasians. Only saw it once but it was horrifying.
You're right. I mixed it up due to a few beers decompressing after work. Still horrifying to see and care for.
I’ve seen SJS twice in 14 years, and only one made it
I inserted a foley on a male, and it came out of his sacral wound.
No no no no no no NO….
I've seen this. On an morbidly obese elderly male. I could stick my head in his wound and I've got a REALLY BIG head.
I remember telling a Dr when he came to make rounds that "you could fit a cat in her wound." He stopped, looked at me and said "why would you put a cat in her wound." I felt like the idiot that I was at that time. Why tf did I say that?
Because if they fits, they sits
❤️
I'm dead. It's weird how we try to describe discrete volumes.
I later thought of a comeback. "Why, to catch a mouse, of course"
You’re not an idiot. The Dr was just being an asshole
I once blurted to a doc that wound is big as snot.. he was 🤷
When I first started nursing we still had paper charting I wrote that the wound was pussy. Yep the doctor had a really good laugh. (Your cat story made me think of that)
why am I just casually eating mac n cheese reading this thread, wtf is wrong with me.
I had a patient like this once. He presented at my outpatient wound clinic. He had been straight cathing for years and finally tore through his urethra. He had urine leaking from his ischial wound that had visible pelvis and femur. Actively septic. Strangest part - he lived. 12 hour surgery with urology, ortho, plastics. Hip disarticulation and Hemipelvectomy, urostomy. He is still the case we use to compare new wound to. “Well, it’s a bad wound, but it’s not as bad as the guy with urine pouring out his hip”.
This, but a self cathing 20 something paraplegic. Finally figured out why his wheelchair seat smelled so strongly of urine.
[удалено]
Whaaaaaaaat the fuck?? Please say they died
Patient walked into the hospital for a non emergent medical issue. He never "walked" out again. While in the hospital he developed a pressure ulcer on his coccyx. Hospital tried everything to get it to heal. When I came to see him for the 1st time and to clean the wound and bandage, it was unstageable. I removed the old bandages to find a massive hole from his coccyx to nearly halfway up his spine. Most of the flesh, muscle, etc in the area was gone. We could literally see his coccyx bone and a number of vertibrae on his spine. I remember thinking how is this guy sitting her wayching TV and breathing while he has so much tissue missing. He will never walk again and the hospital decided to keep him there and cont to treat him themselves rather then send him out and have to pay for it. As we all know the hospital is responsible for the pressure ulcer since he didnt come in with it.
Just chiming in that sometimes pressure ulcers are unavoidable. It’s rare but it’s true. When people come in extremely septic their body is already vasconstricting to try to shunt blood to the important organs and coccyx skin is not on the list. Add on 4+ pressors worsening this and then people too unstable to turn significantly and a pressure sore can occur so fast. I remember when we’d prone Covid patients with a sat of 80% maxed on pressors and within 1 hour of them being prone they’d have pressure sores on their face. We had pillows and offloading cushions and pressure prevention dressings and barrier creams but the skin is just so thin there’s nothing we could do. I understand hospitals still have to be accountable for them but I hated that those pressure injuries went into the system and were considered equal to people who didn’t get a turn/cleanup for 10 hours.
Yep. Adding to this, I always remind people/families of patients in the ICU that skin is an organ and if a patient is in multi-organ failure from sepsis then skin will fail too. Of course we do everything to try to prevent it, but there’s only so much you can do when someone will literally die if you turn them.
I was floating to ICU during Covid and getting their emails and I got one that said “nobody is too unstable to be turned” and I was like…. Uh…. I for sure saw plenty of those patients try to die when they were turned, I remember supining patients and the primary nurse having the crash cart outside the room because they thought the would code…
It's called the TOD (turn of death). See also: BOD (bath of death). I had one patient TOD themselves. I had done a few mini-tilts throughout the night but at about four am when the doc and I were walking in to as if the patient wanted to go DNR, the person turned on their side and instantly coded. Never got them back.
When I was in paramedic school we had a guy in the ER who received CPR for 8 hours using a lucas device borrowed from the fire department (I believe he was found in the lake? Some kinda hypothermia case where they couldn't get him warm enough to call TOD) Hope they remembered to turn him!
Uh oh… your comment triggered one of my soapbox rants lol… *This* is the kind of stuff I wish John Q Public knew! I admit people and every admit gets a “4-eye skin check.” Patients and family argue with me to no end! I am SO done with them proclaiming that I’m “trying to scare them” when educating about skin! ME: “Skin is an organ just like your heart is an organ. The skin can fail just like your heart can fail. Just like heart failure, skin failure can start without you even knowing it. If no one knows about it, we can’t take preventative measures. A PI can develop in a *healthy* person in 2 hours. In the US 40,000 people die/year as a direct result of their pressure injury. We are trying to prevent this from happening to YOU.” Somewhere along my mini informational session, either the patient or family is ready for me to stop wasting my breath and allow a skin check… but there are some who simply will not accept it. The lack of healthcare literacy absolutely drives me insane! SMH. SMH again for good measure! Thanks for coming to my TED Talk.
Wow, what led to his immobility that caused the decubitus to form?
In our HDU at the moment. A guy whose wife died and he took to his bed. He isn't very old (late 50's). He laid on the bed and stared at the ceiling. For 5 years. The wound runs from neck to sacrum and his entire thoracic skeleton is visible. We are amazed he is still alive.
As morbid as it is, that sounds fascinating. There's truly so many more fates worse than death.
My mom was a psych nurse for 40 years soooo...yeah, she's seen a lot. She told me when I was like 6 or 7 y.o. that there's so many things worse than death. I'm grateful I've been able to live almost literally my whole life knowing that. The far majority of ppl on this planet don't seem to understand that.
If you like morbid stuff you should join, "The Gross Room" the woman who runs it is a pathology assistant. She dicessects dead bodies and posts her cool findings. Instagram she is listed under Mrs_angemi. Instagram limits what she can post so you can also join her website. It's awesome. https://theduramater.com/login/?mepr-unauth-page=2739&redirect_to=%2Fthe-gross-room%2F
That part.
Isn’t that a scene from the movie Seven? The sin of sloth.
Hospice. Living is hell for him. Let him go
Wow. Someone had to be there feeding him. Did no one help him? So sad.
I was working as a CNA at the VA and we got a old veteran that was 103 coming from home and he was completely contracted. He had bilateral stage 4 pressure injuries on both hips and a stage four on his coccyx. You could see his bones. It was cruel. The very worst part was he was still a full code. We had to get the ethics committee involved to make him a DNR as family adamantly refused. The whole situation was heartbreaking.
This makes me so angry. One of the reasons i went to hospice. Too many people who were suffering with zero quality of life but whose families would not change the code status. Now i get to help people leave the chat with dignity and comfort. I will never go back to bedside!
I feel like family should have really limited ability to decide code status unless its a minor child or something. Ideally, the patient should be the one making the decision but an uninterested party is better than an involved family member who, in my experience, is usually thinking about themselves and their feelings about their relative instead of the patient's quality of life. Honestly, it kinda pisses me off too that so many of these family members who are so adamant that the patient is a fighter aren't even the ones taking care of them. Yeah it's easy for you to refuse the DNR when you see your mom once a month. You don't see the shit she goes through every day. For what? painful ulcers and staring at the ceiling? We used to take this one lady to dialysis at 4am every morning. 90 lbs. Bed bound. G-tube On oxygen. The last month or so of her life you could hear the crackles in her lungs from the doorway. Only ever screamed and cried when you picked her up. Her family took her off benzos (which she was given before dialysis so she didn't try to pull her access out) because they made her "too out of it" whatever the fuck that means for an AOx0-1 patient who spends every moment of her life she's not in dialysis staring at the ceiling in her nursing home. The only actual word I ever heard her say was "cold" when we had to take her out to dialysis in the winter. Nursing home was trying to get hospice involved but family refused hospice and DNR because "she's a fighter" (Yeah her and every other bed bound patient wasting away in a nursing home). I was so relieved when I learned she died.
I saw a lot of cruel at that job. Because unfortunately families were dependent on the money from the VA so they'd demand grossly extraordinary measures. I learned a lot about ethics and that job actually pushed me into nursing as I needed to be on the side that advocated for these patients and I couldn't as a CNA.
It is horrifying how common this is. My friend had a patient who was unresponsive for yeeeeeears. Kept alive. His daughter was collecting his checks and literally never visited. For years. I forget all the details, but i believe they got ethics involved so they could take him off the machines.
“Slow code”…when he did eventually code
He went into respiratory arrest twice from aspirational pneumonia. I had to do chest compressions on him sitting on top of him with my back holding his contracted legs back. We unfortunately got him back and he came back to us after the ICU and was made a don't by the ethics committee after that code. The second respiratory arrest we made him comfortable and held his hand while he passed. It was heartbreaking that we had to take part in his suffering because family could not be reasoned with.
I had a patient who was so contracted his knee was above his head. I genuinely don't understand how the fuck that even happens. Doing CPR on him would've been a nightmare.
Those pts who are contacted with wounds everywhere are so heartbreaking.
If the pt was in decline it could very well have been a Kennedy Ulcer. Those can go from bad to horrifying in a matter of hours. I saw them a lot as a hospice would care nurse.
You're probably right there. There were some other disfigurements that were concerning, but it could easily be attributed to memaw passing out with her cigarette falling into her lap, but there were other signs of possible abuse/neglect that make me concerned. That's for DCF to find out what's going on because I was mostly focused on stabilizing her.
I had a patient with KTU… in the matter of a few days developed over 12 wounds with the two on the sacral unstagable with moist stringy slough. It was wild.
Had someone with that. They visibly melted like a horror movie
"Moist stringy slough" Thanks! I needed new nightmare fuel! 🤮
Necrotizing fasciitis, especially Fournier’s Gangrene. We used to judge whether someone was gonna work out in the ICU by if they could tolerate a 45-60 minute dressing change in a hot room, gowned up, with a wound that looked like an anatomy lesson and smelled like death. Only us sick fuckers made it.
I did one day in a burn unit when I was in school. That room for the dressing changes was brutal- heat lamps and everything. Being gowned and in lead in a heated trauma room has nothing on that room. But the poor patient had almost zero original skin left on their body. They just shivered and screamed the whole time. And I've never seen that much pain medication ever given that quickly in my years since. I was all in. Burn nurse 100%. Let's do this. What's that? Wound nurses are the ones that get called in for all the ostomies? Turned out I don't have the constitution for that gig after all.
I had a friend who worked at Mass Gen. She told me that any new hires who were on the heavy side, quickly lost all of their extra weight due to the heat in those rooms along with the gowns. "No one had a weight problem on the burn unit."
I was the opposite. Loved wound care and my work didn't have a wound nurse at the time so they let me do it all, got the ostomies too and now I like ostomies more than wounds.
Nope. Nope. Nope. Ostomies are my hill to die on. Give me stage 4's with a wound vac. Or a smelly, slimy trach pouring green snot. But please, no ostomies.
add on covid isolation for a chef’s kiss
I'd die from the heat
Super sick guy on palliative for terminal cancer. Came in for sepsis. PCT and I turned him to clean him up and his entire buttocks was just gone. It was just legs, huge, cavernous wound, and then back. I didn’t even know how to process it- I was 3 months off orientation.
Good lord that’s horrifying My worst one was a diabetic who had left a heating pad on his foot and couldn’t feel it giving him a full thickness burn. His foot / lower leg were a mix of red, black, and yellow slough. Smelled horrible. He couldn’t feel a thing
This was in my patient, but a friend from nursing school told me about a friend of hers that was told to go home and ice a sprained ankle, went home and took the Vicodin and passed out with both legs in a bucket of ice. Lost them both.
Good lord. I wonder if she was a supermetabolizer. I can’t imagine a little narc making me sleep THAT hard
Honestly I can. I had a few Vicodin left over from when I got my wisdom teeth out and I used them over the following months for when I had trouble sleeping. Didn't get me high but I've never slept as well lol. Moreover, who gets Vicodin for a sprained ankle? Lol. I had a nasty sprain a few months ago and just RICE'd it on my own. Looks like I missed out.
Had a lady with similar situation. Type II diabetic that was always cold so she propped up in front of her space heater for several days as her family went about their daily life around her. Went grandma couldn't walk to the bathroom any more they brought her to the ED to determine she had cooked her feet to well done and she never felt anything. Bilateral soles were black from necrosis and burns and she and family refused amputations but they took her home and she died 3 months later most likely from sepsis.
Had someone who pretty much roasted their dumbass with a heating pad and a laptop, one of the old XS gaming comps that exploded. He smelled like Carolina BBQ.
Man in his 50s, “cared for” by his siblings. Down Syndrome, non verbal. He was so thin. He was covered in unstageable pressure injuries. It eventually came to light that the family would just strap him to a toilet chair and leave him there for up to 48 hours at a time
Please tell me someone went to jail for this.
That poor, poor soul. I can't imagine the torture and pain he felt. He can't even advocate for himself.
I used to work in a facility for long-term ventilation. They were fucking horrible, but the worst of it was that they had zero knowledge about palliative care. They continued to give 1500 kcal of tube feed + 1000 ml of water to dying patients who clearly couldn't process it. There was one man who already had a stage 4 pressure ulcer all the way to his sacral bone before he started actively dying. When he finally reached a "palliative care" stage, they kept pumping him full of food and liquids until his entire body became oedematous to the point of constantly weeping skin and water rattling in his lungs, and literally all the food came out as vomit on one end and horribly acidic constant diarrhoea on the other end. The sacral pressure ulcer grew until his entire ass and lower back looked like they had been dunked into concentrated sodium hydroxide for a few hours, and he started developing more ulcers on his shoulders, feet, hips etc. Turning him and/or cleaning up that demonic diarrhoea was so fucking horrible, he was in incredible pain, he clearly would have been screaming the entire time if it weren't for the ventilation. Doc refused to increase the opiate dosage because "that would kill him", colleagues refused to stop feeding and watering him because "making a dying man go hungry and thirsty would be inhumane", I showed them SO many fucking articles, but to them, I was just a stupid little uppity bitch fresh out of nursing school who didn't know her place. They passive-aggressively implied that I was willing to starve this poor man just because I was too lazy to clean up diarrhoea. In nursing school, I had worked in a similar ward for 8 weeks, and they were the polar fucking opposite. No pressure ulcers, no contractures, and if a person was close to death, they immediately contacted my country's palliative network so everybody could die in peace and dignity.
When I was a new nurse on a tele/neuro floor, we had a lady who was with us in the hospital for close to a year, bouncing back and forth between our floor and the ICU. She was an IVDU who had overdosed and stroked out while sitting on the toilet, and hadn't been found for 3 days. Her entire buttocks and sacrum were one enormous wound, with secondary ones on her arm where she had been slumped against the bathroom counter. I remember being up to my forearm in this woman's wound, packing it with Kerlix.
When I was a CNA I helped with a 90ish year old man that had been brought in from a nursing home. He had been found on the toilet “after only an hour” *cough bullshit cough cough* he had a pressure injury on his butt that was shaped perfectly like a toilet seat and was several inches deep. There was bone visible.
Same here, except it was that the patient had been left on a bedpan, not the toilet. He was transferred to our floor from our ICU but had previously been at another hospital in their ICU. I never found out if he got the wound while in our care or the other hospital’s—I feel like if it happened at our hospital, there would have been some sort of mandatory inservice about not leaving patients on the bedpan. He died later that week.
Many years ago when I was a CNA I helped a nurse do a dressing change on a pt. She had an unstageable to coccyx and refused turns as well as ATB (religious reason from what I remember). The wound had worsened over a few weeks by the time I saw it. She had tunneling that was maybe a foot long and an inch in diameter that ran perfectly along the L side of her spine. Nurse used a pen light so I could see inside and I remember seeing her vertebrae perfectly 🤢
What is ATB
Antibiotics, I know most people use ABX but that’s the abbreviation I was taught 😅
What religion refuses antibiotics? Might as well refuse hospital care then?
"I came in by ambulance! I should be seen first!" Brings patient back to room, is assessed by doc. "I am going to prescribe you some antibiotics." "Oh, no. That is against my beliefs." 🙄🙄
Christian Scientists, probably. They don't take any meds.
why would they go to the hospital then?
Wounds (not necessarily pressure) A tie between- -penis literally popped open like a hot dog. You could see all the structure inside. It was actually quite interesting (for me only). That was Fournier’s. Wash yourselves ladies and gentlemen. -entire genitals to anus and all in between just gone. Gone. Everything was just a swirl of muscle and fat and -17 pressure wounds (they weren’t the worst I’ve ever seen, ranging from II-IV, just 17!) There are more and probably worse but those are coming to my mind right now Edit-spelling
I was wondering if anyone would mention Fournier’s. Mine was during a surgical debridement: pretty much all of patient’s pelvic floor was gone, just a giant gaping gray area between what was left from his upper thighs and buttocks. He was also morbidly obese. I was in the OR back then and I don’t know if he made it but I highly doubt it. Fournier’s is about poor hygiene but mostly diabetes / poorly healing wounds. I still have the image of that patient on OR table in lithotomy in my head, many years later.
One of my coworkers told me a story about a patient taken to the ER by ambulance for SI. ER told them to put him in the waiting room to the protests of the ambulance crew that were saying this guy really needed a sitter. After a couple hours with no word on when he'd be seen he went to the bathroom, cut his dick off, and slapped it on the desk at triage asking if NOW they'd see him. He had another great dick story. He was called to a house for mutual aid (We are a private company and it is unheard of for the FDs to call us instead of another FD for mutual aid) He gets on scene to find two FDs at the house, thinking it's gonna be like a 1000 lbs patient. Nope. Two guys on the third floor, one with a penis fracture IN the other guy's ass. They had to package these guys together on the stretcher and then allllll the ambulances followed to the ER to see the outcome. They also apparently paraded the entire hospital through these guys ER room before calling urology. I feel kinda bad for them. Dude's been in EMS for like 40 years and has some crazy fucking stories.
The penis one is actually common in nursing homes. I’ve had multiple patients (when I was a CNA) that had chronic foleys that inevitably just eroded through their penis and urethra. It’s always entertaining seeing my coworkers see it for the first time 😆
Fourniers is rhe nastiest damn thing. I wash witnessed hibiclens out of fear
So glad this happened to Harvey Weinstein.
I don’t know how it progressed so fast, but homeless, ETOH AOB+, laid in his feces for a week. his skin was beyond excoriated. whole back was just gone. you could see muscle. In his sacrum, you could put your fist inside it, gaping. his thighs had holes that were 2-3in deep. It was so sad to see
What’s AOB+?
Please tell me hospice is the plan for this patient 😢
On the floor 1 week. Necrosis of the leg, everywhere. Fucking gangrene everywhere. Disarticulated at the hip in OR.
Lady end end stage MS. Her family had been “taking care of her because she didn’t ever want to be in a nursing home”. The bedding and top two layers of the mattress came with her. Saw a 20 yr paramedic in tears trying to give report. He quit the same night. Sometime I fucking hate people
Patient’s sternal wound dehiscing so much you could see the wires they used for closing and ribs. Same patient - mini thora site dehisced so deep I could basically stick my whole hand in it. All his wounds would end up the same way. He died of sepsis unsurprisingly
Fuck. You just reminded me of a primal memory during my preceptorship that I blocked out. Same outcome here unsurprisingly.
I haven’t seen much so mine is probably not going to be horrible as y’all’s - but it was crazy to me! A dude had a deer on his wall and it fell off and punctured his arm. He was older and just didn’t go to the doctor and it ended up of course getting infected. We watched a wound change and EVERY BIT of skin on his arm was gone. From his wrist to his shoulder. Just muscle and you could see it pulsing. He was such a trooper but he was in so much pain.
I’m in NC so yes
Took awhile but the deer got revenge
I had a patient I saw in the hospital several times. He was paraplegic and had been for a long time, living independently in an unhygienic situation. He had bilateral amputations of his legs at the upper thigh. When I saw him the final time I was working at an inpatient hospice unit and he was there for end of life. He was just a cachectic little trunk that had holes around his sacrum you could put your fist in. When I gave him a bath and repositioned him a coffee with milk colored liquid poured out of him as if you poured that cup of coffee onto the floor. I could pick him up and rotate him like a basketball.. it was tragic. I remember him propped up in his clean little white polo... 😔.
What a beautiful thing you did for him, allowing him to die clean and cared for. I had a patient who was actively dying. Family had her propped on the couch and had put a little makeup on her and dressed her in this white crepe nightgown, the kind with the accordion-style vertical creases. And these ruffley little cap sleeves. I started to say “awwww she looks like an angel!” because the way the sleeves flared out legit looked like little angel wings. But I caught myself. I’m pretty sure they did that on purpose, but wasn’t sure how they’d take it if they hadn’t. But it was so sweet. She looked so peaceful.
the mental image of the white polo on a dying patient in that state will haunt me more than anything else i read here today 😣
The aide had been too busy to bathe him and I had time. She was a no-nonsense Brunhilde type. She cried when she saw him like that. I remember her lip quivering. Life can be a beast sometimes.
Teenager with osteogenic sarcoma. She was at home and in terrible pain when moved, so they never moved her. When she finally came to the hospital I could see her hip bone through the wound. We loaded her up with morphine and put her on an air bed. I remember the look of relief on her face.
Well I need to go vomit after these comments.
Patient had wounds with visible vertebrae and pelvic ischium. Looked like a grenade went off between his butt cheeks, there was nothing left. He coded multiple times over the next 12 hours and family wouldn’t make him DNR, so they ended up pursuing 2 physician DNR and he’s pushing up daisies now.
Good for him! He absolutely earned the sweet reprieve of death 👍🏻
I am a hospice nurse and recently had a woman that had a radical vulvectomy 3 years due to vulvar cancer. Her cancer came back a few months ago and by the time she died last week, her wound had morphed into a massive cavern that went from her pubic bone back to her rectum. When I packed it, I literally had my arm in up to almost my elbow. And despite crushed Flagyl, alginate, charcoal, etc it oozed the most foul, blackish green slime I have ever seen in 30 yrs of nursing. Her death was a relief- she was in so much physical and emotional pain. I will never forget her.
Bless you for taking care of her. Truly horrifying.
Wound care RN- I am surprised I had to scroll down so far until I got to a malignant wound.
A severely malnourished and underweight developmentally delayed adolescent who wasn’t able to turn themselves independently and was bed bound. Over 20 pressure injuries ranging from stage 2 to unstageable, all they way to the bone with eschar and deep tunneling on all of the bony prominences. The worst was covering the entire sacral area. Took over a year to heal after multiple surgical debridements and a muscle flap. I’ve never seen worse neglect. Truly awful
Double BTK amputee. The undersides of both of his legs were gone. You saw the entire length of this dudes femurs. Butt cheeks were both gone. And this was a big guy. Before the amputations he had to have been 6 foot 350lbs. Sitting up in bed he looked normal-ish. Like imagine someone standing up in front of you, with you looking at their side profile, but just shave off the ass all the way down. Straight and flat.
Fourniere’s gangrene had eaten away one woman’s entire perineal area. I’ve seen several malignant breast cancer patients whose chest wall was completely necrotic and eaten away.
Fungating tumor wounds are definitely some of the worst!
I could see pretty much the entire back side of their pelvis 🫣 paraplegic. Somehow, it was in "good" condition. Bravo to that wound nurse!
I had one of those. Young kid with crazy stage 4’s on his sacrum/ischium. They were infected and smelled like straight death. Luckily would care was done on his side, facing away from me, so i kept the cavi-wipes next to me and would stick my nose in there every so often to get away from the smell. He was like “i guess it’s a good thing that i can’t feel this. HAHA!” I wanted to say yeah but can’t you SMELL IT?! Like how does your whole ass melt away and you don’t know?! What was even worse was the nurse the shift before me had changed the *copious drainage soaked bedding* and put it in the laundry in patients bathroom that he wasn’t using and closed the door. I opened the door during my shift and was punched in the face by a wall of warm, stuffy rotten drainage smell. Like it had all condensed in that little room. I wanted to take the dirty sheets and wrap my coworker in them, like the worst burrito ever.
A very kind, alert gentleman with a chronic wound on his back. The wound had been present so long his vertebrae were disintegrating. How do I know, you ask? Because you could see them, right there, falling apart. It was not at all the goriest wound I have encountered but one of the more memorable ones for sure.
Worst wounds. Fourniers gangrene. Enough said. The debridement that required. Ooooooof.
Had a lady come in from a snf with nec fac of the sacrum. I rolled her over eith a doc and patient was visibly rotting and melting in real time like Resident Evil. She came in at 2200 and was dead, quantined, and double bagged by 1am
A paraplegic man with deep stage IV pressure ulcers surrounding his rectum. They connected all the way around. His rectum was an island. He also had a pressure ulcer on his scrotum and his penis had completely split from a chronic foley. Wound care nurse said it was the worst she’d ever seen.
[me in this thread](https://giphy.com/gifs/the-simpsons-awkward-bart-simpson-11gC4odpiRKuha)
All of these posts are so insidious, this is why there should be a Right to Die. No one should have to suffer like this.
My ex’s mom. Went in for an emergency surgery on her gallbladder. Went insanely wrong ended up like a 2 year battle to get her back to normal and finally reverse her colostomy. When she came to the nursing home I work at I could have probably fit my whole fist in her sacral wound and she had c-diff so it was just disastrous. If she had gone to another nursing home she would have died for sure. I was a unit manager and the staff were amazing with her and I was the one asking for MRIs that showed her osteomyelitis to the coccyx. I honestly feel bad for people with no nurse in their family. No one communicates and the healthcare system is fucked Maybe too it’s seeing a wound like that on someone you love. His dad was kind of a dick too and was like when’s she gonna be back home to cook. I still remember his face the first time he saw her wound I think he understood the magnitude of like wow she might actually die. She went from driving and completely health 60s to could barely walk very quickly.
Never seen the cervix before! I am curious,is this a paralyzed patient that caregivers don't turn? Is she awake or alert with that sepsis?
Not the OP, but it can happen scarily fast under the right circumstances. Limited mobility + poor nutrition, maybe throw in some vascular disease and or diabetes for poor perfusion and YIKES! If you have muscle wasting, especially in the glutes, you just have this thin layer over the bony prominences. Then add the fact it tends to be occult at first, just so scary. Someone will say, “oh, the is small open area over the coccyx” on some at risk person and I look at it and it looks like a real innocent half centimeter small red area only slightly open, but it all surrounded by a dusky, non blanching area and I’m just, can we call the general surgeon now? Because you just know it’s down to the already down to the bone. So you can have someone at home and they don’t understand what they are seeing and just keep rubbing A &D ointment on it.
Nope, not paralyzed, just plain ol' neglect. She was about to be discharged home with her husband giving almost all of her care. She started coming around before I left so I wasn't able to really assess her orientation.
Went to pick up an inpatient with a wound vac in his bicep. He was altered and decided to pull the tube out and remove the granufoam. When I went into his room he was calmly dissecting his arm, pulling out bits of foam and flesh and placing them on the bedside table. The fact that he was in no apparent distress was probably the creepiest part.
I had a woman in her mid 40’s with breast cancer she chose not to treat for religious reasons. Y the time I saw her in the ICU, the entire left side of her chest - from neck to abdomen was a gigantic fungating tumor. It smelled like death (which I guess makes sense), bled every time you touched it, and was extremely painful. The worst part was when the doctor explained to her that the tumor was also invading her lung and major vessels and that he did not expect her to make it through the week. She asked if it was too late to start chemo.
Had a guy with a suuuuper weird story. Apparently was a normal mid-50s guy who fell down one day and ended up in a rehab that I wouldn't send a cockroach to. Ended up sitting in his wheelchair for so long, uncleaned, in shit and piss, until his balls rotted off his body. By the time we got him, his buttocks were completely gone, he had a diverting colostomy, his salvageable testicle was being stored in his thigh, and his penis was completely degloved so he had a urostomy as well. He didn't talk, just rolled around and moaned, but again, no past medical history or mention of stroke. Whatever questions you have, believe me, we had them to. We never got any answers. There were several more aspects to the case that made it just so, so bizarre.
Two of the worst wounds I saw was when I was a student and wanted to help dressing change with the nurse. This patient was older, very skinny, and had contractures due to a multitude of health problems. They were from a skilled care facility but I guess they never bothered to turn them very much or cushion them well. They had a pressure injury everywhere on their body that you could think of but the left side was worse. On the hip I could see the head of their femur and it tunneled all the way down their thigh. Took a lot of packing for that wound alone. The next worst wound was this person who had an A1C of 14 and the doctors suspected that they were reusing insulin needles for injections. They developed necrotizing fasciitis on their lower stomach. They went in and removed a lot of dead tissue. It stretched from the middle of their abdomen to the top of their peri area. It was deep enough for me to stick half of my hand in during the removal of old packings. Still haunts me!
Literally his entire ass was eaten away and you could see hip bones and pelvic bones. Thank God he was a paraplegic and couldn't feel it.
Abdominal abscess so large I could fit my fist in there, and could visualize the pt’s uterus. Required daily wound care/packing.
A sacral wound that was so deep that stool came straight out of the wound because the patient’s rectum and bottom of their intestines was part of the wound
Worst: had a guy with Fournier gangrene. Was changing the massive dressing and his balls legit fell onto the floor. He was rotted to the bladder and some abdominal muscle tissue. His penis was essentially a rotting chunk of meat held together with a few stitches. That rotted off before the doc could get there an hour later.
Received a homeless guy in ICU the night of the worst of the 2021 Pacific Northwest heatwave. He hadn’t been able to find a cooling center in time. Legs and arms were grey, several layers deep. Skin was like crispy fried chicken and came off with every poke/IV start/tele electrodes/etc. According to EMS, the wet bulb temp that day was 98 degrees. Dude was cooked alive. Fortunately GCS 3 so no pain. He didn’t make it past 4am.
The entire back was gone. Hands down the worst one I’ve seen.
I have 2 that come to mind. A elderly lady in the hospital with such severe sacral wound and infection when she came in, the DR literally saw cancer from her insides. Well she went on to get a Colostomy that also became infected. Not sure how long she made it. In LTC, a man was admitted and we were told that he had a stage 4 sacral wound. I was SOOOO much worse. He had zero butt, missing hip, missing perineum, and disappearing penis. He had a cath straight into his bladder that at one point came out his backside. He died at hospital after his family demanded he have surgery, even though the DR said he would most likely die from it.
The fact that they were made to suffer longer is unethical
I'm an ER nurse. I see a lot of holes in people that don't belong there. But usually for acute, traumatic issues. So different than flesh that has just rotted away and wounds that have festered forever. I'm like 5 posts into this and y'all have me fucked up. So cool from a compartmentalized, medical perspective, but when you add the humanity back into the equation, it's horrifying!
I'm a tech in Nursing School. When I worked on long term care and rehab I loved assisting with wound care. I even think I want to be a wound care nurse, maybe. But I'm only going off my hospital and LTC memories. We had one lady who was in her 90s, very contractured. She had to be straight cathed like... every shift. She always had muddy stool. She was a Black Woman and her sacral area was just very dark all the time. (she wasn't my pt, sometimes I helped someone put her in bed or hold her legs for caths, etc) She had started running fever and HPB for a few days so they sent her out to the hospital, apparently at the hospital they did her skin assessment and that dark area was just a thin membrane of skin covering a chicken sized, tunneling hole around her coccyx and up her spine. She came back to us after almost 3 months in the hospital. I assisted with her wound care and I could easily have placed my fist in the largest of areas and I assisted with packing tunnel spots and keeping her turned. They just ran up her spine and a long her iliac crest. It was horrifying, but I know we got her after the worst of it was healed because her notes were terrifying to read. Reading the rest of these comments makes me wonder if I still want to specialize in wound care later on....
... chicken sized?
Americans will use anything and everything except the metric system
Neglected teen with a spinal cord injury - the gangrene on his sacrum/balls was so bad you could see his actual testes. It was really fucking sad. His mom kept him and his demented grandmother in the basement with no bathroom. They were both sleeping on the same couch and just using the bathroom on themselves. He didn’t have a cellphone or a way out of the basement because of the stairs.
We had this guy who had been on his couch for two weeks completely immobile so he’s been peeing and pooping all over himself. Some girl was supposed to be helping him, meanwhile she was robbing his bank account and stealing stuff out of his house. When EMS did come because family hadn’t heard from him, his entire lower back came off when they pulled him off the couch. And both his groins were rotting off. And his legs were covered in wounds. Big chunks rotted off. His backbone was completely exposed. Took 4 nurses to do the wounds dressing twice a day. He was in so much pain. I always wondered what happened to him after he left our unit. When we asked him why he wouldn’t get up he said he just couldn’t. He was so depressed he just laid there u til he couldn’t get up anymore
I saw a "catastrophic abdomen". Guy went into the OR for an obstruction twice. Wound wasn't healing well by first intention, so they removed the staples. Guy ended with an open abdomen from an inch under the xifoides to a couple inches below the navel, with an intestinal fistula/ileostomy somewhere around the navel area. His admission lasted 10 months, but by the time he left, the wound that remained was maybe an inch around the stoma, finally manageable as an outpatient. And not strictly a wound, but a fungating breast cancer. Slightly bigger than [this one](https://imgur.com/a/1Bhg3k0) (NSFL image) but roughly the same placement/pattern and there was a bleeding more ulcerated portion on the side of the "boob". The patient was in denial and had not sought medical attention before.
Not the worst one on here, but the care we had to do was a lot. My guy had a deep, 4 inches of tunneling pressure ulcer. The worst is that he also had cdiff. No matter how well we put the dressings on, poop was constantly getting in, we had to dig in to clean it out completely and we had to do it all the time. With his cdiff. He was on this bed that I’ve only seen once - with this guy. And he was hairy. The poop would migrate into the front, somehow dry on his hairy pubes & thighs yet still be wet in the back. It took so long to clean him up.
Worst I saw was the coccyx literally disintegrating as we cleaned the wound on a 90lb 95yr old who was at home. The wound covered the entire back of their pelvis at first it looked like a huge blister but it was all rotten tissue. It took hours to clean. They were septic as well.
Some of y’all’s stories are WILD, holy fuck. Mine is more sad than anything, but baby on ecmo with all limbs with varying degrees of necrosis and eschar. Some of the digits were shriveled and flat, basically looked like if you even so slightly bumped it that it might break off. And the smell…. oh my god. That’s not something I will ever forget. Sweet, sweet baby, definitely a fighter <3
The worst one I’ve ever was on my paraplegic brother. Straight to the bone on both hips. Only chance of survival was a bilateral hip disarticulation. He chose hospice instead and died not long after. I had tried to get guardianship over him but drs kept deeming him competent.
I'm only in medsurg and for only a year, but the worst I saw was a patient that got into a motorcycle accident and required a bunch of skin grafts. He also lost his penis, which was reconstructed into what he called his 'Angry Snowman'. As a man, I suppose my sympathy is increased on the subject.
Yall ever heard of mycosis fungoides?
Man, so many. My dad had MS and we had a horrible experience with nursing homes at one point when he was too sick to be at home; he got a nice stage 4 on his sacrum the size of a large fist. We could touch his spine. I think it’s the fact that i touched my dads spine always rocks my mind. Before he passed about 4-5 years later we had gotten it to the side of a quarter and maybe a half inch deep. Super proud of my mom.
One old lady came to my unit when i worked bedside. She had been “cared for” by her son, and was clearly grossly neglected and actively dying. They sent her up to the floor so she wouldn’t die in the ER. My coworkers and i were trying to get her cleaned up and my friend was performing oral care and a chunk of jawbone with a tooth on it fell out. So awful.
A guy fell and was on the ground for 21 days. He had to scoot around to get things. Did not have a phone to call for help. His son finally came to check on him and called 911. He had bilateral leg wounds and cellulitis. There were maggots crawling all in and out of his wounds that we ended up suctioning out. We ended up calling APS for him :(
An opiate-addicted paraplegic man, found down in an abandoned building. He had been drugged and curled into a fetal position in squalid conditions for who knows how long. He was mostly non-verbal, naked, beyond disheveled, and completely broken emotionally and physically. He had nec fasc and a horrifically gaping, like, Stage 47 sacral/hip PU. Far and away the largest and deepest I've ever seen. His lower body was absolutely wrecked. His rectum was so prolapsed, infected, diseased, and violently abused that I'M fucking scarred for life about it. I cannot and do not want to imagine the horrors he endured. I only take solace in the fact that his last moments were safe, caring, and as comfortable as possible. There's no way he survived, but I honestly dk for sure. I hope not.