A trick to treat, part 1

I have had some strange patient encounters lately! It all started after I met a mysterious stranger at a wound care conference and remarked on how quiet things had been lately. Needless to say, that didn't last long! I am posting here in the hope that my experiences will assist other clinicians. Over the next three days, I'll be sharing three eerie cases. Enjoy!

Case 1: Wicked wounds

History: 87-year-old woman with past medical history significant for verrucous keratosis, aquaphobia, and hypercholesterolemia presents with bilateral sores over the ischial tuberosities which she reports noting after spending a prolonged period of time on a “broomstick.” She states she prefers “natural” remedies and has been treating wounds with eye of newt and wing of bat.

Assessment: Two stage 2 pressure ulcers noted over the ischial tuberosities with exposed subcutaneous tissue. Small amount of serosanguineous drainage. Surrounding skin is intact, erythematous.

Plan: Advised against application of non-sterile animal products to wounds. Area cleansed with antiseptic and gauze. Zinc-oxide based hydrophilic paste applied to wound and peri-wound. Emphasized the importance of offloading and urged her to reposition slightly every 15 to 20 minutes while seated, and spend no more than 60 minutes at a time seated for at least the next seven days to allow tissues to heal. Also discussed importance of adequate nutrition, and I advised patient to consume at least 1.2 g/kg/day of protein, preferably more (1.6 g/kg/day). Patient inquired if children contain protein. I recommended she avoid red meat due to its high cholesterol content and obtain protein from legumes, poultry, fish, and whole grains. If appetite insufficient, may add supplement such as Arginaid® to achieve intake goals. Follow up in one week.

Disclaimer: These cases are fictional, created in the spirit of the spooky season. Any resemblance to actual persons, living or (un)dead, events or localities is entirely coincidental. However, the plans detailed above are based on actual evidence and/or informed by my professional experience and training. This content is for informational purposes only and should not be taken as medical advice or construed as the basis of a patient-provider relationship. Always seek the advice of a physician or other qualified clinician with any questions you have regarding a medical condition or treatment plan.

For more information on having a safe and healthful Halloween, check out these tips from the CDC.