1. During the congestion and ruddy period, the local skin becomes red, swollen, hot, numb or tender due to pressure. At this time, the patient should lie on the air cushion bed (also called Operating Room Positioner) to increase the number of turns and massages, and assign special personnel to care if necessary. 45% alcohol or 50% safflower wine can be poured into the palm of the hand for local massage under pressure for 10 min. The red and swollen part of the pressure ulcer is smeared with 0.5% iodine tincture.
2. During the inflammatory infiltration period, local redness and swelling do not subside, and the compressed skin turns purple red. Subcutaneous induration occurs, and epidermal blisters form, which is very easy to break, and the patient feels pain. At this time, use a cotton swab dipped in 4.75g/l-5.25g/l complex iodine to wipe the surface of the affected area to dry the part, and pay attention to avoid continuous pressure; Large blisters can be extracted with a syringe under the operation of aseptic technology (without cutting off the epidermis), then coated with 0.02% Furacilin Solution and wrapped with sterile dressing. In addition, combined with infrared or ultraviolet radiation treatment, it can play the role of anti-inflammatory, drying and promoting blood circulation. If the blister is broken, the inner membrane of fresh egg can be flattened and tightened on the wound, and covered with sterile gauze. If there are bubbles under the inner membrane of the egg, gently squeeze it with a sterile cotton ball to drain it, then cover it with sterile gauze, and change the dressing locally once a day or two until the wound is healed. The inner membrane of egg can prevent the loss of water and heat, avoid bacterial infection, and is conducive to epithelial growth; This dressing change method has definite curative effect on the second stage bedsore, short course of treatment, convenient operation and less pain for patients.
3. Superficial ulcer stage. Epidermal blisters gradually expand and burst, and there is yellow exudate in the dermal wound. After infection, pus flows out, and superficial tissue necrosis and ulcer formation. First, rinse with 1:5000 potassium permanganate solution, and then dry the wound and surrounding skin. Secondly, patients can use a 60 watt incandescent lamp to irradiate the part where bedsore occurs. The infrared ray emitted by the incandescent lamp has a good therapeutic effect on bedsore. The irradiation distance is about 30cm. When baking, the bulb should not be too close to the wound to avoid scalding, and should not be too far. Reduce the baking effect. The distance should be based on promoting the drying and healing of the wound. 1 – 2 times a day, 10 – 15min each time. Then it was treated according to the aseptic dressing change method of surgery; Moisturizing dressings can also be used to create a suitable environment for the healing of the sore surface, so that the new epithelial cells can cover the wound and gradually heal the sore surface. Local conditions should be observed at any time during irradiation to prevent scalding. Infrared local irradiation can dilate local skin capillaries and promote local tissue blood circulation. Secondly, for long-term non healing wounds, apply a layer of white granulated sugar on the wound, then cover it with sterile gauze, seal the wound with a whole piece of adhesive tape, and replace the dressing every 3 to 7 days. With the help of the hyperosmotic effect of sugar, it can kill bacteria, reduce the swelling of the wound, improve local circulation, increase local nutrition, and promote wound healing.
4. Necrotic ulcer stage. In the necrotic stage, the necrotic tissue invades the lower dermis, the purulent secretion increases, the necrotic tissue blackens, and the odor infection extends to the surrounding and deep tissues, which can reach the bone, and even cause sepsis, endangering the patient’s life. At this stage, first clean the wound, remove the necrotic tissue, keep the drainage unobstructed, and promote the healing of the sore surface. Clean the sore surface with sterile isotonic saline or 0.02% nitrofuran solution, and then wrap it with sterile Vaseline gauze and dressing, and replace it once a day or two. It can also be treated with metronidazole wet compress or isotonic saline after cleaning the sore surface with silver sulfadiazine or nitrofuran. For those with deep ulcer and poor drainage, 3% hydrogen peroxide solution should be used to flush to inhibit the growth of anaerobic bacteria. The secretion of infected sore surface should be collected regularly for bacterial culture and drug sensitivity test, once a week, and drugs should be selected according to the inspection results.
(For reference only)