Would you open this wound?

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    I have a 106 yo patient who has been on and off hospice for over a year. She is palliative care now and is being evaluated for hospice again this week and I am sure will get signed on.Anyways, she has a stage 2 which is turning into an unable to stage with the yellow / black tissue in the wound bed. Using silvadene to it, it seems to helping the red areas nicely. I don't know what's going to happen to the rest. She has very minimal po intake, is very thin and if we were to even mechanically deride any of that tissue, the woman would have a big hole in her back that had no chance of healing and would cause her too much pain and she has made it this far being relatively pain free.I explained the situation to the family, they seem to agree.What do you think? Palliative wound care is appropriate, right?
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    Right, palliative wound care IS important.

    This is a toughie.
    I probably would not debride the wound IF the patient is expected to have a short terminal course.
    If there is any possibility that this patient will be a live discharge, you will want to generate a plan that heals the wound asap.
    It sounds like she is pretty medically frail,
    it is very tempting to allow a non painful wound to remain non painful in the EOL setting
    and the goals of the family are right there too


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