Hey, y'all! Okay, I know this could get a bit scary, so if you're not into this kind of thing, please move on! This has the potential to become VERY GRAPHIC. Disclaimer over. ;>) However, I'm figuring that if this topic could keep us entertained for HOURS on a slow night, surely some of you have some stories to share that get your eyes gleamin' as well. ;>P A PICU nurse who was floated to my unit the other day was telling us about a pediatric organ donor they had had recently. She was invited to witness the actual surgery and the 'claiming' of the organs that were being distributed to various recipients. She said that, despite the sadness and overwhelming loss she felt when the patient was declared clinically dead (she'd taken care of that little girl for weeks and had become very attached to her and her family), she could not help but be completely fascinated by witnessing the procedure. She hadn't been in surgery since nursing school, and she said she just could not get over seeing the cavity open and empty like that after the organs had been 'claimed'. This got us started on our favorite gross-out wound and cavity stories, and you know NURSES, who can freak out a burly man in a nanosecond with stories of pus, blood, flesh, and insects!!! We, I admit, were laughing our butts off and enjoying every minute of it, all the while cackling that our husbands would have fled the room fifteen minutes ago in absolute horror. Call it stress relief. So, in continuing with that conversation, I thought I'd see if y'all would like to contribute. I promise you that your stories will be recounted truthfully, down to the stickiest, smelliest detail!!! should we ever get another slow night (which, considering the trend, will be NEVER!!). Here are some of mine... mine come from nursing school, as I am a relatively new grad and have been NICU nursing since graduation. In nursing school, during our MICU rotation, I had a lovely older woman who had undergone a TAH. The surgeon had accidentally nicked her bowel, and after multiple trips to OR to attempt to repair the damage, she had developed a fistula and was leaking fecal matter into her now spacious abdominal cavity. She had this ENORMOUS abd dressing that had to be changed, and being the student-nurse-gopher that I was, it was my job, along with two other nurses in attendance, to change it! I swear, it took almost TWO hours to change this sucker. Her entire abdominal cavity was open, and when I removed the packing, I got to see EVERYTHING. I know, I'm a dork, but it was totally spectacular. This brownish, thick, melted-milkshake fluid was leaking out, and when it touched my gloved hands for the first time, it was so warm it SCARED ME! I actually jerked my hands back because I was startled! When she had been rinsed suffeciently, it was time to repack the wound. I kid you not, my entire hands were inside of her abdomen, and I felt like a surgeon! We just kept packing and packing and packing and I thought, dear God, there's no way she can hold all of this inside her! She was on one of those vacuum-seal doodads, with the sponge? I forget what they're called now... we packed the sponge in and applied this HUUUUUUUUGE op-site. Realize, I was in SCHOOL and was just totally blown away by this! I went home high on endorphins and grinning like a psychopath. Ahhhhhhhhhhh, the gore. Just something about it, you know? :>)
Sep 19, '02
I will never forget....1984.. Toledo Hospital... the guy had gangrene. We were using bed cradles (are those still used?) to keep the sheets off of his foot. I had never smelled something so bad in my life. To curb the smell, the nurse manager put oil of wintergreen in a little bowl under the bed. To this day, I cannot smell wintergreen without wanting to hurl.
Sep 19, '02
Ooh, I have more! ;>P (rubbing her hands together gleefully) Forgive me, I'm in that kind of mood this afternoon! In a different, med/surg rotation, my patient was an Irish IDDM who hadn't had treatment since he'd relocated to the U.S. He and his girlfriend had been living on the street and he'd begun to get these huge, painfully swollen boils under his armpits and in his groin. Well, she, being the expert in such things, suggested that they attempt to lance the boils with a hypodermic needle, that, incidentally, they had been using to shoot up heroin. Naturally, despite his cheerful demeanor and handsome-but-in-desperate-need-of-a-shower good looks, he became infected with bacteria. One of the boils abscessed and a fistula tunneled it's way from his pit to beneath his sternum. The ENTIRE thing was filled with pus and the morning I had this guy, it was time for incision and drainage. OOh, I got chills when I heard that! Now, before you go pointing fingers, I know dang well that some of you feel the same way. It's gross, I admit, but still amazingly fascinating!!! We gathered around the bed (it was a teaching hospital) and donned gowns and goggles for safe measure. The med student in charge of the I&D lanced this puppy and it literally EXPLODED in a burst of clotted pus and blood the likes of which I have NEVER seen! It practically gushed around all sides of the gauze that the student was using as a shield and I swear, if the gauze hadn't been there, that stuff would have easily flown ten feet or more in a straight stream over the bed!!! After it was drained and debrided, the wound was packed and as the student packed it, he became paler and paler, because each time he had to reach his fingers deeper and deeper to push the packing in...at one point, all of his fingers AND the tongs he was using were inside this guys armpit! I thought that guy was going to die from the pain. *shudder* One of the girls I work with was telling us about this woman she had who was unconscious and had blackheads the size of pencil erasers all over her face. Needless to say, that woman woke up looking like she'd had a spa treatment!! And another nurse I work with said that she used to do home health, and she had a diabetic patient who had a boil on her back that had festered so long......well, she arrived at her home for the visit and the woman asked her to take a look at it. When the patient lifted her blouse, the nurse said her back fairly RIPPLED, like poking your finger in a waterbed and seeing the bed undulate? The ENTIRE thing had turned into one huge layer of pus-y material and the top layer of her upper back looked FLUID. The patient begged her to lance it, and she did, and she said that it just blew up all over, draining this disgusting, greenish pus for what seemed like an hour. All she had to do was touch the woman's shoulder blades and it would just seep out, with barely any pressure at all. Can you imagine!?@???? I told you this was gross. Forgive me my guilty pleasures. I'm a good person, really. ;>)
Sep 19, '02
Gangrenous wounds, black toes falling off in my hands, wounds the size of the entire buttocks, multi wounds inflicted by a boat propeller--deep and wide crossing the entire lower backside, smelly infected pressure ulcers, pressure ulcer on the scalp always make me say eeeewwwww, chemical and fire burns, I could go on and on!!! This ol' wound care nurse wont gross you out with the details today.
Sep 19, '02
I am so glad I am not the only one with a morbid facination for the gross and disgusting! I once had a woman's toes fall off her foot into the bed- the foot dressing fell off during the night and the toes waited until I lifted the sheets off her foot to check her bandage- then plop- right off the end of her foot like very dried raisins! yuck! I don't enjoy raisins as much as I used to!
Sep 19, '02
We once had a s/p CABG guy in the SICU whose sternum became infected requiring removal of his sternum. We had to do wet to drys right on his heart. If he took a deep breath, your fingers would be entrapped until he breathed again. You could actually take his pulse right off of his heart when the dressing was out.
The guy actually lived through all this and would come up to see us whenever he was in town. They made him a plastic shield to wear when he was driving.
Another goody: a guy I used to work with (male LPN) was not a very fastidious hand washer. One time I went to lunch with him, and I noticed that when he picked up his sandwich he had Mylanta poop on the edge of his hand.
Sep 19, '02
kristi you need to be a wound nurse! That is what I do now and love it. I also do infection control as it came with the wound nurse job, I find it interesting but not like wounds. By the way the vaccum sealed doodad is a wound VAC, vaccum assisted closure. I use them routinely.
In the last year I have had a patient with no butt. She had a small area that was like a little pimple that got a bit bigger, like a boil she said. Had been treating it at home with sitz baths. After several months it hadn't healed and had gotten quite painful, so finally she went to the doc. The area was CA and had in fact eaten into most of the tissue. She had already had 7 debridements before she got to me. I could see the bladder wall easily. The only treatment that had any hope of being successful was a wound vac, and try getting a seal on that. Open hip to hip, literally no butt. Bless her heart she did not survive.
Fungal infection of the testicles. Most of the testicles removed through debridement. Last debridement in my facility, closed with a skin graft a couple weeks later.
500 lb patient with an open back wound hip to hip, about 8-9 deep and nearly 12 inches wide. First time I opened it up the green drainage was almost flouresant, and the pseudomonas smell was enough to knock out a horse. One of the few times I have actually gagged. Had three student nurses in the room, 2 left immediately, the third stayed until I shooed her out because I was afraid she was going to pass out. The pseudomonas ended up being a resistant strain, and we ended up using quarter strength dakins solution. (I know, I know wound nurses don't throw bricks at me, but it worked) Once we had beefy red clean tissue wound vac went on. 6 months later it was closed. I work longterm acute care, and it took us four months just to get this guy off the vent.
Another lady fell broke her leg at home. Had a small open area at the ankle when she came to us, when I stuck the q-tip in to measure depth the damn thing went in clear to the other side and the crap that came out was amazing, probably 500 cc worth of creamy beige yuck. With a foul, foul smell. Staph epidermitis. xray confirmed what I suspected, the bone itself was gone. She ended up with AKA. She died of massive sepsis from the staph.
I get lots of open abd. wounds. Have three right now. One with two fistula's that nothing is working on to keep the drainage under control because the surrounding tissue has no epitheial layer, never can spell that word right! Anyway I have tried everything I can think of to keep a dressing on it, to no avail. The best thing I have found is to put down a bordered duoderm, with small open areas cut where the fistulas are, then to place a wound manager over it, then put very low sx to it. It usually only lasts a day, but better then the 4-5 times a day it was. Yesterday the surgeon tried to plug the fistulas with the new fibrogen plugs we have used on a couple others with success but did not work for this poor guy.
Have had necrotisizing fascititis as well with several patient. One of the top of a patients hand, could easily see all the bones, did well with hyperbaric tx, wound vac and eventual closure with skin graft. Another got it while seeking alternative tx in Mexico for colon CA. It affected his penis, testicles, periarea and back of his thighs. Got him closed too, though he recently died from his CA. His brother came up to tell us.
I see many trauma patients with bone exposure, horrid road rash, many cellulitis patients, diabetic wounds and venous stasis. Not too many pressure ulcers, though there are some.
I find it very gratifying to have patients with horrid wounds and to get them to heal. Had a patient last month transferred to us from U of M for wound healing. 12 different wounds bilat legs. Etiology unknown. 8 of them are 12 cm or bigger. Tried the wound vac but she is the first patient I have ever had that is allergic to the sticky drape. Got blisters under it all over. Insurance won't cover hyperbaric tx, wanted to try apligraf, got it approved than the company closed it's doors because they have overextended financially, (will probably be picked up by another company) so now we are going to try dermagraft. Cross my fingers, it is something I have never tried before, though sister facility have had good healing with it.
Maybe wound care is your calling. I work with many nurses who hate doing the dressing changes when I'm not there. And not because of the time it takes. :chuckle
Sep 19, '02
work in ed. saw my first (and a very impressive, i'm told) degloving injury a couple of weeks ago. his skin was just "off" from right below the knee to his ankle. the skin was still intact to itself, though, and it just looked sort of like a sock scrunched down around his ankle. seemed to be quite a lot of vessel involvement. great anatomy lesson. motorcycle accident. 20 y.o. checked in the computer last noc for his progress. they ended up having to do an AKA unfortunately.
Sep 19, '02
Alright I got a story for you. We got a pt that was having sinus headaches for awhile. Well he came to the hospital when his skin around his sinus's was becoming an open sore. Well within days of being admitted his whole face was being eaten away. The dr. had to remove is nose, his eyes, his upper palate. He had no face from his eyebrows to his mustache. He some how got a staph infection in his sinus's that ate away his skin. It looked like someone took an ice cream scooper and scooped out is face. The amazing thing is they rebuilt his face. They attached magnets to the back of his face and attached a plastic face. He made Ripley's Belive it or not. There are pictures of this on my hospital's website. www.ulh.org
It is very interesting.
Another story... We got a MCA that the handle bars went through his abd. Just about slicing him in half. At the scene they had to but all his organs back in his abd. He went straight to OR. Since there was so much infection they could not close him. This was a very big guy to began with. So when he came to us he just had a sterile towel staped to keep everything in. Both femurs were fx along with his pelvis so he had an external fixator that was pretty much keeping his legs attached dto his body. He had huge lacerations that were open in each groin. There were this man had such severe trauma that he was just urinating into his abd. So our whole floor smelled like urine and decaying flesh. I have never smelled anything like that before. Of course he died from trauma and infection. When the funneral home got there he wanted us to take the fixator out and we told him if we take that out you will have to take him in two pieces. He just looked at us and said ok leave it. I hate to say it but they should have let him die at the scene.
Sep 19, '02
I have had a few patient's with scrotal infections... one guy in particular, developed necrotizing fasciitis... the surgeon had to do an I&D of the scrotum... wound up removing a very significant portion of the skin in that area. The poor guys testicles were completely exposed..
We did dressing changes... wet to dry initially until a wound VAC was appropriate. I recall using 2 entire rolls of kerlix... packing my entire hand inside and up along his thigh and around the buttocks. The stench was intense. Like another poster... we used wintergreen oil to minimize the odor (it could be noted all through the hall)... which did work, but I certainly don't buy wintergreen Life Saver's anymore...
Far too many abdominal wounds to describe... fistulas, etc.... Guess our fascination with such gore helps us in our Profession.
Sep 19, '02
Oh wow~that's pretty much all I can say. I do find this all very interesting, but rncountry boy did your stories gross me out. I definitely know that wound care is not for me. You people have guts!
Sep 19, '02
I once had a patient with necrotizing fascitis on her leg. After awhile she was finally able to take a shower and so I stayed in there with her and helped. Imagine making light conversation with someone showering, while their propped up leg is missing all the flesh on the anterior side! Could see the tibia and fibula, ligaments, etc.
"we'll just try not to get shampoo on that..."
Sep 20, '02
I'm a psych nurse...I went into nursing to work in psychiatry. I'm so grossed out but I can't quit reading! Even after 12 years, I freak at minor dressing changes.
You are damn good story tellers too!! Keep 'em coming!