eschar toes

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I have a question about escahr on toes. I have a patient with eschar on 4 of his 5 toes. we are currently doing wound care BID....he is in home health. we clean it with wound cleanser, pat dry, apply accuzyme to the eschar, and then around the outer part of the eschar is red, and also all the toenails have fallen off....so we put triple antibiotic ointment on that area...we have 2X2's between toes...and then wrapped with kerlex. we do this two times a day. This patient is on dialysis 3 days a week, has CHF, Blood surgars out of control. The dr has given us until Aug 30 to try and do something with these toes....otherwise they will amputate...either the foot...or even the whole leg. The Patients toes were looking good about two weeks ago...went into the hospital with a CHF episode....for 3.5days....not one nurse did woundcare on his feet. when he came back home...all the toes were had been working on are now all black...and the toenails off. Any suggestions for anything different to try? or is what we are doing the only thing left before amputation? Any help would be great. Thanks! :)

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Specializes in LTC, assisted living, med-surg, psych.

Unfortunately, once toes get to that point, amputation is about the only thing left to do. When they're black and shriveled up like little raisins, it's because there is no circulation to work with; I once did a dressing change on a patient like this, and two of his toes fell off in my (gloved) hands as I removed the Kerlix! YECCCCCCHHHHHHH!!

Sorry to be so graphic, but I've never seen toes like this heal, and your patient's other medical problems only make things worse. The sooner those toes are removed, the more of his leg they'll be able to save.......they really shouldn't wait, IMHO.

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Unfortunately, once toes get to that point, amputation is about the only thing left to do. When they're black and shriveled up like little raisins, it's because there is no circulation to work with; I once did a dressing change on a patient like this, and two of his toes fell off in my (gloved) hands as I removed the Kerlix! YECCCCCCHHHHHHH!!

Sorry to be so graphic, but I've never seen toes like this heal, and your patient's other medical problems only make things worse. The sooner those toes are removed, the more of his leg they'll be able to save.......they really shouldn't wait, IMHO.

I was thinking the same thing. I just didn't understand....we had just 4 small parts of his toes that were black...not even 2 cm all around...and then when he comes back from the hospital...all four toes...had turn black. they are hard right now...not shriveled up yet....ya think there is no hope at all......Ya...>I am scared when I do the dressing change now...the little toe especially may just fall off. I don't know what I will do if that happens to me!

thanks for your info!

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Amputation is what needed. If the toe falls off, it won't seem that strange, it is already dead to begin with. It has no circulation and no blood flow.

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Specializes in LTC, assisted living, med-surg, psych.

I was fresh out of nursing school when that poor patient's toes fell off in my hands; he, of course, didn't feel anything, but I had 2 CNAs watching me at the time and I knew I couldn't freak out in front of everybody. So I just swallowed hard a couple of times, disposed of the digits discreetly, re-dressed the foot as quickly as possible, and got the heck OUT of there. I managed not to throw up only by sheer force of will......eight years later, the memory still creeps me out. Ewwwwww. :uhoh21:

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Specializes in LTC,Hospice/palliative care,acute care.

Is this patient ready for hospice care?

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