Kennedy Ulcer

So sad that "the family isn't ready to go there yet". You are correct, death usually occurs within 8 to 48 hours. I'm assuming he is in a LTC facility. Comfort measures would be nice, but if the family in unwilling to agree, you will have to code that poor soul. This link is an interesting read. http://www.kennedyterminalulcer.com/

Our hospital had a lady in her 50's who came in through the ER with EMS in a code blue. She was resuscitated and survived, then was sent to ICU on the vent. Within a couple of days, her coccyx became reddened, and over the next few days it became a very large ulcer that was very deep. The changes were so fast, and did not respond to any treatment. It ended being diagnosed as a kennedy ulcer. The wound care nurse ended up getting a wound vac ordered, and over time the ulcer healed. The way she explained it was that when she coded she had skin cell death and it caused the ulcer. It was amazing at how fast it occurred, but over time it did heal up. Very interesting I thought!!!

I saw one once..and the pt was dead within 12 hours. I would notify the physician.

This is what we commonly refer to as the "butterfly" pattern of pressure ulcer on the coccyx in the my region.

In my experience it is most common in the very elderly bedbound and terminal patients.

However, I have seen rapid onset pressure ulcers on the calf and heel, which certainly meet the criteria of a Kennedy ulcer, in patients of all ages who are debilitated are nutritionally comprimised.

In your instance the best thing I would advise is to establish a good professional trust relationship with this patient, if possible, and the family/DPOA. It sounds like they really need some nursing education from a compassionate and kind soul to help them make good choices for their loved one.

In terms of pain management...you are correct to assume that this would be painful. Are you familiar with the PAINAD? This unfortunate guy may benefit from having an opiate in the dressing/gel applied to the wound assuming it is open.

Good luck...heshe will very possibly be gone to the next adventure by the time you read this...

My resident is still hanging in there. Thank you for the links. I am going to look into the PAINAD? I haven't heard of this. THANKS

So sad that "the family isn't ready to go there yet". You are correct, death usually occurs within 8 to 48 hours. I'm assuming he is in a LTC facility. Comfort measures would be nice, but if the family in unwilling to agree, you will have to code that poor soul. This link is an interesting read. http://www.kennedyterminalulcer.com/

Thanks for that link. We have a poor soul whose family won't let him go and have been having a terrible time keeping him from breaking down - we're not, in fact. His coccyx wound followed the pattern. Got that healed and broke down his hips. Poor thing.