in shock my daughters life on the line need your help!!!

[cathleenrmermaid7]

I cant believe what just transpired today!! I brought my daughter to the ER after her pca's called me and said you need to come look at this wound(bedsore) We have been trying to get it healed for some time. She sees a wound care specialist every other week. My daughter has spastic cp and is wheelchair bound. She is 30 years old and lives in her own home. anyways I am trying to make this a quick question. The bedsore went from a small pinhole wound to being the size of a fist and to the bone i can actually see bone, in two days due to neucrotic tissue, when i looked at it at her house i almost fainted (and i work in the icu at Maine Medical Center not as a RN yet but I am a student anyways the sore is HUGE and infected. I asked the surgeon what was the plan and he said oh just have her go home and have the pcas pack it and have them call a plasic surgeon!!! I was so in shock I just said what??? THen i told him i worked in a hospital and he said oh is that right, then he said well it is so deep and infected that we cant handle it here so we need to send her to Maine Medical Center. What the !!! it wasnt so bad a minute ago. She has had them before because she hates to go to bed but NEVER this bad, we were aquaciling it the wet to dry but to no avail. Can you believe this?? So tomorrow she is going to Maine Med because their are not any beds available tonight there she is in the local hospitals icu right now. I just needed to vent and know that my faith mostly are in nurses not Dr.s

I know you cant give medical advice but how dangerous is this if it is so deep and infected?? PS when the RN looked at it upstairs her face turned white and mouthed oh my god to me of course so my daughter couldnt here but what the ** was the Dr. thinking?? He did smell alittle like alcohol and no i dont mean rubbing alcohol. Sorry such a long rant but i have such a faith in nurses I work with amazing ones. how worried should i be, and was i overeacting??

[TiredMD]

Did you see post 9 and I think it was 14? What else do you want to add, keeping in mind we aren't allowed to give medical advice. Thanks.

Sorry, I wasn't clear.

Stage 4 decubs don't develop in two days, and everyone here knows it, but no one wants to say anything because of the emotion involved. They are chronic problems that develop over weeks to months. And while the sympathy for a grieving mother is understandable, I don't think that requires acting like this was a huge emergency that required middle-of-the-night surgical intervention, unless there were other signs that she was sick (which there apparently weren't).

Looking at this objectively, we have a mother, going through training to work in health care, who probably feels guilty that she was unaware of her daughter's worsening chronic health problem, and so flipped out when it was brought to her attention. Sad? Yes. But chronic problems are not emergencies. I don't see anything in this story that validates calling all doctors incompetent and untrustworthy.

That's all I was getting at.

[Liddle Noodnik]

sorry, i wasn't clear.

stage 4 decubs don't develop in two days, and everyone here knows it

but they can be missed due to tunnelling and appear to be just a small spot, and suddenly reveal themselves, as they seemed to in this instance, right?

they are chronic problems that develop over weeks to months. and while the sympathy for a grieving mother is understandable, i don't think that requires acting like this was a huge emergency that required middle-of-the-night surgical intervention

i would assume that starting iv antibiotics immediately would be appropriate though, right, in order to prevent sepsis?

looking at this objectively, we have a mother, going through training to work in health care, who probably feels guilty that she was unaware of her daughter's worsening chronic health problem,

oh i am sure! i don't know who the primary caregiver is that was supposed to be monitoring the daughter's skin but as a mother i would feel horribly guilty for missing something like that ... health care worker or not ...

i don't see anything in this story that validates calling all doctors incompetent and untrustworthy.

i didn't hear anyone saying "all" - she did say she thought she smelled alcohol, that is the primary reason she was thinking she should report.

do you feel that the intervention the doctor suggested initially would have been adequate for this situation? or maybe something else?

anyway - guilt on the part of the mom was not mentioned - but i'm sure she has had to deal w/ that aspect of the situation. i know i would feel that way myself... that i should have known, and 'if only', etc.

[TiredMD]

I didn't see the wound, so I can't really comment on whether or not it was infected. I have seen plenty of stage 4 decubs that are not infected. The real issue with these things is that you have to figure out how to get them off of the area. You can treat them with everything in orificenal, but if the person is still parked on their backside 18hrs a day, it will never heal. In many cases, Plastics will refuse to flap them unless there is a clear plan in place on how to keep pressure off the area.

I don't think the decision to send the patient home with wound care was necessarily inappropriate on its face. Depending on the exact details of the situation, it sounds like we have a patient with a chronic, long-standing wound, already receiving home health and home wound nursing care. That limited description sounds more like someone who needs regular nursing care, not urgent hospital admission.

The crucial error on the part of the physician was to make that rapid turnaround, from "She can go home" to "We need to transfer to a higher level of care." This destroyed any trust between the mother and the doctor, and was a really stupid rookie mistake.

I think anyone with more than a year of health care experience is quietly thinking what I'm thinking about what went on here: Doctor didn't think the patient warranted admission. Mother disagrees and brings up her health care credentials. Doctor is a jerk who doesn't want to deal with this anymore, so he transfers her somewhere else.

The only part that aggrevated me in the original post, and prompted me to comment, was this:

I just needed to vent and know that my faith mostly are in nurses not Dr.s

I mean, she already had a wound care nurse coming to her house, right? Not trying to make an issue out of this, just feeling a little grumpy today.

PS - Yeah, you're right about the tunneling, I wasn't thinking about that possibility.