Derm: Pressure ulcers: Free MSRA Podcast

⚕️ FREE MSRA PODCAST – Pressure Ulcers🎧 A clear, high-yield breakdown of this preventable yet serious skin condition – perfect for exam prep and real-life clinical scenarios.🧠 Key Learning Points📌 Definition• Localised injury to the skin and/or underlying tissue over bony prominences• Caused by sustained pressure, shear, or friction• Also known as bedsores or decubitus ulcers📌 Causes & Risk Factors• Prolonged immobility – e.g. bedbound or wheelchair users• Shear – skin layers sliding (e.g. slumping in bed)• Friction – rubbing skin against surfaces• Moisture – incontinence or sweat• Poor nutrition and hydration• Advanced age – thinner, less elastic skin• Sensory impairment – e.g. diabetes, spinal injury• Chronic illnesses – COPD, malignancy, vascular disease• Low BMI, weight loss, or smoking🧠 Mnemonic: "P-SMILE" – Pressure, Shear, Moisture, Immobility, Low nutrition, Elderly📌 Pathophysiology• Pressure > capillary pressure → ischaemia → cell death• Leads to tissue necrosis and ulcer formation• Inflammation and infection can worsen damage• Poor healing if malnourished, diabetic, or systemically unwell📌 Symptoms• Start as non-blanchable redness → progress to open wounds• Grades 1–4:– Grade 1: Intact skin, red/discoloured area– Grade 2: Blister/shallow ulcer– Grade 3: Full thickness loss to fat– Grade 4: Exposure of muscle, tendon, or bone• Unstageable: Covered with slough or eschar• May include pain, swelling, or foul odour📌 Differential Diagnosis• Venous ulcers – gaiter region, oedema, brown skin• Arterial ulcers – painful, pale, distal• Diabetic ulcers – pressure areas, neuropathic• Dermatitis• Traumatic wounds📌 Diagnosis• Clinical assessment – look, measure, describe• Use risk tools: Waterlow, Braden, or Norton score– Waterlow: 0–9 low risk, 10–14 at risk, 15–19 high risk, 20+ very high risk• Do NOT swab routinely – only if signs of infection• Bloods: albumin, CRP, WCC, U&Es if unwell• Imaging (e.g. MRI or X-ray) if suspect osteomyelitis or abscess🧠 MSRA tip: Don’t swab unless signs of infection📌 Management• Relieve pressure – 2-hourly turns, pressure-relieving devices• Wound care – gentle cleansing, appropriate dressings• Nutritional support – protein, vitamins, fluids• Pain control• Infection control:– Systemic antibiotics only if clinical infection/sepsis– Topical antibiotics not routinely used• Debridement – autolytic, surgical if needed• Surgery – flap closure for non-healing ulcers📌 Prevention• Risk assessment on admission (e.g. Waterlow within 4 hours)• Repositioning – 2-hourly turns• Support surfaces – special mattresses, cushions• Daily skin checks, especially over bony areas• Barrier creams if incontinent• Emollients, moisture control• Nutrition/hydration optimisation• Educate patients and carers📌 Complications• Cellulitis, osteomyelitis, abscess• Sepsis – can be life-threatening• Chronic wounds, scarring, contractures• Pain, reduced mobility, psychological impact📌 Prognosis• Early-stage ulcers heal well with care• Grade 3/4 ulcers → prolonged healing, complications• Mortality risk ↑ in frail, elderly, or septic patients• Prevention is key – cheaper and more effective than treatment📎 More MSRA Resources for Pressure Ulcers📝 Revision Notes:https://www.passthemsra.com/topic/pressure-ulcers-revision-notes/🧠 Flashcards:https://www.passthemsra.com/topic/pressure-ulcers-flashcards/💬 Accordion Q&A Notes:https://www.passthemsra.com/topic/pressure-ulcers-accordion-qa-notes/🚀 Rapid Quiz:https://www.passthemsra.com/topic/pressure-ulcers-rapid-quiz/🎓 Full Course:https://www.passthemsra.com/courses/dermatology-for-the-msra/Hashtags#MSRA #MSRARevision #MSRATextbook #MSRAQuiz #MSRAQuestionBank #MSRAFlashcards #MSRAQandANotes #MSRAAccordions #MultiSpecialtyRecruitmentAssessment #MSRAOnlineRevision #MSRARevisionWebsite #PressureUlcers #Dermatology