CSI: You are observing an elderly woman who is seeing a personal trainer as part of her rehabilitation therapy. The woman was hospitalized for problems associated with obesity and high blood sugar. She is now going through an exercise program to help bring her back to health. While working out, one of her socks rolled down exposing the lower part of her left leg. A glance at the side of her left leg revealed a large, shiny, deep, red sore. The sore had a dark margin, like tanned skin. Parts of it looked as if you could see right through to the muscle. The woman saw your face reacting to the sore and kindly said, “Do not worry about that, it doesn’t cause me any pain.” Part of the personal trainer’s responsibility is to pay attention to any pathology that can be worsened by the patient’s rehabilitation. How would you use your observation to assist the personal trainer in judging the possible physical limitations of this patient? What is the most likely cause of this woman’s sore, and how could it affect any exercise or rehabilitation programs?

This woman has probably developed a pressure ulcer, her personal trainer should inform the attending physician of this and stop the exercise until medical evaluation.

What is a Pressure Ulcer?

A pressure ulcer is a localized injury to the skin or underlying tissues that occurs when there is reduced blood flow caused by pressure applied to a specific area.

What are the signs of eschar?

The eschar usually appears as a superficial lesion, which can evolve into a deeper lesion, if the individual is not moved adequately. These sores can be smelly, different in color, lumpy, and may even itch.

How to treat pressure ulcer?

For the treatment of pressure injuries, first of all, it is necessary to assess the tissue impairment of the affected region. Deep wounds with necrosis (dead tissue) require rigorous cleaning, performed by a doctor or stoma therapist nurse.

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