Pressure injuryMANAGEMENT

DERMATOLOGY PRESENTATIONS · 12 SECTIONS

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736 items

☷ Legend

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Cardiovascular Presentations66▾

Respiratory Presentations47▾

Neurological Presentations77▾

Gastrointestinal Presentations63▾

Genitourinary and Reproductive Presentations44▾

Infectious Disease Presentations146▾

Trauma Presentations88▾

Toxicologic Presentations67▾

Psychiatric Presentations25▾

Musculoskeletal and Rheumatologic Presentations89▾

Dermatology Presentations21▾

Allergic contact dermatitis Bullous Pemphigoid Cutaneous Abscess Eczema Herpeticum Erysipelas Erythema multiforme Henoch-Schönlein purpura Herpes Zoster (Shingles)Herpetic Whitlow Paronychia Pediculosis (Lice)Pemphigus Vulgaris Pilonidal Abscess Pressure injury Psoriasis (acute flare)Psoriasis Flare Staphylococcal Scalded Skin Syndrome Stevens-Johnson Syndrome (SJS)Toxic Epidermal Necrolysis (TEN)Urticaria (acute)Warfarin-induced Skin Necrosis

Environmental and Exposure Presentations26▾

Hematologic and Oncologic Presentations30▾

Pediatric-Specific Presentations13▾

Endocrine and Metabolic Presentations42▾

ENT and Maxillofacial Presentations21▾

Ophthalmologic Presentations15▾

Obstetric Presentations17▾

Systemic and Miscellaneous Presentations15▾

01Approach to the Critical Patient/attcp57

Initial triage and escalation

›High risk states

›Sepsis physiology

›Fever

›Hypothermia

›Tachycardia

›Hypotension

›Necrotizing soft tissue infection concern

›Pain out of proportion

›Rapid progression hours to days

›Crepitus

›Osteomyelitis concern

›Exposed bone

›Probe to bone positive

›Critical ischemia concern

›Cool mottled limb

›Absent distal pulses

›Uncontrolled bleeding

›Anticoagulant use

›Coagulopathy

›Immediate actions when unstable

›Airway and breathing support if altered or respiratory distress

›Oxygen for hypoxemia

›Noninvasive ventilation consideration for fatigue

›Circulation support for shock

›IV access

›Crystalloid bolus for hypotension

›Vasopressor if fluid refractory

›Broad infection evaluation if systemic signs

›Blood cultures before antibiotics if feasible

›Lactate for hypoperfusion

›Early consultation triggers

›Surgery for suspected necrotizing infection

›Orthopedics or plastics for deep wound with exposed bone

›Wound care team for staging and dressing plan

Key decision points

›Care pathway selection

›Prevention focus

›At risk skin

›Stage 1 injury

›Local wound management focus

›Stage 2 injury

›No systemic infection

›Deep infection pathway

›Stage 3 injury

›Stage 4 injury

›Undermining or tunneling

›Surgical pathway

›Extensive necrosis

›Unstageable injury with eschar and infection

›Flap candidacy evaluation needed

Hemodynamic and pain priorities

›Targets and monitoring

›Perfusion maintenance

›Mean arterial pressure goal individualized

›Urine output monitoring if critically ill

›Pain control

›Rest pain

›Dressing change pain

›Neuropathic features

02History/hx78

Risk profile and timeline

›Pressure injury context

›Duration of immobility

›Bedbound status

›Wheelchair dependence

›Onset timeline

›First skin change date

›Rapid progression days

›Precipitating factors

›Recent hospitalization

›Recent surgery

›Recent device placement

›Prior pressure injuries

›Prior locations

›Prior flap surgery

›Predisposing conditions

›Neurologic impairment

›Spinal cord injury

›Stroke

›Sedation

›Perfusion impairment

›Peripheral arterial disease

›Heart failure

›Shock history

›Metabolic conditions

›Diabetes

›Chronic kidney disease

›Malnutrition risk

›Weight loss

›Low intake

›Dysphagia

›Moisture exposure

›Urinary incontinence

›Fecal incontinence

›Heavy perspiration

Infection and complication features

›Local infection features

›Increasing pain

›New pain in insensate region concern

›Pain with minimal manipulation

›Drainage change

›Increased volume

›Purulent character

›Odor change

›New foul odor

›Persistent odor after cleansing

›Surrounding skin change

›New erythema

›Spreading warmth

›Systemic features

›Fever or chills

›New fevers

›Rigors

›Weakness or confusion

›Delirium

›Lethargy

›Poor intake

›Dehydration risk

›Hypoglycemia risk

Care environment and equipment

›Current prevention measures

›Repositioning pattern

›Bed turns frequency

›Chair weight shifts frequency

›Support surface

›Standard foam mattress

›High specification foam

›Alternating pressure surface

›Skin care routine

›Barrier creams

›Cleansing products

›Offloading devices

›Heel protectors

›Seat cushion type

›Social and functional considerations

›Caregiver availability

›Home support

›Facility support

›Ability to perform offloading

›Upper extremity strength

›Cognitive capacity

03Physical Exam/exam97

Whole patient assessment

›Physiologic status

›Vital signs

›Fever

›Hypotension

›Tachycardia

›Hydration

›Dry mucosa

›Orthostasis

›Nutrition appearance

›Cachexia

›Edema

›Skin survey

›High risk sites

›Sacrum and coccyx

›Heels

›Trochanters

›Ischial tuberosities

›Occiput

›Device contact points

Wound assessment and staging

›Pressure injury characterization

›Location and laterality

›Bony prominence association

›Device related location

›Measurements

›Length

›Width

›Depth

›Wound bed tissue

›Granulation

›Slough

›Eschar

›Wound edges and spaces

›Undermining

›Tunneling

›Sinus tracts

›Exudate

›Amount

›Color

›Viscosity

›Surrounding skin

›Erythema

›Maceration

›Induration

›Pain response

›Tenderness

›Allodynia

›Staging features

›Stage 1 features

›Intact skin with nonblanchable erythema

›Color change compared with adjacent skin

›Stage 2 features

›Partial thickness skin loss

›Exposed dermis

›Stage 3 features

›Full thickness skin loss

›Adipose visible

›Stage 4 features

›Full thickness skin and tissue loss

›Exposed fascia

›Exposed muscle

›Exposed tendon

›Exposed bone

›Unstageable features

›Obscured depth by slough

›Obscured depth by eschar

›Deep tissue pressure injury features

›Persistent nonblanchable deep red discoloration

›Purple discoloration

›Maroon discoloration

›Blood filled blister

›Mucosal membrane pressure injury features

›Device related mucosal injury

›Staging not applicable

Neurovascular and infection exam

›Perfusion assessment

›Peripheral pulses

›Dorsalis pedis palpation

›Posterior tibial palpation

›Capillary refill

›Delayed refill

›Asymmetry

›Limb temperature

›Cool extremity

›Asymmetric warmth

›Infection depth assessment

›Cellulitis

›Expanding erythema

›Lymphangitic streaking

›Abscess

›Fluctuance

›Focal tenderness

›Necrotizing infection

›Bullae

›Skin anesthesia

›Crepitus

›Bone involvement

›Visible bone

›Probe to bone response

04Differential Diagnosis/ddx50

Mimics and alternative etiologies

›Skin breakdown differentials

›Moisture associated skin damage

›Incontinence associated dermatitis

›Intertriginous dermatitis

›Friction injury

›Sheet shear injury

›Transfer related abrasion

›Skin tears

›Fragile geriatric skin

›Steroid related skin fragility

›Burns

›Thermal contact injury

›Chemical irritant injury

›Allergic contact dermatitis

›Adhesive reaction

›Topical product reaction

›Ulcer differentials by location

›Venous leg ulcer

›Gaiter area predominance

›Edema

›Arterial ulcer

›Distal toes

›Punched out edges

›Diabetic foot ulcer

›Plantar surface

›Peripheral neuropathy

›Vasculitic ulcer

›Purpura

›Livedo

›Pyoderma gangrenosum

›Pathergy

›Violaceous undermined border

›Malignancy in chronic ulcer

›Marjolin ulcer concern

›Rolled edges

Coding aligned problem list

›Common codes

›ICD-10 CM L89 series pressure ulcer by site and stage

›L89.0 elbow region

›L89.1 upper back

›L89.2 lower back

›L89.3 buttock

›L89.4 hip

›L89.5 ankle

›L89.6 other site

›L89.8 other site

›L89.9 unspecified site

›SNOMED CT concepts

›Pressure ulcer disorder

›Pressure injury stage finding

›Medical device related pressure injury

05Laboratory Tests/lt39

Baseline and nutrition risk

›Metabolic and nutrition labs

›Serum albumin for chronic malnutrition risk

›Low values as severity marker

›Limited utility as isolated nutrition marker

›Electrolytes for dehydration risk

›Sodium abnormalities

›Potassium abnormalities

›Creatinine for renal dosing needs

›Antibiotic adjustment planning

›Contrast imaging planning

›HbA1c for glycemic burden

›Poor control risk for impaired healing

›Hyperglycemia association with infection risk

Infection evaluation

›Infection labs when clinically infected

›Complete blood count for leukocytosis

›Leukocytosis supportive not diagnostic

›Normal count in immunosuppressed states

›C reactive protein for inflammation trend

›Baseline for treatment response

›Nonspecific elevation

›Erythrocyte sedimentation rate for osteomyelitis support

›Higher values increase suspicion

›Nonspecific elevation

›Lactate for hypoperfusion

›Elevated values support sepsis physiology

›Trend for resuscitation response

›Blood cultures when systemic signs

›Higher yield in sepsis

›Pre antibiotic collection when feasible

Microbiology sampling

›Wound microbiology principles

›Superficial swab limitations

›Colonization representation

›Poor correlation with deep infection

›Deep tissue culture value

›After debridement sampling

›Targeted antibiotic selection support

›Bone culture and histopathology

›Reference standard for osteomyelitis diagnosis

›Guidance for prolonged antibiotic selection

06Diagnostic Tests/dt54

Scoring Systems

›Risk and healing assessment tools

›Braden Scale

›Sensory perception domain

›Moisture domain

›Activity domain

›Mobility domain

›Nutrition domain

›Friction and shear domain

›PUSH tool

›Surface area component

›Exudate amount component

›Tissue type component

›Bates Jensen Wound Assessment Tool

›Size and depth items

›Edges and undermining items

›Application cautions

›Tool scores not sole basis for support surface selection

›Clinical judgment integration

MRI

›MRI indications and limitations

›Osteomyelitis evaluation

›Persistent deep ulcer with exposed bone

›Refractory to optimized offloading and wound care

›Deep soft tissue infection evaluation

›Abscess extent delineation

›Sinus tract mapping

›Contraindications and barriers

›Non MRI compatible implants

›Severe claustrophobia

›Interpretation pearls

›Marrow edema as sensitive finding

›Correlation with clinical and culture data

›CT applications

›Gas in soft tissues

›Necrotizing infection support

›Surgical consultation trigger

›Abscess detection

›Pelvic and perirectal collections

›Deep undermining extent

›Bone cortical destruction

›Chronic osteomyelitis features

›Lower sensitivity than MRI for early disease

›Contrast considerations

›Renal function review before IV contrast

›Allergy history review

Ultrasound

›Point of care ultrasound uses

›Soft tissue abscess

›Drainable fluid collection identification

›Cellulitis cobblestoning pattern

›Guidance for procedures

›Abscess aspiration guidance

›Vascular access guidance

›Lower extremity vascular screening adjunct

›Venous thrombosis evaluation in immobilized patients

›Perfusion assessment adjunct with Doppler

07Disposition/dispo56

Admission and level of care

›Inpatient indications

›Systemic infection

›Sepsis physiology

›Bacteremia concern

›Deep infection

›Suspected osteomyelitis

›Abscess requiring drainage

›Necrotizing infection concern

›Rapid progression

›Crepitus

›Uncontrolled pain

›Opioid requiring pain

›Dressing change intolerance

›Inability to offload

›No safe repositioning support

›Severe contractures without equipment

›Major comorbidity decompensation

›Heart failure exacerbation

›Renal failure with metabolic derangements

›Higher acuity indications

›Shock

›Vasopressor requirement

›Persistent lactate elevation

›Rapidly spreading infection

›Extensive cellulitis

›Concern for surgical source control

Outpatient management criteria

›Discharge readiness

›Hemodynamic stability

›No shock physiology

›No escalating oxygen needs

›No systemic infection

›Afebrile or stable baseline

›No delirium

›Offloading plan feasible

›Support surface available

›Repositioning assistance available

›Wound care plan feasible

›Dressing supplies secured

›Follow up arranged

Transfer and consultation

›Transfer triggers

›Need for complex flap reconstruction

›Stage 4 with large dead space

›Recurrent ulcer after prior flap

›Specialized imaging or surgery access limitations

›MRI unavailable when urgently needed

›Surgical team unavailable for source control

›Consultation triggers

›Surgery

›Debridement need

›Abscess drainage need

›Infectious diseases

›Suspected osteomyelitis

›Multidrug resistant organism history

›Nutrition

›Severe malnutrition concern

›Enteral access consideration

08Treatment/t178

Pressure redistribution and prevention bundle

›Offloading and repositioning

›Repositioning schedule

›High risk adults reposition at least every 4 hours

›Children and youth reposition more frequently than every 4 hours

›Head of bed minimization

›Shear reduction

›Aspiration risk balance

›Heel offloading

›Heel suspension device

›Pillow under calves with heels floating

›Wheelchair pressure relief

›Weight shifts every 15 to 30 minutes when able

›Limit sitting duration if ulcer on ischium or sacrum

›Support surfaces

›High specification foam mattress

›Baseline for established pressure injury

›Limited efficacy if repositioning absent

›Dynamic support surface

›Refractory pressure injury

›Inability to reposition adequately

›Seat cushion selection

›Pressure redistributing cushion

›Fit assessment to pelvis and posture

Local wound care

›Cleansing and moisture balance

›Cleansing fluid selection

›Normal saline

›Potable water when appropriate

›Avoidance of cytotoxic solutions for routine care

›Hydrogen peroxide routine avoidance

›Iodine routine avoidance on healthy granulation

›Moist wound healing principles

›Excess exudate control

›Desiccation avoidance

›Debridement selection

›Autolytic debridement

›Occlusive dressing approach

›Avoid in overt infection

›Mechanical debridement

›Low pressure irrigation

›Wet to dry routine avoidance

›Enzymatic debridement

›Collagenase use for slough

›Avoid with exposed tendon without protection

›Sharp or surgical debridement

›Extensive necrosis

›Rapid infection source control need

›Dressing selection by wound characteristics

›Foam dressing

›Moderate exudate

›Cushioning and protection

›Hydrocolloid dressing

›Low to moderate exudate

›Autolytic debridement support

›Alginate dressing

›Heavy exudate

›Bleeding control adjunct

›Hydrofiber dressing

›Heavy exudate

›Reduced maceration risk

›Antimicrobial dressing

›High bioburden concern

›Short course reassessment

›Negative pressure wound therapy

›Indications

›Stage 3 or stage 4 with depth

›Heavy exudate requiring management

›Contraindications

›Untreated osteomyelitis without plan

›Malignancy in wound bed

›Technique considerations

›Dead space fill

›Seal integrity monitoring

Infection management

›When antibiotics are indicated

›Cellulitis around wound

›Expanding erythema

›Warmth and tenderness

›Deep soft tissue infection

›Abscess

›Fasciitis concern

›Osteomyelitis

›Bone culture guided therapy

›Surgical source control planning

›When antibiotics are not indicated

›Colonization without clinical infection

›Odor alone after cleansing

›Stable chronic drainage without cellulitis

›Superficial swab growth without infection signs

›Avoid antibiotic escalation based on swab alone

›Focus on offloading and wound bed prep

›Empiric antibiotics for severe infection

›Broad coverage strategy

›MRSA coverage for high risk

›Gram negative coverage for deep ulcers

›Anaerobe coverage for necrotic tissue

›Vancomycin IV

›Loading dose 20 to 25 mg per kg actual body weight for severe infection

›Maintenance 15 to 20 mg per kg every 8 to 12 hours

›Trough based monitoring per local protocol

›Renal dose adjustment

›Piperacillin tazobactam IV

›4.5 g every 6 to 8 hours

›Renal dose adjustment

›Extended infusion per local protocol when available

›Alternative for beta lactam allergy

›Vancomycin IV

›Same dosing framework

›Therapeutic drug monitoring

›Aztreonam IV

›2 g every 8 hours

›Renal dose adjustment

›Metronidazole IV or PO

›500 mg every 8 hours

›Anaerobe coverage

›Targeted antibiotics for mild cellulitis

›Nonpurulent cellulitis

›Cephalexin PO

›500 mg four times daily

›Typical duration 5 to 7 days

›Clindamycin PO

›300 to 450 mg three times daily

›C difficile risk counseling

›MRSA risk cellulitis

›Doxycycline PO

›100 mg twice daily

›Avoid in pregnancy

›Trimethoprim sulfamethoxazole PO

›1 to 2 double strength tablets twice daily

›Hyperkalemia risk monitoring

Pain and symptom management

›Analgesia ladder

›Acetaminophen PO

›650 mg every 6 hours as needed

›Maximum daily dose per local guidance

›Ibuprofen PO

›400 mg every 6 to 8 hours as needed

›Avoid in renal injury and GI bleeding risk

›Opioid for severe pain

›Morphine PO

›5 to 10 mg every 4 hours as needed

›Constipation prophylaxis

›Hydromorphone PO

›1 to 2 mg every 4 to 6 hours as needed

›Sedation monitoring

›Dressing change pain control

›Premedication timing

›Oral analgesic 30 to 60 minutes prior

›IV analgesic 10 to 20 minutes prior when inpatient

›Topical anesthetic consideration

›Lidocaine gel when appropriate

›Avoid on large surface area without supervision

Nutrition and metabolic optimization

›Nutritional support

›Protein goals

›Increased protein intake for healing

›Renal disease tailored protein plan

›Caloric adequacy

›Dietitian guided plan

›Enteral supplementation when intake poor

›Micronutrients

›Vitamin C adequacy

›Zinc supplementation only if deficiency or high risk

›Glycemic management

›Hyperglycemia control

›Basal bolus insulin inpatient when needed

›Sick day plan outpatient

Surgical and advanced therapies

›Source control procedures

›Incision and drainage

›Drainable abscess

›Culture collection from deep tissue

›Operative debridement

›Extensive eschar with infection

›Necrotizing infection concern

›Reconstruction planning

›Flap coverage evaluation

›Large stage 4 defects

›Recurrent ulcers despite optimization

›Pre flap prerequisites

›Offloading plan reliable

›Nutrition optimization underway

›Smoking cessation support

09Special Populations/sp33

Pregnancy

›Pregnancy considerations

›Positioning constraints

›Left lateral tilt in later pregnancy

›Aortocaval compression avoidance

›Medication safety

›Avoid doxycycline

›NSAID avoidance in third trimester

›Infection escalation threshold

›Lower threshold for sepsis evaluation

›Obstetric consultation for systemic infection

Geriatric

›Older adult considerations

›Frailty and sarcopenia

›High malnutrition prevalence

›Higher recurrence risk

›Polypharmacy

›Anticoagulant associated bleeding risk

›Sedative associated immobility risk

›Skin fragility

›Higher skin tear risk during dressing changes

›Adhesive minimization

Pediatrics

›Pediatric considerations

›Higher device related injury burden

›Nasal cannula and masks

›Splints and casts

›Support surface guidance

›High specification mattress for children with ulcer

›Specialist support surfaces when appropriate

›Dosing and monitoring

›Weight based antibiotic dosing

›Analgesic dosing by weight

›Safeguarding considerations

›Nonaccidental injury evaluation when pattern inconsistent

›Social work involvement when neglect concern

10Background/b43

Epidemiology

›Frequency and burden

›Hospital prevalence ranges

›2.2 percent to 24.7 percent reported across studies

›Higher prevalence in long term care and palliative settings

›Global prevalence estimates

›Pooled prevalence around 12.8 percent across 2008 to 2018 data

›Regional variation across continents

›Nursing home prevalence example

›About 11 percent of nursing home residents reported with pressure ulcers in US 2004 data

Pathophysiology

›Mechanisms of injury

›Pressure intensity and duration

›Capillary occlusion and ischemia

›Reperfusion injury contribution

›Shear forces

›Deep tissue deformation

›Microvascular compromise

›Moisture and friction

›Maceration increases susceptibility

›Skin barrier breakdown

›Injury phenotypes

›Bony prominence injury

›Sacral and heel predominance

›Deep tissue involvement possible before skin breakdown

›Medical device related injury

›Localized to device contact area

›Shape mirrors device

Therapeutic Considerations

›Core principles

›Pressure redistribution as primary therapy

›Offloading effectiveness dependent on adherence

›Support surface adjunct not replacement for repositioning

›Wound bed preparation

›Nonviable tissue removal

›Moisture balance

›Infection stewardship

›Antibiotics for clinical infection only

›Culture directed therapy preferred for deep infection

›Guideline alignment

›International Guideline third edition 2019

›Prevention and treatment recommendations comprehensive

›Evidence appraisal methodology described

›NICE CG179

›Risk assessment and prevention for all ages

›Repositioning frequency guidance for high risk

11Patient Discharge Instructions/pdi38

copy discharge instructions

›Home care plan

›Offloading and positioning

›Reposition at least every 4 hours if high risk adult

›More frequent repositioning if child or teen at high risk

›Skin care

›Keep skin clean and dry

›Barrier cream for incontinence

›Dressing care

›Keep dressing clean and dry

›Dressing change schedule per wound care plan

›Pain control

›Use prescribed pain meds before dressing changes

›Avoid exceeding acetaminophen daily maximum

›Return to ED now

›Infection warning signs

›Fever

›Spreading redness around wound

›New pus drainage

›Worsening foul odor after cleansing

›Sepsis warning signs

›Confusion

›Fainting

›Fast breathing

›Severe weakness

›Necrotizing infection warning signs

›Rapid worsening pain

›Skin turning purple or black quickly

›Blistering

›Bleeding concerns

›Persistent bleeding soaking dressings

›Black stools if on NSAIDs or anticoagulants

›Follow up

›Wound care clinic within 3 to 7 days

›Earlier if stage 3 or stage 4

›Earlier if new pain or drainage

›Primary care for risk factor control

›Diabetes management plan

›Nutrition support plan

12References/r13

Guidelines and key sources

›Core references

›EPUAP NPIAP PPPIA Prevention and Treatment of Pressure Ulcers Injuries Clinical Practice Guideline International Guideline 2019

›NICE CG179 Pressure ulcers prevention and management 2014 last reviewed 2018

›NPIAP Pressure Injury Stages definitions document updated staging system

›Wound Healing Society Guidelines for the Treatment of Pressure Ulcers 2023 update

›RNAO Assessment and Management of Pressure Injuries clinical best practice guideline

›Evidence and epidemiology sources

›Hospital prevalence ranges 2.2 percent to 24.7 percent reported in recent review literature

›Global prevalence estimate 12.8 percent across 2008 to 2018 pooled data

›CDC nursing home pressure ulcer prevalence report 2004

›Osteomyelitis considerations

›Bone biopsy culture and histopathology as reference for osteomyelitis diagnosis in pressure ulcer contexts

›MRI favored when osteomyelitis diagnosis remains in doubt after clinical and initial studies in related ulcer infection guidance

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed June 16, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.