BOSTON, MA – Nurse Amy Johnson has seen some pretty bad sacral decubitus ulcers in her long career as a wound care nurse, but this new consult takes the cake. In her own words, she described a patient’s sacral pressure ulcer earlier today as “not stage 4 and not even unstageable… it is the rarest of rare: a stage 5.” Johnson’s note and assessment has left everyone speechless.
“I know a stage 4 pressure ulcer involves full-thickness tissue loss with exposed bone, tendon, or muscle,” explained infectious diseases specialist Leanne Burton. “An unstageable wound has unknown depth because it’s obscured by slough or eschar. But stage 5? Wow. That sounds serious. What does that even mean?”
No one really knows. A search on PubMed for “stage 5 pressure ulcers” yielded no results, as did a similar search on UpToDate. Even a search on the two most evidence-based websites of them all, Wikipedia and The Dr. Oz Show, yielded no results.
“A pressure ulcer that’s stage 5 out of 4 is impressive,” said plastic surgeon Ryan Jones. “That’s like having 20 out of 10 pain; it must be bad!”
No one has been able to reach Johnson for further clarification, presumably she’s in a state of shock or gone for the day, thus leaving us only to conjecture. Until she can be reached, our crack staff at GomerBlog have come up with a few guesses on what might constitute a stage 5 pressure ulcer:
- Full-thickness tissue loss to the other side (sacral wound penetrates the rectus abdominis)
- Full-thickness tissue loss with exposure of soul or childhood memories
- Tissue loss wide enough to fit a whole wound V.A.C.
- Tissue loss wide enough to swallow one adult whole
In other news, it has been reported that a Los Angeles nephrologist has documented a patient’s renal failure as “beyond ESRD” or a “stage 6.” GomerBlog will investigate.