Wound Care: When to request an eConsult

Myra Varnado, Director of Clinical Services at Corstrata

It is important that we know when should they request an eConsult. You know, these are the types of wounds typically that we see. All those lower extremities. We see wounds who have a mixed etiology a lot of times. And those are really kind of tricky ’cause uh, you know, we’ve already said, okay, you don’t have great arterial flow, but guess what, your venous flow isn’t great either. So that’s, those are a little bit tricky. We can manage those and we can certainly work with those, they have to be assessed properly. The studies have to be done correctly, as far as venous and arterial doppler. And then, the plan is going to be very specific to whatever it is we find with that mixed disease, again, pressure injuries, we see a lot of wounds that have a stable scar.

Stable eschar is something that a lot of times you’ll see, for example, your patients who maybe are bed bound or patients who are palliative or hospice patients. those are patients that they’re complicated just by virtue of being long-term care patients or by being palliative or hospice. At that point, we have to really look at what are the goals of managing this patient’s care. Stable eschar is a scar that is typically leathery kind of hard. You’ll see it a whole lot of the time, for example, on a heel. It’s related to typical pressure injury. Okay? And what we’ll see is though it’s not a boggy feeling, it’s doesn’t have drainage, it’s not inflamed it’s stable. Okay? So if you have a patient like that, you know, you have to know, okay, that’s a patient we’re not gonna be aggressive with.

Whereas if that would be someone else you maybe would be very aggressive on how you’re going to address that particular limb. It’s just real important that we have a good history. So we know those things and we know the background of the patient and we get a lot of wounds that are unknown etiology and those just have to be worked up. And sometimes when we see those wounds, quite frankly, we’re looking at the medical history and labs and that kind of thing, but we’re also at some point just looking at what it is we see and making recommendations based upon what we see in the wound. That’s the best we can do. Whereas we may not have a great grasp necessarily on the etiology yet. We see a lot of wounds that are stalled wounds. Those can happen for a variety of reasons, and sometimes it has to do with the way we cleanse wounds and the way we take care of them. Certainly a lot of the wounds that we see, we also will include information on, as I said earlier in another slide, the recidivism. We don’t wanna see that happen. So, what are the things we can do? Okay, you get this wound closed. Now what are the things that can be done to prevent these wounds or this wound from reoccurring?