A 24-Year-Old Man with Hypoxic-Ischemic Brain Injury Is Sent to the Hospital

A 24-year-old man with hypoxic-ischemic brain injury is sent to the hospital from a nursing facility for evaluation of a skin ulcer.  The patient has a history of injection drug use, and 6 months ago he was found unresponsive at home with agonal respirations and pulseless electrical activity.  He required cardiopulmonary resuscitation, endotracheal intubation, and mechanical ventilation.  Since then, the patient's neurocognitive functions have not improved, and he receives mechanical ventilation through a tracheostomy and feeding through a gastrostomy tube.  Several days ago, the staff noticed a small ulceration over the patient's right heel, which has not healed.  Temperature is 37 C (98.6 F) , blood pressure is 110/70 mm Hg, and pulse is 68/min.  He moans to painful stimuli but does not follow any instructions.  Corneal and gag reflexes are present.  Heart sounds are normal.  Bilateral breath sounds are equal with no added sounds.  The abdomen is soft and nontender.  Skin examination shows an area of nonblanchable erythema overlying the sacral region.  On the posterior aspect of the right heel, there is a skin ulcer that is 2 cm x 1 cm with exposed dermis.  Which of the following would have been most effective in preventing this patient's skin lesions?

A) Aspirin and statin
B) Compression stockings
C) Elevation of head of bed to 45 degrees
D) Frequent skin massage
E) High-calorie feeding
F) Pneumatic compression devices
G) Pressure redistribution

Correct Answer:

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