[Answered]: Patient with a Sustained Unwitnessed Fall Mr

Patient with a Sustained Unwitnessed Fall Mr. D is a 90-year-old man who recently experienced an unwitnessed fall, leading to an unstable T10-T11 spinal fracture. He underwent neurosurgery for this injury and has been wearing a thoracic lumbar sacral orthosis (TLSO) brace. His condition was complicated by a pressure injury to his mid-back. He was transferred from an acute hospital in the Greater Toronto Area (GTA) to a neurology unit. Past Medical History: Mr. D has a history of several health issues including endocarditis, heart failure, valve replacements, mitral stenosis and regurgitation, osteoarthritis, osteoporosis, retinal detachment, and pulmonary embolism. He also has kyphosis. Current Medications: Tylenol (Acetaminophen) for pain Hydromorphone (opioid) for severe pain Digoxin, Atenolol (for heart conditions) Dalteparin (anticoagulant) Risedronate (for osteoporosis) Mirtazapine (antidepressant) Vital Signs: Temperature fluctuated from normal to 38.6°C Pulse ranged from 113 to 125 beats/min Respiratory rate between 26 to 30/min Blood pressure varied from 90/60 mmHg to 140/90 mmHg Laboratory Tests: CBC, electrolytes, and CRP tests were performed; a blood culture was taken. Orders: Activity as tolerated with TLSO brace use, head of bed elevated above 45 degrees Wound care for a stage 2 pressure injury NG tube feeding initiated for nutritional support Pressure Injury Progression: Initially a skin tear, it progressed to a stage 2 pressure ulcer and eventually became unstageable with 60% necrosis after 4 weeks. VAC and PICO therapy were started. Additional Issues: Abdominal bloating and diarrhea from feeding formula led to a second pressure injury on the coccyx. Orthopedic and plastic surgery consults led to the removal of the TLSO brace. The patient developed spinal cord compression with bilateral lower extremity loss of sensation. Pain management was challenging due to family concerns about analgesics causing confusion or respiratory depression. Hydromorphone showed minimal effect