Iatrogenic skin ulceration following neurological assessment

摘要

A 75 years male presented to the emergency departmentwith a history of headache on frontal region associated withvomiting. On examination, his Glasgow Coma Scale (GCS) wasE4V2M4.His nutritional statuswas poor.Computerized tomographyangiogram revealed aneurysmal subarachnoid hemorrhage.Clipping of the aneurysm was carried out under general anaesthesiaand was transferred to the intensive care unit undermechanical ventilation. Hourly neurological assessment wasperformed. He was extubated after 2 days of mechanical ventilationwith GCS of E4V4M5. On the second day of transfer tostep down unit, skin ulceration was noted in the region wherethe sternal rub was performed for assessment of GCS (Fig. 1).Regular dressing was carried out with subsequent healing of thewound. Hewas discharged home after 15 days of hospitalization.Rubbing should be gentle with frequent assessment in areascovered by clothing to prevent iatrogenic complications.