A 60-year-old woman was presented with an ulcer on the right foot. She was diabetic for 18 years. There is a black, bloody, discharge from the ulcer. The bleeding was profuse, and the smell was intolerable. There is some pain in the foot but no sense of touch. There was also numbness in both the legs. Appetite was poor, and she was sleepless. She complained of a chilly sensation in the body, and her extremities were cold to touch.
History suggest it is diabetic foot Foul smelling discharge suggest gangrenous infection Control the diabetes with insulin+oha Debridement of ulcers Broadspectrum antibiotics inj Ceftriaxozone Inj lenazolinid Inj meteronidazole Dressings with placentrax +meterogyl+mupirocin oint Irrigation with h2o2 and NS Infiltrate insulin locally If no response and difficult to salvage This would be fit case for Amputation
IT'S A..CASE OF.. * UNCONTROLLED DIABETES WITH.. GANGRENOUS ULCER FOOT.. * NEED'S.. STRICT GLYCEMIC CONTROL WITH ANTIDIABETIC MANAGEMENT WITH EXPERTS OPINION.. * WOUND MANAGEMENT WITH SURGEONS OPINION.. * INVESTIGATIONS TO CONCLUDE DIAGNOSIS AND TREATMENT..
This is a case of diabetic foot with multiple nonhealing neuropathic ulcers ??? Gangrenous and limb threatening . Do the following investigations FPG PPG HbA1C RFT LFT Serum electrolytes Lipid profile CBP Micral ECG 2DEcho CUE Culture and sensitivity of pus from the ulcers. X ray right foot and leg both AP and lateral view s to exclude Osteomyelitis. Vascular Doppler of both lower limbs both arterial and venous to exclude obstruction of arterial blood flow and to exclude venous ulcer. MRI foot if necessary. Palpate Dorsalis pedis and Posterior tibial arterial pulses to exclude ischemia. Coming to the treatment 1) Admit the case under high risk consent and explain and discuss the pros and cons of the case with patient and her relatives in detail. 2) Extensive debridement of the wound by general surgeon. 3) Tight Control of blood sugars by Insulin only either basal bolus or premixed depending on blood sugars and ketone bodies. 4) Both gram positive and gram negative antibiotics along with anti anerobic antibiotics should be given intravenously. 5) Tissue lytics like Trypsin and chymotrypsin to reduce the tissue edema. 6) Lifeline fluids and symptomatic treatment. 7) Elevation of the limb 8) All these should be done if there is proper blood supply to foot, otherwise limb amputation meticulously below the knee or above the knee depending on arterial supply is only one option leftover to save the life. 9)Life is more important than limb. Timely and proper intervention saves the life. Otherwise it is life-threatening infection which spreads rapidly and endagers the life of the patient .
Diabetic Neuropathy...caused Diabetic foot. Diabetic ulcers are most commonly caused by: poor circulation. high blood sugar (hyperglycemia) nerve damage
Diabetic foot Neuropathic foot ? Avascular limb with gangrene Sepsis with septecemia Admission, tight control of DM with insulin, debridement, pus and blood culture, IV antibiotics, IV metronidazole ,Flucanazole X-ray foot, arterial colour Doppler Amputation may be required ..
Looks like Uncontrolled Diabetes. And Foul smelling discharge ?? Gangrenous Ulcer foot. Strict Control Diabetes with insulin Treat with Broad spectrum Antibiotics. Clean and dressing in Routine. Maintain proper personal hygiene.
Uncontrolled DM Peripheral neuritis Diabetic ulcer Controll dm by insuline Propr wound care with removing Slough Broade spectrum antibiotics Gsbapen300mgtds
Diabetic foot with gangrenous Ulcer foot. Needs further investigation and evaluation to conclude and treatment plan. Till reports complied. Debridement under LA and ASD with betadine lotion. Keep area clean and covered with sofra tullu gauge. Inj CEFTUM 1gm iv bd. Analgesic antiflamatory orally. Multivitamin and antioxidants orally. Strict control over DM by medicine,diet and change of life style. X Ray foot result will be crucial for surgical intervention and to avoid eventuality.
Ulcers Foot/Diabetes with impending gangrenous changes.
Diabetic foot with ulceration and impending gangrene.control of bsl, appropriate antibiotics, debridement and amputation as a last resort.
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