Diabetic foot Suggest a perfect line of treatment.



Apart from improving pt.'s general condition by correcting his B.sugar, electrolytes..he needs Proper antibiotic coverage and Extensive debridement..tow has to be amputated with extensive debridement of dead tissue over foot. after that Daily dressing. Antibiotic coverage (amoxy-clav or accrdng to sensitivity) and Control of blood sugar is must (b.k is not required yet as in infectious case we would want to preserve as much foot as we can,if we will have to,we will amputate foot) There is cellulitic changes present over ankle (musy be extending to leg) which can be dealt with Leg raising, Sumag dressing.

CT-angio is nt required yet..amputation has to be decided by visible gangrene..

Amputation would be the ultimate destiny of patient as it seems to be too late to controll to normalcy . Contrary best care of diabetes controll shuld be taken even after surgery

Shift Pt on insulin first Clean the wound up fresh tissues Suspected fungal infection with gangrene Amputation is recommended Broad spectrum antibiotics gram Positive + Gram Negative IV line Heamogram ESR Blood sugar F & PP IV albumin Ornidazole BD Chymotrypsin BD Aceclofenac Paracetamol saeropeptidase BD Tab Multivitamins OD Dressing properly with precautions .

why albumin? I would not give analgesics to this patient without knowing creatinine.

Inv: CBC,RBS,Serum acetone,SGPT,Serum creatinine,HIV,Australia antigen, Vascular doppler of the affected limb. admission, Inj:zostum 3gm iv bd Inj metrogyl iv 8hrly Inj levoflox iv bd Debridement of gangrenous area . pus C&S

Emergency amputation and control of diabetes.

It is criminal to let go to this extent. I don't know what else to suggest. It only surgeon and diabetolist can decide.

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Krishna Mohan sir, waiting for your response

Thanks dear Narayan for tagging me.

Total amputation not advisable. Medial toes are salvageable. Require blood sugar control,dressing with normal saline, surgical consultation. clindmycin and offloading of pressure point

This is a case of T2DM Gangrenous Extensive Diabetic Foot syndrome. This needs investigations like FPG 2hr PG HbA1c RFR Serum Electrolytes X Ray Foot and ankle AP & Lateral view Vascular Doppler CT Angiography. Treatment. First admit the patient, Take high risk consent after explaining the real situation to the patient and attendants. 1) Meticulously control DM with Basal Bolus insulin. 2) Correction of Dehydration. 3) Correction of Electrolytes 4) Decide the level of Amputation by means of CT Angiography. 5) Once the patient is metabolically fit for Surgery, carry out with amputation. 6) Mostly he requires B/K Amputation. 7) At the time of Discharge Counseling against Proper foot care Proper foot ware. Maintenance of Glycemia Regular medical check ups Artificial Limb after 2 months if stump is hard enough and healthy enough. Thanks all and at the same time this case is an example for height of negligence on the part of patient as well as the doctors for not treating in a proper way. My intention is not to hurt anyone. Please don't misunderstand me.

yes Sir agree with you. this is gross negligence on the part of patient as well as doctor . negligence on part of doctor can lead to legal complications

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Until what extent

open the colostrum 2 capsules and sprinkle over the wound and ask the patient to take 2capsule bid for 15 days. definitely results will come... n along with augmentin half BID...

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