diabetic foot patient before and after treatment.pptx

a case presentation

1. DIABETIC FOOT CASE DISCUSSION DR SANOBER GUL RESIDENT INTERNAL MEDICINE

2. PRESENTATION A 44 year old male k/c of type 2 DM for last 6 years On insulin 70/30 and oral hypoglycemics ( sitagliptin and metformin ) with poor glycemic control Presenting complaint: ulcer on dorsum of left foot for 2 weeks After formation of bullae

3. EXAMINATION His vitals were: BP: 110/70 HR: 78 RR: 16/min Sats: 94% at room air BSR: 298mg/dl Systemic examination was unremarkable

4. ON EXAMINATION Ulcer on dorsum of left foot Measuring 4 x 4 cm With active signs of inflammation Swollen, erythematous, warmth, pus discharge with some necrotic patches Tendons were also exposed

5. NEUROLOGICAL EXAMINATION Pinprick and vibration sensations were reduced up to ankle VASCULAR EXAMINATION Pulses were feeble on left foot

6. INVESTIGATIONS Hb: 14 with normochromic normocytic picture TLC: 8K with neutrophilic leukocytosis Platelets: 525000 CRP: 40 HbA1c: 10.9 Deranged lipid profile b/l arterial doppler of lower limbs was normal

7. SINBAD SCORE OF 4

8. GRADE 3 ULCER

9. TYPE OF ULCER Neuropathic type of ulcer

10. MANAGEMENT Tissue c/s was sent General surgery consult for debridement of wound was done Antibiotics started ( inj : sulzone ) Insulin dose and oral medications adjusted Daily dressing, foot care, off loading advised Diet and life style counselling was also done

11. After the culture report which showed sensitivity to co-amoxiclav Patient was shifted to oral antibiotics ( Augmentin 1gm BD )

12. Wound After Incision And Drainage

13. Learning objectives Early recognition of wound on the basis of severity Prompt decision about in vs outpatient management Any new event should be notified early Ensure strict glycemic control Wound care

14. THANK YOU!