#Severe Diabetic foot ulcer
Failed outpatient treatment with Doxy and Metronizadole for 14 days.
Probed to bone @2.5cm. Tenderness absent 2/2 to neuropathy. Erythema and edema present. Mild crepitus present (indicating mixed infection w/ GNR and anaerobes or clostridium). Purulent. Debrided and packed. Wound Cx and BCx pending. Will consider MRI and bone biopsy to r/o osteomyelitis.
Tx: Antibiotics (Vancomycin and Zosyn). Bedrest, Elevate extremity, Non-weight bearing status. Wound care. Glycemic control. Surgical debridement as needed. Consult his podiatrist, Dr. Wood to see the patient in the hospital.
#Diabetes, II
Will hold Metformin and start SSI. Accuchecks q6h. Lantus 8units plus SSI.