Diabetic foot resident survival guide

Resident Survival Guide
Introduction
Team
Guide
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Examine the Patient Template
Navigation Bar Template
Checklist
Topics

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ifrah Fatima, M.B.B.S[2]

Overview

This section provides a short and straight to the point overview of the disease or symptom. The first sentence of the overview must contain the name of the disease.

Causes

Life Threatening Causes

Life-threatening causes include conditions that may result in death or permanent disability within 24 hours if left untreated. Diabetic foot superseded with the following may result in sepsis and death.

• Infected diabetic foot
• Osteomyelitis

Common Causes

• Poor glycemic control
• Peripheral neuropathy
  • Autonomic neuropathy
  • Somatic/Motor neuropathy
• Peripheral arterial disease
• Peripheral ischemia
• Improper footwear
• Foot deformities including Charcot arthropathy

Diagnosis

Assessment of diabetic foot includes evaluation of peripheral arterial disease, peripheral neuropathy, and foot deformities. Shown below is an algorithm summarizing the diagnosis of [[disease name]] according the the [...] guidelines.

Characterize the symptoms: ❑ Onset ❑ Type of sensation ❑ Location ❑ Nocturnal variation ❑ Aggravating factors ❑ Relieving factors Obtain a detailed history: ❑ Onset of diabetes ❑ Duration of diabetes ❑ Compliance with medication ❑ History of glycemic control ❑ History of other diabetic complcatios ❑ Foot deformities/injuries/ulcers ❑ History of lower limb amputation ❑ Type of footwear ❑ Foot hygiene ❑ History of claudication ❑ Smoking history

Examine the patient: Inspection ❑ Location of ulcer ❑ Integrity and charcteristic (dry/cracked) of skin ❑ Sweating Palpation ❑ Pedal (dorsalis pedis) pulses ❑ Vibration sensation ❑ Ulcer site- warmth, tenderness, edema Non-invasive tests ❑ Semmes-Weinstein monofilament test ❑ Probe-to-bone test if suspected osteomyelitis ❑ Measure ABI (Ankle-Brachial Index) with a Arterial doppler

Order tests: ❑ Peripheral blood smear ❑ CBC and differential ❑ Reticulocyte count ❑ LDH ❑ LFT ❑ Renal function test ❑ Clotting screen ❑ PT ❑ aPTT ❑ Fibrinogen ❑ Haptoglobin ❑ D-dimer ❑ Request a hematology consult

❑ Order additional tests based on the results of the CBC-D and peripheral blood smear

Possible Pseudothrombocytopenia ❑ Clumped platelets

True thrombocytopenia

❑ Order platelet count on heparinized blood specimen

Isolated thrombocytopenia

Thrombocytopenia with abnormalities in other blood lineages

Guide your next step by specific findings

Consider: ❑ ITP ❑ Drug induced thrombocytopenia ❑ HIV ❑ HCV ❑ H. pylori ❑ DIC ❑ Gestational thrombocytopenia

Look for: ❑ Schistocytes ❑ Spherocytes ❑ Dacrocytes ❑ Blasts ❑ Giant platelets ❑ Granulations ❑ Hypersegmented neutrophils ❑ Macrocytosis ❑ Lymphocytosis ❑ Neutropenia

Treatment

Shown below is an algorithm summarizing the treatment of [[disease name]] according the the [...] guidelines.

Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.

References

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