67 yr old male with diabetic foot and heart failure

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Case history of 67 yr old male

K/c/o diabetes since 13years

Patient presented to surgery OPD on 1-11-23 with diabetic foot(c/o: blackish discoloration of 2nd and 3rd toe since 20 days) , before coming to kamineni he went to local rmp where first aid was done then he came to  kamineni where he had amputation of 2nd and 3rd toe of Right leg on 1-11-23

1-11-23 to 11-11-23 ( dressings were done)

On 11-11-23 he developed shortnes of breath,chest pain  (trop-i was 1080, diagnosed as NSTEMI ,for which patient went to the KHLon 12-11-23 where angiogram was done ( shown-lcx and rca blockade) , they are unable  to afford money to undergo stent 

They visited virnchi hospital(on 15-11-23)  and where he had PTCA and 2 STENTS to lcx and rca, he stayed 5 days (till 20-11-23)

On 20-11-23 he came to kamineni hospital to get dressings done for his rt foot 

On 24-11-23 case was shifted to gm I/v/o high blood sugars was kept on hai .

On 26-11-23 case was transferred to gs to get dressings done ,but shifted to gm on 5-11-23

I/v/o high blood sugars and deranged rft and haemogram 

Then he had dialysis for 3 days continuously,also first 2 days he had 1prbc transfusion on each day

Then on 12-12-23 he had dialysis and transfusion

 

 13-12-23 (haemogram and rft)

ECG:

Grbs 

PERSONAL HISTORY: 

Diet - Mixed

Appetite - normal

Sleep - adequate 

Bowel and bladder movements -regular 

no hlo addictions.

GENERAL EXAMINATION 

Patient is irritable,non-cooperative

There is presence of pallor 

No cyanosis, clubbing, lymphadenopathy,edema

Vitals on admission - 

Temp -afebrile

BP - 110/70 mm hg 

PR - 121bpm 

RR- 34cpm 

SYSTEMIC EXAMINATION:

CVS: s1,s2 are heard ,no murmurs

RS:BAE present, crepitations are heard

  P/A-soft,non tender

Diagnosis: diabetic ulcer over sole of right leg .

S/P- debridement and amputation of 2 nd and 3rd toe of right leg

Heart failure with reduced ejection fraction with anemia

S/P- PTCA and 2 STENTS to lcx and rca

AKI( hemodialysis was done)

Treatment plan

 inj piptaz 2.25 g iv

Cap.doxycycline 100 mg

Iv.fluids NS@50ml/hr

Inj.dobutamine 1amp(5ml in 45ml NS @3-6ml /hr

Inj.hai s/c tid

Inj nph s/c bd

Nen.budecort 8th hrly

Inj.iron sucrose 200 mg in 100 mlNS iv / od

Tab.rosavastatin 40 mg po/ od

Tab.spirnolactone 20 mg po/ od

Tab.metoprolol 25mg po/ od

Tab.sacubitril plus valsartan