Case Scenario
John Doe, 53y.o., has a history of Type I diabetes mellitus, cigarette smoking 40 pack years, CAD, and PVD. Six weeks ago, he developed a wound in his left heel which measured 4cm by 2cm when he discovered it. Despite IV antibiotics and chemical debridement, the wound developed a gangrene infection. He is scheduled for a BKA of the left lower extremity tomorrow at 10:00am. His meds include daily insulin, aspirin 325mg/day, Pletaal 100mg BID.
Summary:
Given case: 53 years old, male
History of
- Type-1 diabetes mellitus,
- CAD ( Coronary Artery Disease)
- PAD ( peripheral artery disease)
- Cigarette smoking 40 packs per year
COMPLAINTS:
- 6 weeks ago, he developed a wound in his left heel.
- Despite antibiotics, patient developed a gangrene infection.
ADVISE:
- To undergo BKA ( Below knee amputation) of left lower extremities
MEDICATION:
Daily insulin, aspirin 325 mg /day, pletaal 100 mg BD
Post-operative Data:
Post-operatively, Mr. Doe goes to the Post Anesthesia Care Unit (PACU) where he is extubated and begins to awaken from surgery. He is drowsy but arousable; tends to move and be restless. His expected blood loss is 800 cc. He has an IV in his right arm infusing D5.45%iL at 100 cc/hr. Post-operative labs are drawn and sent. His vital signs: BP100/60mmHg, PR-92bpm, RR-22cpm; and his dressing is slightly soaked with blood and with a removal drain at the site.
Main Question:
What post-operative assessments and immediate post-operative interventions should be performed for Mr. Doe?
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