tailieunhanh - PATHWAY 1_DIABETIC FOOT DISORDERS

After a diabetes-related LEA has been reported to be as low as 28% to 31% (169, 170). Persons with renal failure or more proximal levels of amputation have a poor prognosis and higher mortality rate. Those who undergo a diabetesrelated amputation have a 40% to 50 % chance of undergoing a contralateral amputation within 2 years (36, 171, 172). ASSESSMENT OF THE DIABETIC FOOT (Pathway 1) The pedal manifestations of diabetes are well documented and potentially limb-threatening when left untreated. Recognition of risk factors and treatment of diabetic foot disorders require the skill of a specialized practitioner to diagnose,. | PATHWAY 1 DIABETIC FOOT DISORDERS SIGNIFICANT HISTORY Duration of Diabetes Previous ulceration infection Charcot amputation Pain I sensation PAD or prior revascularization SIGNIFICANT FINDINGS Initial Patient Evaluation Dermatologic Erythema Warmth Cellulitis Ulcer Trophic changes Laboratory Tests CBC with differential ESR CRP Blood glucose HbA1c Musculoskeletal Swelling Deformity Joint mobility Joint dislocation Neurologic Degree of neuropathy assessed by Semmes-Weinstein monofilaments vibratory proprioception Vascular Absent or asymmetric pedal pulses Dependent rubor Gangrene Diagnostic Imaging Plain radiographs V Imaging studies CT MRI Bone scan Noninvasive Vascular Studies Arterial Doppler ABI toe pressures waveforms Transcutaneous oxygen tensions Radiographic Findings Additional Diagnostic Procedures as Indicated INFECTION Proceed to Pathway 4 CELLULITIS ABSCESS OSTEOMYELITIS CHARCOT ULCERATON Bone density Fractures Joints bones involved Dislocation Osteolysis Soft tissue edema Deformity Vascular calcifications ISCHEMIA Deformity Proceed to Pathway 2 CHARCOT ULCER Treatment DIABETIC FOOT DISORDERS VOLUME 45 NUMBER 5 SEPTEMBER OCTOBER 2006 S-9 after a diabetes-related LEA has been reported to be as low as 28 to 31 169 170 . Persons with renal failure or more proximal levels of amputation have a poor prognosis and higher mortality rate. Those who undergo a diabetes-related amputation have a 40 to 50 chance of undergoing a contralateral amputation within 2 years 36 171 172 . ASSESSMENT OF THE DIABETIC FOOT Pathway 1 The pedal manifestations of diabetes are well documented and potentially limb-threatening when left untreated. Recognition of risk factors and treatment of diabetic foot disorders require the skill of a specialized practitioner to diagnose manage treat and counsel the patient. Integration of knowledge and experience through a multidisciplinary team approach promotes more effective treatment thereby improving outcomes and limiting the risk of lower .

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