Joe diamond just got back to the chair that's true I did I can't deny it no 34 year old man 557847 medications list afibrocept atorvastatin 40 mg once a day ezetimibe 10 mg once a day levemir insulin novorapid insulin sertraline 100 mg as directed indapamide 2.5 mg once in the morning brinzolamide 10 mg/mg eye drops 1 drop twice daily to both eyes amlodipine 10 mg once a day furlic acid 5 mg once a day stexoril d 3 1000 unit tablets once per day ramipril 10 mg once a day codeine 30 mg 1 to 2 4 times a day versatis 700 mg medicated plasters apply for 12 hours then remove for 12 hours issues recurrent cellulitis charcot's arthropathy pressure injury of the right fourth metatarsal head ulcer and chronic leg ulcers metabolic associated fatty liver disease ocular hypertension glaucoma type 2 diabetes mellitus type 1 diabetes mellitus with diabetic retinopathy diabetic neuropathy and diabetic retinopathy proliferative hypertension multiple admissions with diabetic ketoacidosis in 2004 2010 and 2011 allergies amoxicillin clarithromycin clindamycin cotrimoxazole duloxetine erythromycin trimethoprim and venlafaxine medications list albumin 34 alp a 197 in keeping with bone disease sodium a 131 from previously a 138 potassium normal creatinine 286 from baseline 130 a k I 2 gfr 24 from 62 lfts alp 1 97 alt 64 which is raised from previous 33 crp 343 from previously 6 urea 23.6 from 6.8 at baseline bst 85 phosphate 1.12 magnesium 1.07 full blood count hemoglobin 113 from a 140 previously white cells 19.5 from 8.9 platelets normal neutrophils 16.17 venous blood gas ph 7.35 with lactate 2.1 note previous microbiology pre discuss microbiology 12/24/2025 mssa from right leg wound swap consider po cephalexin and linezolid with usual look up for interactions contraindications if no improvement no morbidly obese over 150 kg previous microbiology light growth of staphylococcus aureus which was susceptible to flucloxacillin linezolid and trimethoprim resistant to penicillin doxycycline clindamycin and clarithromycin considering po kefalexin last time based upon sensitivities add to the past medical history type 1 diabetes with autonomic and sensory neuropathy 2 minor hypoglycemic episodes per week generally aware of these chronic neuropathic ulcer on right fourth metatarsal head they don't think he's safe recurrent cellulitis bilateral charcot foot mild lvh on echocardiogram august 2021 with ejection fraction 55% and a trace of mitral regurgitation ckd 2 to 3 bmi 54 social history mobilized with clutches pain limits exertion able to dress wash and do light elsewhere including hoovering but cannot do anything heavier than this seats on 4 pillows due to pain in his back and has done so since he experienced covid does not suck pmd stay in portugal waiting some places to stay if I may definitely till monday until this got done I'll do something different so the family's been so go you can have the room it's just like now good I think good fine like I said I'm brock I'm 1 of the medical experts likes to meet I'm sorry to see you in the hospital you're quite poorly by the looks of your blood tests yeah I've had last year as well you feel crap and how did this all start well I started off with dnv 6 days ago started clearing up 6 days ago I woke up leg was swollen red typical sinus cellulitis then I started leaking everywhere your right leg and was that the leg that you had infected before yeah and that's where you've got your chronic ulcer on your foot isn't it yeah is it the ulcer that you think's infected no cellulitis around you and you've dressed it for the first time you said just with compression to try it yeah I'm just nurse yeah okay fine alright and obviously you've got diabetes type 1 diabetes and you take insulin basal bolus insulin don't you so you take novorapid how much do you take well I'm on carb counting okay and you you you dose that yourself yeah then you take levemir in the evening is it how much levemir do you have I take 42 42 42 in the morning 42 in the yeah of 11 and then you use novorapid 3 times daily yes and you can't that's fine roughly what kind of range do you move between on the novorapid on a good day between 5 and 10 5 and 10 fine on on a day where I may misjudge something 10 and above mhmm yeah fine but you do sometimes go low don't yeah more than go high yeah yeah fine alright yeah apart apart from the 6 days I just slept and I know it just went high as a kite mhmm I've got the blood sugar right back down under control okay great I'm glad well we'll keep try and keep them under control while you're in hospital you're gonna need some antibiotics first you're allergic to lots of antibiotics based on your gp record are they true allergies or the things you're allergic to right so probably gonna be cephalexin I think based on your previous sensitivities that's the medicine you had last time last time I was here I was given something else as well okay I was treat I was treated down in the ward next to the reception yeah fine just in the acute medical unit yeah and they gave me some I came in every day for 2 weeks fine so you had ambulatory antibiotics at that time at the moment the infection 's hit your kidneys a little bit ah so you need a bit of fluid to wash the kidneys through before you can think about doing ambulatory antibiotics but we'll get there yeah because being honest with you don't particularly want to stay in the hospital of course not no 1 does but if I can go home and someone can come out and give me the drip yeah then that I'll be a lot happier that would be good I suspect you might be staying in hospital tonight so we can give you a drip of fluid overnight and keep a close eye on those kidney levels is that alright yeah but then agreed if things are better tomorrow could try and get you out of there okay do you feel like your diabetes is under control at your the blood test was okay for diabetes that's good can I have a look at you yeah you're saying if if I wasn't I'd be snapping and snoring at you yeah good fine you totally you do feel a bit sweaty and clammy day got a tracing of your heart yet yeah ecg got the can I see your tongue if you like that's fine can you tell me about all of the room for me that's lovely and your tongue's a little bit pinky a little bit dry heart heart sounds sounds normal turn around the back okay yep see if we're in there already okay let me get in perfect and last so you see the vascular surgeon with the diabetic team don't you in clinic I I do vascular you didn't see vascular what do you mean by vascular surgeons that operate on people with leg ulcers and things like that no I'm still worried by mdt here an mdt but I'm getting treated by podiatry here as well okay fine this can actually be diarrhea that affects the blood vessel and poor poor blood supply to this area is what's causing the problem I am on the lower limb as well are you and royal devon is that or is that here no here but by my breathing controls I'm just and you see doctor spire here don't you it's doctor spire jill spire I think I saw a letter from her how about the role yeah who knows well they both teams work together yeah fine I don't need to undress your leg ulcer but I can see it looks very red all the way up to your groin area has it been spreading and moving over the night it did spread yes you're short of breath no I'm just kids with the yeah no dnb the dnb the dnb I nest on top I'm I'm just sick just washed out yeah as a dnb completely stopped now yeah that's good fine great so I'll have a look at everything you've got I'll put all your medicines in and I'll find the right antibiotic for you based on what you had last time and is there anything I can do about the seat because I find it really uncomfortable about the seat yeah yeah of course you do it's they're not designed for people who need who are poor poorly like you so we need just need to get you a pet I'm sorry that you're in the seat I will do my best yeah because it's bad but it gives the blisters at the right night no I know yeah okay I'm sorry I'll do my best thank you you're our sickest person here so we'll do our best to meet you better and get you to the best okay let's get you straight let's get you walking test you're okay you did did you yeah I did guys this got started all off yeah it's so sad it's it's so yeah really yeah you sure yeah so I'm gonna move the thumb plate back to you yeah I've got a drip in here with me that's gonna be do me take that over do you want to help you oh not here is it a hernia no okay got it hello it's not a camera alright alright 1 alright good 1 right back and on the edge you need to get a little phone back over there yeah you're do a bit of reading and writing some of different things impression social history as above impression right leg cellulitis secondary to infected metatarsal leg ulcer secondary to diabetes mellitus stage 2 aki plan move to bed as soon as possible number 2 iv fluids number 3 antibiotics to be guided by microbiology given multiple allergies and challenging previous sensitivities number next chest x-ray number next urine mcns number next wound swab from leg for further sensitivities number next blood cultures number next diabetic team review number next consider vascular surgery review given recurrent cellulitis and nonhealing ulcer number next add h b a 1 c number next daily u and e while an aki number next input output monitoring number next urine dip number next diabetes ward if possible number next tep for full escalation number next pharmacological vte prophylaxis