62yr old male with blackish discoloration of great toe,( post op bradycardia)

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A 62 yrs old pt came to GS opd with blackish discoloration of left great toe since 15 days.

HOPI

pta was apparently asymptomatic 3 months back and developed a blister on the left great toe and that has ruptured and formed an ulcer which is not healed and that infection has gradually increased.

15 days back pt came to hospital with blackish discoloration of that great toe.

No h/o any fever

No h/o itching

No h/o vomitings ( at the time of joining)

PAST HISTORY:

Patient had similar complaints in the past 1 yr back for the right great toe and got amputated other outside hospital.

20 yrs back patient suddenly develoed blurring of vision for some time and rushed to a local hospital and found out that he had diabetes. (Diabetic since 20yrs )

Not a k/c/o HTN, ASTHMA, CVA, TB.

PERSONAL HISTORY:

Normal appetite

Mixed type of diet and irresistible eating of sweets.

Regular bowel and bladder movements

There are no allergies for food or any drugs

Addictions : patient used to drink and smoke daily in the past for 40 yrs and stopped10yrs back.

TREATMENT HISTORY:

50yrs back he got amputated his ring finger upto distal Interphalangeal joint because of trauma to that finger.

Since 20 yrs he is on oral metformin for diabetes.

2 yrs back he started taking insulin for diabetes.

1 yr back got amputated his right great toe.

FAMILY HISTORY:

His brothers have diabetes

VITALS

Temp: 98.7

Spo 2: 98%

Bp: 110/60 mm of hg

RR: 16cycles / min

Pulse: 66 bpm

GENERAL EXAMINATION:

Pt is well built and malnourished , well cooperative coherent and coordinative.

pallor : present

Icterus : absent

Cyanosis : absent

Clubbing : absent

Koilonochia : absent

Lymphadenopathy :absent

Pedal edema : mild

Mid arm circumference 28 cm

Mamc: 23.6 mm

Triceps skinfold thickness:14mm

Abdominal girth: 98cm

Fvf ratio: 98-23.6 =4.15

SYSTEMIC EXAMINATION

Cvs

S1S2 heard

No murmurs

Respiratory system:

Trachea central

Normal vesicular breath sounds heard

Cns :

No focal neurological deficits are observed

Per abdomen:

Scaphoid abdomen

No tenderness and localised raise of temp.

No scars and sinuses

No organomegaly

Bowel sounds heard

LOCAL EXAMINATION:

Left leg

After rays amputation.

Healthy granulation tissue is seen.

Margins are regular.

No bleeding.

INVESTIGATIONS:

Ecg

25/10/2023

26/10/2023

27/10/2023

30/10/2023

26/10/2023

RFT

1) 30/10/2023

2) 25/10/2023

GLYCATED HAEMOGLOBIN

Blood sugar fasting
28/10/2023

Random Blood sugar

Serological tests

ABG

LIVER FUNCTION TEST

APTT

BLEEDING and CLOTTING TIME

Prothrombin time