"That "deep swab wound culture" bothers me a lot in that article. What effect do they think the antibiotic has on the GO flora and subsequent absorption?"
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Michael S. Miller DO
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Indications for lower extremity amputation
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As a wound care specialist, I see far too many patients who have either undergone a lower extremity amputation that based on their history and description of their presenting problem was a…Continue
Started this discussion. Last reply by passionrn Apr 2, 2011.
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Michael S. Miller DO replied to Kimberly Davis, LVN's discussion Nutrition for Wounds"Nutrition is no longer a "Add another can of Ensure and scoop of ProMod". With so much at stake in wound healing, you simply cannot afford to guesstimate at what the patients status is nor what they need. I have started…"
Michael S. Miller DO replied to WoundTalk's discussion What is your favorite wound product to use on heavily draining venous ulcers?"My question is, what do you do for the ongoing putrefying, macerating drainage for the two to three weeks it takes you to find out what the problem is and then "fix the problem, use compression therapy..." ? The costs of what you…"
Michael S. Miller DO replied to WoundTalk's discussion What is your favorite wound product to use on heavily draining venous ulcers?"The problem with using dressings that simply hold the drainage is that in reality, they do very poorly holding the drainage. It remains in contact with the skin guaranteeing maceration and more, that lovely smell that develops as the drainage…"
passionrn replied to Michael S. Miller DO's discussion Indications for lower extremity amputation"I think it is up to the dr and nurse to educate the patient and let patient deceide."
passionrn replied to Michael S. Miller DO's discussion Indications for lower extremity amputation"Plus are we talking amputation of entire leg or just a single toe? Single toes are often amputated with gangrene and osteomyelitis. This depends on the Dr and patient, some patients just want the pain to end and want a quick toe amputation. Some…"
passionrn replied to Michael S. Miller DO's discussion Indications for lower extremity amputation"critical limb ischemia with no revascularization options. gangrene unresponsive to surgical debridement and antibiotics, patient going septic, vitals becoming unstable."
Michael S. Miller DO replied to Michael S. Miller DO's discussion Indications for lower extremity amputation"Yes, but what are those indications you would specifically consider letting a patient undergo an amputation such as gangrenous toes or other things. I am trying to identify if there are any specific indications for this or are they all…"
passionrn replied to Michael S. Miller DO's discussion Indications for lower extremity amputation"Amputation last choice, agressive wound care, treating osteomylelitis, and wound infections. bone debridment and hyperbarics would be how i would try to save the limb. Would only amputate if all else fails."
Michael S. Miller DO replied to Enid Mercado,BSN,RN,CRRN's discussion Measuring post Gastric bypass patients"Tough question. We all have patients with open wounds surrounded by excess skin and sub Q. Basically, there is really no right answer however, the definitive key to doing this is consistency. PIck a position that seems comfortable…"
Michael S. Miller DO replied to Lois Darnell's discussion Chronic Shoulder Draining Wound for 18 months"Lot's of questions. Was/Is she on antibiotics for osteomyelitis which is likely since the prosthesis became infected? Has she had and MRI or bone scan for Osteo? Did he debride the infected bone in the area and send it for…"
Michael S. Miller DO posted a discussionIndications for lower extremity amputation
As a wound care specialist, I see far too many patients who have either undergone a lower extremity amputation that based on their history and description of their presenting problem was a questionable" call. Of course, telling a patient that their condition/wound/erythema, etc. will "SPREAD" is a sure way to guarantee that an amputation will take place. Like many of you, I also see many patients who are "sentenced" to amputation when in fact, their wounds and conditions have been obscenely…See More
Michael S. Miller DO replied to Paula Jean Washington (Payne's discussion Transparent Film Dressings"The first and most important thing to do with any skin tera is to immediately try to replace the skin back completely over the open wound. Using some form of adherent strips can often help keep the tear on stretch and in place. A dressing applied to…"
Michael S. Miller DO replied to Irma Lee Zimnitsky`'s discussion Chronic Stage III wound"The group will need more information to help you out. Location, measurements, amount of drainage, age and physical status of patient, nutritional status, previous products used, a picture would also help."
Michael S. Miller DO replied to carol purcell's discussion home health wound care"And the problem is that most of the "non-wound care" conferences have little to no education about wound care and when they do, it is usually from a part time "dabbler" who does 4 hours per week at a "cookbook" wound…"
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- At 12:18pm on March 9, 2010,
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