MANAGEMENT

Advice and Information

 Educate patient and family about his condition: possible etiology, risk factors, course of disease,
signs and symptoms, complications if left untreated, prognosis and medical options for treatment
including its benefits, side effects, risk and alternatives. Increasing patient’s knowledge about his
condition to improve medical compliance and assist in symptom management.
 Educate the patient about the major role played by smoking in the development, progression and
prognosis of TAO.
 All possible means should be used to encourage him to give up the use of tobacco, in all its forms,
completely and definitively.
 He should be reassured that if he manages to give up smoking completely, the disease will go into
remission and amputation will be avoided
 Early and aggressive treatment of extremity injuries to protect against infections.

Non-pharmacologic Management
Preoperative Management
 Admit to ward
 Vital signs monitoring q 4h
 Start IVF PNSS 1L @ 33 gtts/min
 Local Wound Car to cleanse the wound with the creation of sufficient new tissue to enable healing.
 Allow the patient the opportunity to ask any questions and address any concerns he may have. Make sure that he has
an understanding about the procedure so he can make an informed decision.
 For surgical evaluation; If the patient's physical condition is compromised, stabilization to render him fit for
anesthesia should be carried out before surgery is undertaken.
Surgical Management
Revascularization treatment is rarely possible due to the diffusion of vascular damage and the distal nature of the
disease. Nevertheless, every effort should be made to improve distal arterial flow in patients with TAO.

Ray Amputation
A ray amputation is a particular form of minor amputation where a toe and part of the corresponding metatarsal bone is
removed. It provides a more viable option of ensuring an adequate surgical debridement of the septic margins. Indications may include a wet
or dry gangrene of a toe, osteomyelitis of the metatarsal head and/or proximal phalanx, septic arthritis of the metatarsophalangeal
joint (MTPJ) and gross infection of the toe.

Post-operative Management
 Maintain the individual on a pressure-redistribution system to reduce shear and pressure on the area.
 Monitor site signs of bleeding.
 Monitor site for edema, changes in color, drainage, temperature changes, pain.
 Assess the area carefully for signs of infection and delays in healing,
 Maintain skin integrity to the extent possible.
 Monitor vital signs
 Bed rest.
 Reposition and turn the individual at periodic intervals, in accordance with the individual’s wishes and tolerance.
 Control wound odor. Cleanse the surgical site and surrounding skin at the time of each dressing change.
 Provide adequate nutrition for healing.
 IVF PNSS 1L

PHARMACOLOGIC MANAGEMENT
Drug Name Efficacy Safety Suitability Cost
PAIN MANAGEMENT
It is a nonsteroidal anti- This should be Relief to mild to 500's
Paracetamol inflammatory drug that contraindicated to those moderately severe pain of (P1429.08/pac
Biogesic exhibits analgesic and who ingested products musculoskeletal origin eg k)
300 mg IV q 4h prn antipyretic activities by containing alcohol. It is muscle pain. It is also
for T > or equal to inhibiting prostaglandin contraindicated to those indicated to reduce fever. Biogesic oral
38C synthesis that may serve as with previous susp 250 mg/5
mediators of pain and hypersensitivity to mL- 60 mL x
 fever, primarily in the CNS. ibuprofen and related 1's
compounds. Adverse (P87.28/bottle
reactions include asthma, )
urticaria or allergic-type
reaction following NSAID
administration
MONITORING AND FOLLOW-UP
 Frequent follow-up examination by a physician or wound-care specialist is important.
PRESCRIPTION:
Alvin Pasuquin, MD
Silliman University Medical Center
Name:________________________________ Age/Sex:______________
Address:___________________________ Date: ________________
Jan Sibala, MD
Silliman University Medical Center
Name:________________________________ Age/Sex:______________
Address:___________________________ Date: ________________

___________________________ ___________________________
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Arianne Rodriguez Edessa Reyes, MD

, MD
Silliman University Medical Center
Name:________________________________ Age/Sex:______________
Address:_____________________________ Date: ________________
Silliman University Medical Center
Name:________________________________ Age/Sex:______________
Address:___________________________ Date: ________________

___________________________
SIGNATURE
___________________________
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REFERENCES:

References:
Braunwald et. al. 2008. Harrison’s Principles of Internal Medicine. 18th ed. McGraw Hill Companies, USA.
Fauci, A., et al. (2008). Harrison’s Principles of Internal Medicine. 17th Ed. McGraw-Hill Medical Publishing Division, United
States of America
Katzung, B. (2007). Basic and Clinical Pharmacology. 10th Ed. Lange McGraw-Hill. USA
Kee, J.L. & Hayes, E.R. 2003. Pharmacology A Nursing Approach. 4th ed. Elsevier Science, USA.
MIMS Philippines. 113th Ed. 2007
Strandell, C. et al. (2000). Manual of Laboratory and Diagnostic Tests. 6th Ed. Lippincott Williams & Wilkins. Philadelphia.