34. A 58-year-old man is evaluated in the emergency departme…
34. A 58-year-old man is evaluated in the emergency department for fever and a wound to his right foot. He has a deep 4-cm × 4-cm wound to the plantar aspect of his right first metatarsal head and reports the wound has been present for roughly 3 months. There is surrounding erythema and swelling to the forefoot. He has a 10-year history of poorly controlled type 2 diabetes mellitus and hypertension. There is a positive probe-to-bone test. His blood pressure is 90/60 mm Hg, heart rate is 110 beats/minute, and temperature is 100.9°F. Laboratory work reveals a white blood cell count of 15,000µL (15 × 109/L) and elevated inflammatory markers. Blood cultures have been collected. The results of a plain radiograph of the foot and surgical consultation are pending. What initial treatment would be appropriate in this patient?
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