4.3 of 7 Ratings
A 79-year-old male presents to the emergency room with difficulty breathing, productive cough, and fever for several days. He has a history of chronic obstructive pulmonary disease (COPD), type II diabetes mellitus, and hypertension. After initiation of oxygen by nasal cannula, albuterol and ipratroprium nebulizers, a chest radiograph is obtained. The results are shown in Figure A. The patient is admitted to the hospital for antibiotic therapy. On the second day of his hospital course, he becomes tachypneic and desaturates, and the decision is made to transfer him to the intensive care unit and intubate him. He remains sedated on the ventilator for the next week as his respiratory infection is treated, and he is started on total parenteral nutrition. On his eighth day in the hospital, his nurse notes that his heel appears as in Figure B. At this time, the patient’s temperature is 99.8°F (37.7°C), blood pressure is 119/65 mmHg, pulse is 85/min, and respirations are 13/min on the ventilator. Which of the following is the best next step in management?
Initiate intravenous vancomycin
Obtain foot MRI
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