A 73-Year-Old Man Is Brought to the Emergency Department Due

A 73-year-old man is brought to the emergency department due to increasing confusion for the last day.  The patient has a history of type 2 diabetes mellitus, neuropathy, nonhealing foot ulcer, and coronary artery disease.  On arrival, he is lethargic.  Temperature is 37.6 C (99.7 F) , blood pressure is 80/50 mm Hg, pulse is 120/min, and respirations are 18/min.  Pulse oximetry on room air shows an oxygen saturation of 97%.  Mucous membranes are moist.  Cardiopulmonary examination reveals no abnormalities.  The abdomen is soft and nontender.  Neurologic examination shows no focal findings.  A nonhealing diabetic ulcer with small eschar is present over the right heel; there is no purulence, tenderness, or surrounding erythema.  Laboratory results are as follows: Which of the following is the most appropriate next step in management of this patient within the first hour of arrival in the emergency department?

A) CT scan of the head
B) Debridement of the foot eschar
C) Intravenous antibiotics
D) Intravenous dopamine
E) Short-acting insulin

Correct Answer:

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