\documentclass[10pt,a4paper]{article}

% Packages
\usepackage{fancyhdr}           % For header and footer
\usepackage{multicol}           % Allows multicols in tables
\usepackage{tabularx}           % Intelligent column widths
\usepackage{tabulary}           % Used in header and footer
\usepackage{hhline}             % Border under tables
\usepackage{graphicx}           % For images
\usepackage{xcolor}             % For hex colours
%\usepackage[utf8x]{inputenc}    % For unicode character support
\usepackage[T1]{fontenc}        % Without this we get weird character replacements
\usepackage{colortbl}           % For coloured tables
\usepackage{setspace}           % For line height
\usepackage{lastpage}           % Needed for total page number
\usepackage{seqsplit}           % Splits long words.
%\usepackage{opensans}          % Can't make this work so far. Shame. Would be lovely.
\usepackage[normalem]{ulem}     % For underlining links
% Most of the following are not required for the majority
% of cheat sheets but are needed for some symbol support.
\usepackage{amsmath}            % Symbols
\usepackage{MnSymbol}           % Symbols
\usepackage{wasysym}            % Symbols
%\usepackage[english,german,french,spanish,italian]{babel}              % Languages

% Document Info
\author{happyfeet2020}
\pdfinfo{
  /Title (diabetic-foot-ulcers.pdf)
  /Creator (Cheatography)
  /Author (happyfeet2020)
  /Subject (Diabetic Foot ulcers Cheat Sheet)
}

% Lengths and widths
\addtolength{\textwidth}{6cm}
\addtolength{\textheight}{-1cm}
\addtolength{\hoffset}{-3cm}
\addtolength{\voffset}{-2cm}
\setlength{\tabcolsep}{0.2cm} % Space between columns
\setlength{\headsep}{-12pt} % Reduce space between header and content
\setlength{\headheight}{85pt} % If less, LaTeX automatically increases it
\renewcommand{\footrulewidth}{0pt} % Remove footer line
\renewcommand{\headrulewidth}{0pt} % Remove header line
\renewcommand{\seqinsert}{\ifmmode\allowbreak\else\-\fi} % Hyphens in seqsplit
% This two commands together give roughly
% the right line height in the tables
\renewcommand{\arraystretch}{1.3}
\onehalfspacing

% Commands
\newcommand{\SetRowColor}[1]{\noalign{\gdef\RowColorName{#1}}\rowcolor{\RowColorName}} % Shortcut for row colour
\newcommand{\mymulticolumn}[3]{\multicolumn{#1}{>{\columncolor{\RowColorName}}#2}{#3}} % For coloured multi-cols
\newcolumntype{x}[1]{>{\raggedright}p{#1}} % New column types for ragged-right paragraph columns
\newcommand{\tn}{\tabularnewline} % Required as custom column type in use

% Font and Colours
\definecolor{HeadBackground}{HTML}{333333}
\definecolor{FootBackground}{HTML}{666666}
\definecolor{TextColor}{HTML}{333333}
\definecolor{DarkBackground}{HTML}{C21CFF}
\definecolor{LightBackground}{HTML}{FBF0FF}
\renewcommand{\familydefault}{\sfdefault}
\color{TextColor}

% Header and Footer
\pagestyle{fancy}
\fancyhead{} % Set header to blank
\fancyfoot{} % Set footer to blank
\fancyhead[L]{
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{C}
    \SetRowColor{DarkBackground}
    \vspace{-7pt}
    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
    }
\end{tabulary}
\columnbreak
\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Diabetic Foot ulcers Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{happyfeet2020} via \textcolor{DarkBackground}{\uline{cheatography.com/144934/cs/31629/}}}
\end{tabulary}
\end{multicols}}

\fancyfoot[L]{ \footnotesize
\noindent
\begin{multicols}{3}
\begin{tabulary}{5.8cm}{LL}
  \SetRowColor{FootBackground}
  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}happyfeet2020 \\
  \uline{cheatography.com/happyfeet2020} \\
  \end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 14th April, 2022.\\
   Updated 14th April, 2022.\\
   Page {\thepage} of \pageref{LastPage}.
\end{tabulary}
\vfill
\columnbreak
\begin{tabulary}{5.8cm}{L}
  \SetRowColor{FootBackground}
  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Sponsor}}  \\
  \SetRowColor{white}
  \vspace{-5pt}
  %\includegraphics[width=48px,height=48px]{dave.jpeg}
  Measure your website readability!\\
  www.readability-score.com
\end{tabulary}
\end{multicols}}




\begin{document}
\raggedright
\raggedcolumns

% Set font size to small. Switch to any value
% from this page to resize cheat sheet text:
% www.emerson.emory.edu/services/latex/latex_169.html
\footnotesize % Small font.

\begin{multicols*}{3}

\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{History Taking}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\emph{Chief complaint}} & Ask patient why they're here and take HPI (NLDOCAT) \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\emph{Review Medications}} & Ask if they are any changes. Ask about their taking behaviour and any side effects they may be experiencing. Ask about complimentary or alternative medications. \tn 
% Row Count 9 (+ 7)
% Row 2
\SetRowColor{LightBackground}
{\emph{Review Allergies}} & Ask if they have any new allergies \tn 
% Row Count 11 (+ 2)
% Row 3
\SetRowColor{white}
{\emph{Active Practitioners}} & Ask about any recent visits to specialists, including dental eyes, endrocrine, nephron, neuro). \tn 
% Row Count 15 (+ 4)
% Row 4
\SetRowColor{LightBackground}
{\emph{Medical History}} & Inquire about their conditions. Are they any new diagnoses? \tn 
% Row Count 18 (+ 3)
% Row 5
\SetRowColor{white}
 & Diabetes specific questions: date of diagnosis, FBG levels, A1C levels, recent hypoglycemia episodes, history of ulcers (if they are in for wound care, is this their first wound or have they had multiple?) \tn 
% Row Count 26 (+ 8)
% Row 6
\SetRowColor{LightBackground}
{\emph{Social History}} & Inquire about their activity level. Are they working? Do they exercise? Do they live alone? Ask about smoking, alcohol and drug use. \tn 
% Row Count 32 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Remember it is important to get a full picture of the patient as this will impact the treatment plan. Will they and are they able to change dressings? What may be impeding wound healing? Will the patient be compliant with the tx plan including offloading. What is their financial situation? Can they afford appropriate footwear or orthotics?}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Wound Assessment}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\emph{Vascular Testing}} & Inquire the last time they have had any vascular testing. This should be done once a year if they have circulatory insufficiencies or are high risk. Check pulses, cap refill. Skin/hair assessment for venous or arterial insufficiency, assess for swelling- Does the patient wear compression stockings? Inquire about IC night or rest pain. Do we need to take temperature or use doppler. Conclude their overall vascular status and what this means regarding wound healing. \tn 
% Row Count 18 (+ 18)
% Row 1
\SetRowColor{white}
{\emph{Neurological Testing}} & Monofilament, vibration, proprioception and assess small diameter fibres. Inquire about any pain or sensation (burning, tingling, etc). Conclude neurological status, does this contribute to the cause or wound healing? \tn 
% Row Count 27 (+ 9)
% Row 2
\SetRowColor{LightBackground}
{\emph{Examination of Wound}} & Duration of the wound, change in size/appearance, change in number of wounds, pain or altered sensation with wound. Does the patient know the cause of the wound? Ask about systemic signs as well (lethargy, flu, malaise, etc). Look for signs of infection. Note the periphery of the wound is it callused or macerated? Look for exudate. Inspect the wound bed for granulation tissue, note the colour of the base. Note the depth-PTB? Take temperature! Compare to contralateral side. \tn 
% Row Count 46 (+ 19)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Wound Assessment (cont)}}  \tn
% Row 3
\SetRowColor{LightBackground}
{\emph{Deformity}} & Look for any deformities or areas of pressure \tn 
% Row Count 2 (+ 2)
% Row 4
\SetRowColor{white}
{\emph{Skin}} & Look for evidence of skin breakdown. More areas at risk for ulceration? \tn 
% Row Count 5 (+ 3)
% Row 5
\SetRowColor{LightBackground}
{\emph{Footwear}} & Assess footwear. \tn 
% Row Count 6 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Use Diabetic inlow's screening tool. Decide how often the patient needs to be screened. If they are diabetic and have history of ulcer/amputation, need to screen every 1-3 months. LOPS w/wout \seqsplit{PAD/deformity/onychomycosis/evidence} of pressure need to be screened every 3-6 months. If low risk needs to be screened once yearly.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{PEDIS Wound Classification}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/happyfeet2020_1649697931_Screen Shot 2022-04-11 at 1.24.14 PM.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{PEDIS- Perfusion, Extent, Depth, Infection, Sensation}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Wound Types}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/happyfeet2020_1649698478_Screen Shot 2022-04-11 at 1.23.10 PM.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Healing}}: Causes and co-factors that can interfere with healing have been removed. Wound healing occurs in a predictable fashion. Wound may be acute or chronic. \newline {\bf{Non-healing}}: Wound has healing potential, but causes and co-factors that can interfere with healing have not yet been removed. \newline {\bf{Non-healable}}: Causes and co-factors that can interfere with healing cannot be removed (e.g., in cases of terminal disease or end-of-life care).}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Texas Wound Classifcation}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/happyfeet2020_1649696031_Screen Shot 2022-04-11 at 12.53.11 PM.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.69218 cm} x{3.28482 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Diagnostic Tests}}  \tn
% Row 0
\SetRowColor{LightBackground}
Swab Technique & 1. Rinse wound with normal saline. 2. Do not swab pus. exudate, hard eschar or necrotic tissue. Rotate the swab tip (sterile cotton tip) in an area of clean granulation tissue for 5 seconds, using enough pressure to release tissue exudate. Warn patient for pain. 3. Remove protective cap from culture medium and insert cotton tipped applicator into the culture medium. 4. Transport to lab within 24 hours. \tn 
% Row Count 16 (+ 16)
% Row 1
\SetRowColor{white}
Culture \& Sensitivity & Entire petri dish surface is inoculated with test organism and an antibiotic impregnated disc containing a range of abx is paced on the surface. Inhibition of the growth around the disc indicates sensitivity of the organism to the abx. \tn 
% Row Count 26 (+ 10)
% Row 2
\SetRowColor{LightBackground}
Cellulitis & CBC W/diff, ESR/CRP, C\&S, biopsy, x-rays, bone scans, MRI/CT/ultrasound \tn 
% Row Count 29 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.38896 cm} x{2.58804 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Osteomyelitis in Diabetics}}  \tn
% Row 0
\SetRowColor{LightBackground}
Contiguous Focus OM & Soft tissue infection directly extends into adjacent bone. Most common OM in LE. \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
 & X-rays- shows swelling, gas bubbles, mottled bony osteolysis and sclerotic areas (late finding) \tn 
% Row Count 9 (+ 5)
% Row 2
\SetRowColor{LightBackground}
Direct Extension & Puncture wounds, retained foreign body, puncture through shoe (s.aurea, p.aeruginosa) \tn 
% Row Count 14 (+ 5)
% Row 3
\SetRowColor{white}
OM Secondary to Vascular Insuffciency & Caused by arteriosclerosis, diabetics with arterial disease or frostbite \tn 
% Row Count 18 (+ 4)
% Row 4
\SetRowColor{LightBackground}
Physical Examination & Focus on locating a nidus of infection, assessing PVD and sensory function and exploring ulcer of bone. \tn 
% Row Count 24 (+ 6)
% Row 5
\SetRowColor{white}
Diagnosis & X-ray (need 30-50\% of mineral content loss to show on image). First sign is gas in tissue, if gas, then x-ray alone is enough for diagnosis. Also see soft tissue swelling. \tn 
% Row Count 33 (+ 9)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.38896 cm} x{2.58804 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Osteomyelitis in Diabetics (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
 & MRI. Gold standard as it is most sensitive and specific. Can detect change in composition of bone marrow early on. \tn 
% Row Count 6 (+ 6)
% Row 7
\SetRowColor{white}
 & Bone biopsy with bacterial culture is gold standard for OM in diabetic patients. \tn 
% Row Count 10 (+ 4)
% Row 8
\SetRowColor{LightBackground}
Diagnostic Criteria & Exposed bone, persistent sinus tract, tissue necrosis overlying bone, chronic wound over hardware or fracture. \tn 
% Row Count 16 (+ 6)
% Row 9
\SetRowColor{white}
Treatment & Many will need surgery and prolonged abx. \tn 
% Row Count 19 (+ 3)
% Row 10
\SetRowColor{LightBackground}
 & Oral therapy may be just as effective as IV therapy. Ciprofloxacin is most used. \tn 
% Row Count 23 (+ 4)
% Row 11
\SetRowColor{white}
 & Immediate referral to hospital. (Infectious disease specialist, IV abx and maybe surgical intervention). \tn 
% Row Count 29 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Ask patient about systemic symptoms (lethargy, malaise, back pain, fever). Think about predisposing factors (diabetes, PVD, trauma, IV drug use).}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Wagner Wound Classification}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/happyfeet2020_1649696120_Screen Shot 2022-04-11 at 12.54.33 PM.png}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.33919 cm} x{2.63781 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Adjunctive Therapies for Wound Healing}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Negative Pressure Wound Therapy}} & Controlled negative pressure over the wound surface \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
 & Facilitates the drainage of the fluid and debris, reducing bacterial counts and edema and increasing capillary blood flow and granulation tissue formation. \tn 
% Row Count 11 (+ 8)
% Row 2
\SetRowColor{LightBackground}
 & Considered for healable wounds that are stalled and the exudate is greater than what can be managed with conventional advanced dressing modalities \tn 
% Row Count 18 (+ 7)
% Row 3
\SetRowColor{white}
{\bf{Hyperbaric Oxygen Therapy}} & Administration of 100\% O2 at an increased atmospheric pressure to a wound \tn 
% Row Count 22 (+ 4)
% Row 4
\SetRowColor{LightBackground}
 & Improves tissue oxygenation, down regulates inflammatory cytokines, up-regulates growth factors, antibacterial and leukocyte effects \tn 
% Row Count 29 (+ 7)
% Row 5
\SetRowColor{white}
{\bf{Topical Wound Oxygen Therapy}} & Administration of pressurized oxygen topically to the wound bed \tn 
% Row Count 32 (+ 3)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.33919 cm} x{2.63781 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Adjunctive Therapies for Wound Healing (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
 & Supplies continuous or cyclical diffusion of pure oxygen over the surface wound \tn 
% Row Count 4 (+ 4)
% Row 7
\SetRowColor{white}
 & Increase vascular endothelial growth factor expression and blood vessel density \tn 
% Row Count 8 (+ 4)
% Row 8
\SetRowColor{LightBackground}
{\bf{Electrical Stimulation}} & Application of capacitive coupled electrical current to transfer energy to a wound. \tn 
% Row Count 12 (+ 4)
% Row 9
\SetRowColor{white}
 & Increased blood flow and oxygenation, edema and pain reduction, debridement, thrombolysis, bactericidal, faster wound closure, improved scar formation \tn 
% Row Count 20 (+ 8)
% Row 10
\SetRowColor{LightBackground}
{\bf{ Ultrasound}} & Application of ultrasound waves to the wound/per-wound to induce cellular activity \tn 
% Row Count 24 (+ 4)
% Row 11
\SetRowColor{white}
 & Increases the release of growth factors/fribroblasts, accelerates the inflammatory phase and wound contraction, increases vascularity, improves wound tensile strength and elasticity, reduces pain and edema, reduces bruises and hematoma, bactericidal \tn 
% Row Count 36 (+ 12)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.33919 cm} x{2.63781 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Adjunctive Therapies for Wound Healing (cont)}}  \tn
% Row 12
\SetRowColor{LightBackground}
{\bf{Shock Wave}} & Shock waves targeted directly to the wound area to speed healing. Promotes the generation of new connective tissue, has an analgesic effect for pain reduction and facilitates blood flow to the area. \tn 
% Row Count 10 (+ 10)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{International best practice guidelines identifies adjunctive treatments such as negative pressure wound therapy and hyperbaric oxygen therapy may be considered if appropriate but requires advanced clinical decision-making skills.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.44333 cm} x{3.53367 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Popular Wound Dressings}}  \tn
% Row 0
\SetRowColor{LightBackground}
Promogran Prisma & Maintains a physiologically moist environment at the wound surface that is conducive to granulation tissue formation, epithelialization and optimal wound healing. \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
 & Contains silver and antimicrobial agents \tn 
% Row Count 8 (+ 2)
% Row 2
\SetRowColor{LightBackground}
 & Sterile, freeze dried composite of oxidized regenerated cellulose, collagen and silver \tn 
% Row Count 12 (+ 4)
% Row 3
\SetRowColor{white}
 & In the presence of exudate, the prisma transforms into a soft and conformable biodegradable gel allowing contact with all areas of the wound \tn 
% Row Count 17 (+ 5)
% Row 4
\SetRowColor{LightBackground}
 & ORC helps with tissue repair, cell growth and control bacteria growth \tn 
% Row Count 20 (+ 3)
% Row 5
\SetRowColor{white}
Silvercel & Non-adherent antimicrobial alginate dressing \tn 
% Row Count 22 (+ 2)
% Row 6
\SetRowColor{LightBackground}
 & Has carboxy methylcellulose  \& silver. Easy to lift technology \tn 
% Row Count 25 (+ 3)
% Row 7
\SetRowColor{white}
 & Sustained release of silver ions up to 7 days-\textgreater{} effective barrier protection. Good exudate management, maintains moist environment. \tn 
% Row Count 30 (+ 5)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.44333 cm} x{3.53367 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Popular Wound Dressings (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
Acticoat & Antimicrobial barrier dressing consists of three layers: an absorbent rayon/polyester inner core sandwiched between outer layers of silver coated, low adherent polyethylene net. \tn 
% Row Count 7 (+ 7)
% Row 9
\SetRowColor{white}
 & Helps maintain moist environment at the wound surface and has barrier protection for at least 3 days. \tn 
% Row Count 11 (+ 4)
% Row 10
\SetRowColor{LightBackground}
Inadine & Impregnated with polyethylenge base containing 10\% Povidone iodine that has a broad spectrum of antimicrobial action. \tn 
% Row Count 16 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Biofilms are complex microbial communities, containing bacteria and sometimes also fungi, which are embedded in a protective polysaccharide matrix. The matrix attaches the biofilm to a surface, such as a wound bed, and protects the microorganisms from the host's immune system and from antimicrobial agents such as antiseptics and antibiotics. Biofilms are commonly present in chronic wounds, and are thought to contribute to, and perpetuate, a chronic inflammatory state that prevents healing}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.38896 cm} x{2.58804 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Wound Dressings}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Conventional}} & Gauze. Non woven better than woven as it is more absorptive. Does have strike through, adherence and incorporation into wound surface \tn 
% Row Count 7 (+ 7)
% Row 1
\SetRowColor{white}
{\bf{Transparent films}} & Semipermeable adhesive films- Opsite, Tegaderm. Permeable to gas and water vapour but not to water, no fibres, transparent, non absorbent \tn 
% Row Count 14 (+ 7)
% Row 2
\SetRowColor{LightBackground}
{\bf{Low Adherent Wound Contact Layers}} & Non medicated: Adaptic or Mepitel. Medicated: Bactrigras tulle which contains chlorhexidine acetate, Inadine \tn 
% Row Count 20 (+ 6)
% Row 3
\SetRowColor{white}
{\bf{Low Adherent Absorbent Dressings}} & Melolite (highly absorbent cotton and acrylic fibre pad and polyester film). Has rapid drainage of exudate, reduces trauma to healing tissue, very absorbent, comfortable, minimizes pain on removal. \tn 
% Row Count 30 (+ 10)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.38896 cm} x{2.58804 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Wound Dressings (cont)}}  \tn
% Row 4
\SetRowColor{LightBackground}
{\bf{Semipermeable Hydrogels}} & Intrasite gel. Contains \seqsplit{carboxymethylcellulose}. \tn 
% Row Count 3 (+ 3)
% Row 5
\SetRowColor{white}
{\bf{Hydrocolloids}} & Tegasorb, comfeel, duoderm. Form a gel when in contact with wound surface. Semi liquid produced provides moisture and insulated environment, occlusive. Contraindicated in infected wounds. Not good for diabetic ulcers. \tn 
% Row Count 14 (+ 11)
% Row 6
\SetRowColor{LightBackground}
{\bf{Hydrofiber Wound Dressings}} & Aquacel. Moderate to heavily exudating wounds. \tn 
% Row Count 17 (+ 3)
% Row 7
\SetRowColor{white}
{\bf{Alginate Dressings}} & Kaltostat-Calcium Sodium Alginate. Calcium and sodium salts of alginic acid, derived from seaweed. When in contact with blood or exudate, alginate fibers convert into a hydrophilic gel. Gel is absorbent, protective moist interface with the wound. Indicated for moderately to highly exuding chronic and acute wounds and for wounds with minor bleeding. \tn 
% Row Count 35 (+ 18)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.38896 cm} x{2.58804 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Wound Dressings (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
{\bf{Polyurethane Foams}} & Allevyn- moderate amounts of exudate. Allows adequate hydration of the wound surface and has effective thermal insulation. \tn 
% Row Count 7 (+ 7)
% Row 9
\SetRowColor{white}
{\bf{Charcoal Dressing}} & Malodorous exudating wounds. Deodorant dressing with activated charcoa. \tn 
% Row Count 11 (+ 4)
% Row 10
\SetRowColor{LightBackground}
{\bf{Silver agents}} & Antibacterial. Acticoat and silvercel. Usually a combination dressing. \tn 
% Row Count 15 (+ 4)
% Row 11
\SetRowColor{white}
{\bf{Desloughing Agents}} & Iodosorb.  Exerts hydrophillic action, acting as an absorbent, also helps remove debris and bacteria from wound surface by capillary action, beads swell under the influence of exudate and the release of iodine. Intrasite gel, products with enzymes, sterile larvae can also be used for slough. \tn 
% Row Count 30 (+ 15)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.33919 cm} x{2.63781 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Offloading}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Total Contact Cast}} & Gold standard! Contraindicated for infected or ischemia wounds. \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
{\bf{Removable Cast Walker}} & Not for heel ulcers. Can be used for infected wounds. Not good for those with poor balance \tn 
% Row Count 8 (+ 5)
% Row 2
\SetRowColor{LightBackground}
{\bf{Instant Total Contact Cast}} & Not for heel ulcers. May not be tolerable \tn 
% Row Count 10 (+ 2)
% Row 3
\SetRowColor{white}
{\bf{Half shoe (Rearfoot or forefoot)}} & Either good for heel or toe/forefoot ulcers. Very unstable \tn 
% Row Count 13 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{Surgical Shoe}} & Best for forefoot but can be used for all locations. Low cost. Use with orthotic. Good for edema. Only for short term. \tn 
% Row Count 19 (+ 6)
% Row 5
\SetRowColor{white}
{\bf{OTC or custom orthotics/footwear}} & Distributes pressures evenly but expensive \tn 
% Row Count 21 (+ 2)
% Row 6
\SetRowColor{LightBackground}
{\bf{Padding}} & Low cost but offloading property limited. \tn 
% Row Count 23 (+ 2)
% Row 7
\SetRowColor{white}
{\bf{Surgical Offloading}} & Achilles tendon lengthening, joint arthroplasty met head resection or osteotomy can support healing and prevent future ulcer if conservative treatment fails \tn 
% Row Count 31 (+ 8)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.33919 cm} x{2.63781 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Offloading (cont)}}  \tn
% Row 8
\SetRowColor{LightBackground}
 & Cannot be done in ischemia patients or uncontrolled infection \tn 
% Row Count 3 (+ 3)
% Row 9
\SetRowColor{white}
 & Digital flexor tenotomy used to prevent or support healing of toe ulcer when conservative tx fails \tn 
% Row Count 8 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{When choosing offloading device, consider- disease, pressures, ulcer location, type and dressing, physical activity, finances, patient behaviour (ability to adhere to plan/mental capabilities)}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Surgeries- Amputations and Revascularization}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Revascularization}}: & Angioplasty- Using a ballon and/or stent to widen the artery \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
 & Athrectomy - Clear out the plaque that is causing the occlusion \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
 & Bypass Surgery- Surgeon uses a graft of a blood vessel to reroute blood flow around a blockage. \tn 
% Row Count 10 (+ 4)
% Row 3
\SetRowColor{white}
 & Endarterectomy- Surgeon opens artery to remove plaque buildup inside. \tn 
% Row Count 13 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{Amputation}}: & Causes: trauma, ulcers (persistent, decreasing quality of life, necrosis), infection, vascular, deformity \tn 
% Row Count 18 (+ 5)
% Row 5
\SetRowColor{white}
 & Digital- Performed due to extensive ulceration. OM or gangrene. Semi-elliptical incisions carried down to bone. Cartilage on met head better barrier to infection so we don't cut bone in middle. Auto amputation (2-6 months) good for those who shouldn't have surgery \tn 
% Row Count 29 (+ 11)
% Row 6
\SetRowColor{LightBackground}
 & Ray amputations- central, 1st or 5th. Performed for abscess, OM, or necrotizing fasciitis. Converging semi elliptical incisions around base of toe. Met is exposed and resected at point where bone does not appear infected. May have transfer lesions. \tn 
% Row Count 39 (+ 10)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Surgeries- Amputations and Revascularization (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
 & Midfoot amputations- Transmet (will do TAL to decrease FF pressures). Lisfranc (less stable, equinovarus) \tn 
% Row Count 5 (+ 5)
% Row 8
\SetRowColor{white}
 & BKA better than doing syme or chopart amputations. \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.14011 cm} x{2.83689 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Factors that affect Wound Healing}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Glycemic level}} & {\bf{Trauma}} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
{\bf{Activity}} & {\bf{Neuropathy}} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
{\bf{Smoking}} & {\bf{Bony deformity}} \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
{\bf{Footwear}} & {\bf{PAD}} \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
{\bf{History of wounds}} & {\bf{Amputations}} \tn 
% Row Count 7 (+ 2)
% Row 5
\SetRowColor{white}
{\bf{Age}} & {\bf{Other infections in body}} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Smoking and Diabetes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{-Smoking alters blood glucose homeostasis-\textgreater{} increases blood glucose} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{-Smoking can decrease insulin action and impairs measures of B cell function} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{- Exposure to cigarette smoke is associated with vascular damage, endothelial dysfunction and activation of the blood-clotting cascade.} \tn 
% Row Count 7 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{-Cigarette smoking increases risk of micro and macrovascular complications in diabetes} \tn 
% Row Count 9 (+ 2)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{-Smoking cessation should improve glycemic control but cessation often worsens glycemic control, possibly due to weight gain that often occurs after smoking abstinence. Emphasize the importance of both exercise and smoking cessation together!} \tn 
% Row Count 14 (+ 5)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{2.28942 cm} x{2.68758 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Short-Term Management Plan}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Assessment and Classifications}} & Do appropriate assessments and classify wounds. Is this mild/moderate or severe and needs hospitalization right away? Do we need to refer to vascular studies right away? Consider doing ABI and TBI. \tn 
% Row Count 10 (+ 10)
% Row 1
\SetRowColor{white}
{\bf{Treatment}} & Cleanse. (chlorohexidine gluconate 2\%), providone iodone, wound cleanser, sterile saline) \tn 
% Row Count 15 (+ 5)
% Row 2
\SetRowColor{LightBackground}
 & Sharps debridement. Tissue nippers are great to use for undermined edges and it doesn't hurt the patient. \tn 
% Row Count 20 (+ 5)
% Row 3
\SetRowColor{white}
 & Cleanse again. Use antiseptic, mostly like sterile saline. Pat dry. \tn 
% Row Count 24 (+ 4)
% Row 4
\SetRowColor{LightBackground}
 & Apply antiseptic. Betadine most commonly used. \tn 
% Row Count 27 (+ 3)
% Row 5
\SetRowColor{white}
 & Dressing. Choose appropriate dressing that will remove exudate and maintain humidity. Want it to have low adherence and maintain a good temp. Maintain suitable pH and be permeable to gases NOT microorganisms. Think about the comfort and ease for patients. \tn 
% Row Count 40 (+ 13)
\end{tabularx}
\par\addvspace{1.3em}

\vfill
\columnbreak
\begin{tabularx}{5.377cm}{x{2.28942 cm} x{2.68758 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Short-Term Management Plan (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
{\bf{Advice}} & Dressing instructions, activity reduction, protecting wound from trauma and while showering. Instruct how to monitor for signs of infection. Tips to keep skin overall healthy. \tn 
% Row Count 9 (+ 9)
% Row 7
\SetRowColor{white}
{\bf{Social History}} & Understand any underlying factors that may put patient at risk for infections. Such as, UTI, age, mobility, psychosocial factors, self-care ability \tn 
% Row Count 16 (+ 7)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.74195 cm} x{3.23505 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Mid-Term/Short-term Management Plan}}  \tn
% Row 0
\SetRowColor{LightBackground}
{\bf{Reassessment}} & Reassess wound along with dressing and offloading- do we need to make changes?. Abx? culture \& sensitivity? imaging? \tn 
% Row Count 5 (+ 5)
% Row 1
\SetRowColor{white}
 & Asking the patient what they're doing at home. Decreasing or increasing activity? Home care? Do they feel the wound is getting better? Are they wearing offloading devices? \tn 
% Row Count 12 (+ 7)
% Row 2
\SetRowColor{LightBackground}
 & Re-checking vascular status \tn 
% Row Count 14 (+ 2)
% Row 3
\SetRowColor{white}
 & Assessing medications, is it impairing wound healing? (ie steroids) \tn 
% Row Count 17 (+ 3)
% Row 4
\SetRowColor{LightBackground}
{\bf{Advanced Therapies}} & Think about adjunctive therapies and dressings that may be beneficial for the patient. \tn 
% Row Count 21 (+ 4)
% Row 5
\SetRowColor{white}
{\bf{Surgical Referral}} & Foot reconstruction, tenotomy, arthroplasty, etc, vascular surgeries \tn 
% Row Count 24 (+ 3)
% Row 6
\SetRowColor{LightBackground}
{\bf{Other Referrals}} & Nutritionist for nutrition screening, endocrinologist, etc) \tn 
% Row Count 27 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Most of these we would implement in the short-term. Mid-term should focus on preventing infection/reducing risk factors for infection.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Long-Term Management Plan}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Long term goals: PREVENTION! If the wound is closed, how do we ensure we are preventing it from occurring again? Strengthening our circle of care. Referrals for smoking cessation, nutrition management and psychosocial should be made. Including the patient in the long-term plan. What can THEY do to prevent reulceration. When should they be concerned? Advise joining support groups.} \tn 
% Row Count 8 (+ 8)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{If the wound isn't closing, consider referring to infectious disease specialist. Start from the basics (short-term plan)} \tn 
% Row Count 11 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Antibiotics}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Cephalexin or TMP/SMX is 1st line of treatment for cellulitis seen in the diabetic foot. 2nd line is cloxacillin.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Even though most DFU infections are caused by staph and step. Look for signs of pseudomonas (Green ring or odour). In this case, prescribe Ciprofloxacin.} \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{If there is a penicillin allergy or renal insufficiency, consider clindamycin} \tn 
% Row Count 9 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Foul smell or presence of necrotic tissue may indicate anaerobes - use clindamycin or amoxicillin/clavulanate.} \tn 
% Row Count 12 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{When you have doubt regarding the probable organism, go with cephalexin!  \newline If CA-MRSA is cultured, go with TMP/SMX.}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}