Bring the beef broth, coconut aminos, Worcestershire sauce, hot sauce, oregano, pepper and garlic powder to a boil in a medium saucepan over medium-high heat, and then reduce the heat and simmer.
Mix together the egg, almond meal and beef in a medium bowl, combining well.
Form into oval-shaped patties about 1⁄2-inch thick.
In a large skillet, heat 1 tablespoon of the ghee over medium heat and brown the patties for about 90 seconds on each side.
Remove to a plate.
Place the patties back in the skillet and spoon the onions and mushrooms on top.
Pour the sauce over the patties, cover and simmer for 10 minutes.
Add the coconut milk with a few minutes to go in the simmering to give the sauce a nice creamy texture.
Place the Salisbury steak on individual plates and spoon the sauce, mushrooms and onions on top.
Serve at once.