Approach to the critical patient
›First 5 minutes workflow
›Monitoring and access
›Continuous pulse oximetry
›Cardiac monitor if PE or shock concern
›IV access criteria
›Two large bore IV if hypotension
›Consider IO if unable and unstable
›Oxygen criteria
›Titrate to SpO2 92 percent or higher
›Escalate to high flow oxygen if persistent hypoxia
›Diagnostic plan and timing
›If limb threat suspected
›Immediate vascular surgery consult
›Immediate CT angiography if available and no delay to reperfusion
›If DVT suspected without limb threat
›Wells score based pathway selection
›Compression ultrasound timing target within same visit when possible
›Treatment plan by likely diagnosis
›Suspected DVT without contraindication
›Anticoagulation start if imaging delayed and high probability local protocol dependent
›Apixaban oral 10 mg twice daily for 7 days then 5 mg twice daily if appropriate
›Suspected acute limb ischemia
›Start unfractionated heparin IV bolus and infusion local protocol dependent
›Keep limb at neutral position and warm
›Cellulitis without abscess
›Cephalexin oral 500 mg four times daily for 5 to 7 days typical adult dosing
›MRSA coverage based on local resistance and risk factors
›Reassessment loop
›Timing
›Recheck pain and neurovascular status every 30 to 60 minutes in high risk cases
›Repeat vitals after analgesia and fluids
›Escalation triggers
›Worsening pain out of proportion
›New sensory or motor deficit