Approach to the Critical Patient

Immediate priorities

Airway and oxygenation threats

Circulation and shock threats

Diagnostic anchoring

Monitoring and targets

Ventilator and gas exchange monitoring

Escalation triggers

Immediate consults

Consultation triggers

History

Presentation pattern

Core syndrome

Important negatives

Precipitant and risk factors

Pulmonary precipitants

Extrapulmonary precipitants

Modifiable and host risk factors

Collateral and key clues

Collateral history

Family and genetic context

Physical Exam

Vitals and general

Stability snapshot

General appearance

Pulmonary and cardiac exam

Pulmonary findings

Cardiovascular findings

PITFALLS

Under-recognition

Extrapulmonary clues

Differential Diagnosis

Life threats and close mimics

Must-exclude diagnosis

Infectious and hemorrhagic mimics

Subacute and immune mimics

Coding and special presentations

Diagnostic coding

Special presentations

Laboratory Tests

Gas exchange and severity

Arterial blood gas

SpO2/FiO2 ratio

Etiology and organ function

Infection workup

Organ function and discriminators

Advanced and atypical workup

Bronchoalveolar lavage

Autoimmune panel

Diagnostic Tests

Scoring Systems

Berlin definition

2024 New Global Definition

Physiologic and prognostic indices

MRI

MRI chest role

CT

CT chest indications

Contrast considerations

Evidence and guidance

Ultrasound

Lung ultrasound

Echocardiography

Disposition

Level of care selection

ICU admission

ECMO center transfer

Step-down and consultation

Step-down criteria

Specialist consultation triggers

Treatment

Initial stabilization and oxygenation

Airway and oxygen targets

Lung-protective ventilation

Ventilator strategy

Permissive hypercapnia

Prone positioning

Prone positioning protocol

Pharmacotherapy

Corticosteroids

Neuromuscular blockade

Treat the underlying cause

Fluid management and supportive care

Conservative fluid strategy

Supportive bundle

Rescue therapies for refractory hypoxemia

Inhaled pulmonary vasodilators

VV-ECMO

Special Populations

Pregnancy

Pregnancy considerations

Geriatric

Older adult features

Pediatrics

Pediatric ARDS differences

Background

Epidemiology

Frequency and burden

Pathophysiology

Mechanisms

Therapeutic Considerations

Lung-protective principles

Phenotype-directed care

Limited-benefit therapies

Patient Discharge Instructions

copy discharge instructions

ARDS survivor recovery plan

Expected long-term effects

Warning signs to return to ER

Follow up

References

Guidelines and key sources

Guideline sources

Landmark evidence

Coding standards

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.