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Immediate stabilization
Resuscitation priorities
Airway compromise
If GCS < 13, airway protection pathway
If severe agitation or inability to protect airway, RSI with hemodynamic optimization
Breathing failure
If SpO2 < 90% on room air, supplemental oxygen escalation
If increased work of breathing, noninvasive ventilation criteria
If impending respiratory failure, early intubation with lung protective ventilation
Circulatory shock
If MAP < 65 mmHg after fluid challenge, vasopressor initiation
If sepsis suspected, sepsis bundle time zero triggers
Neurologic emergency
If focal deficit or seizures, neurocritical activation
If meningitis encephalitis suspected, time critical antimicrobials
Hemodynamic monitoring
Two large bore IV access
If shock, arterial line consideration for vasoactive titration
High risk HIV contexts
Known HIV with CD4 < 200 cells/μL
Pneumocystis pneumonia risk
Toxoplasma encephalitis risk if CD4 < 100 cells/μL and IgG positive
Known HIV with CD4 < 50 cells/μL
Mycobacterium avium complex risk
CMV end organ disease risk
Unknown HIV status with severe immunosuppression clues
Recurrent oral candidiasis
Unexplained weight loss
Recurrent bacterial infections
Infection control triggers
Airborne precautions
If cough plus weight loss plus night sweats, tuberculosis rule out
If suspected varicella or disseminated zoster, airborne plus contact
Droplet precautions
If meningococcal meningitis concern, droplet isolation
Time critical consult triggers
If suspected cryptococcal meningitis, infectious diseases and neurology
If suspected PJP with hypoxemia, ICU evaluation
If suspected TB, public health notification pathway
If suspected IRIS in unstable patient, infectious diseases input
Evidence framing
Sepsis early antibiotics and fluids aligned with Class I recommendation (strong guideline consensus)
Empiric therapy in suspected CNS infection aligned with Class I recommendation (strong guideline consensus)
ACEP Level C approach for ED risk stratification in immunocompromised febrile patients based on expert consensus
Key concepts
HIV illness patterns
Acute HIV syndrome in early infection
High viral load
Negative or indeterminate antibody testing early window
Chronic HIV with opportunistic infections when cellular immunity declines
CD4 thresholds guide likely pathogens
Noninfectious HIV related illness
Malignancy
Medication toxicity
HIV associated nephropathy and cardiomyopathy
Diagnostic urgency
CD4 and HIV viral load guide risk, not immediate stabilization
Syndromic treatment when delay increases mortality
Drug interactions with antiretroviral therapy affect empiric choices
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.