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Immediate priorities
Time-critical stabilization
Airway risk
Aspiration risk with vomiting
Decreased level of consciousness
Breathing
Oxygen target SpO2 92-96%
Ventilatory support if fatigue or hypercapnia
Circulation
Two large-bore IV lines
Cardiac monitor
Continuous pulse oximetry
Temperature
Shock recognition
Hypotension
Tachycardia
Altered mental status
Cool clammy skin
Early surgical escalation
If peritonitis, immediate surgical consultation
If septic shock, activate resuscitation pathway and immediate surgical consultation
Key red-flag states
Strangulation concern
Severe constant pain out of proportion
Skin erythema or dusky discoloration over hernia
Fever
Tachycardia
Elevated lactate
Peritonitis
Obstruction concern
Persistent vomiting
Obstipation
Abdominal distension
Perforation concern
Diffuse guarding or rigidity
Free air on imaging
Initial orders bundle
NPO status
Oral intake withheld pending operative decision
Antiemetics to reduce aspiration risk
IV fluids
Crystalloid bolus for hypoperfusion
Reassess after each bolus
Analgesia
Opioid analgesia titrated to effect
Avoid masking peritonitis as sole rationale for withholding analgesia
Early antibiotics if strangulation suspected
Broad-spectrum coverage for enteric flora
Dose as sepsis pathway if shock present
Early decision points
Immediate operative pathway triggers
Strangulated hernia suspected
Class I recommendation (expert consensus)
No attempts at manual reduction
Peritonitis
Class I recommendation (expert consensus)
CT should not delay surgery when unstable
Hemodynamic instability
Resuscitation concurrent with surgical activation
ICU-level monitoring consideration
Nonoperative attempt pathway prerequisites
Incarcerated hernia without strangulation features
Short symptom duration
No peritonitis
No systemic toxicity
Manual reduction (taxis) eligibility
Cooperative patient or procedural sedation capability
Immediate surgical backup available
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.