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Immediate stabilization
Resuscitation priorities
Airway risk
Altered mental status
Active emesis
Shock with poor perfusion
Breathing threats
Tachypnea with fatigue
Hypoxemia
Suspected aspiration
Circulation threats
Hypotension
Cool mottled extremities
Capillary refill > 3 seconds
If shock, escalate to resuscitation bay
Early ICU consult
Early surgery consult
Monitoring
Continuous ECG
Dysrhythmia triggers for electrolyte correction
Demand ischemia risk in sepsis
Pulse oximetry
SpO2 target 92-96%
Lower target acceptable in chronic hypercapnia
Noninvasive blood pressure cycling
If vasopressors, arterial line for titration (Class I, expert consensus)
If severe shock, invasive MAP targeting (Class I, expert consensus)
Core temperature
Hypothermia as late sepsis marker
Fever as early infection marker
Hemodynamic targets
MAP >= 65 mmHg (Class I, sepsis consensus)
Higher target if chronic hypertension with altered mentation
Lower target acceptable if bleeding risk and stable mentation
Urine output >= 0.5 mL/kg/hour
Foley catheter in shock or need for strict I and O
Avoid Foley if stable and no monitoring need
Lactate trend to clearance
Lactate >= 2 mmol/L as hypoperfusion marker
Lactate >= 4 mmol/L as high risk marker
Early time-critical actions
NPO status
Aspiration reduction
Operative readiness
Broad-spectrum antibiotics within 1 hour in septic shock (Class I, sepsis consensus)
Do not delay for imaging if unstable
Blood cultures before antibiotics if no delay
IV crystalloid bolus if hypotension or lactate >= 4 mmol/L (Class I, sepsis consensus)
30 mL/kg initial strategy as reference dose
Smaller boluses with frequent reassessment in heart failure
Early source control pathway (Class I, sepsis consensus)
Surgery consult at first suspicion
IR consult if abscess or contained leak suspected
Key concepts
Problem framing
Perforated viscus
Loss of GI tract integrity
Contamination of peritoneal or retroperitoneal space
Chemical peritonitis progressing to bacterial peritonitis
Time dependence
Early antibiotics improve outcomes in intra-abdominal sepsis
Delayed source control increases mortality in peritonitis
High-risk phenotypes
Generalized peritonitis
Rigid abdomen
Rebound tenderness
Guarding with severe pain
Sepsis or septic shock
Hypotension
Elevated lactate
Altered mentation
Contained perforation
Localized tenderness
Stable vitals
CT evidence of localized extraluminal air or fluid
Pitfalls
Common misses
Analgesia avoidance
Pain control does not mask peritonitis progression
Untreated pain worsens tachycardia and work of breathing
Normal initial imaging
Early perforation with minimal free air
Retroperitoneal perforation with subtle findings
Under-triage in older adults
Blunted fever and leukocytosis
Rapid decompensation risk
Delayed antibiotics in suspected perforation
Increased risk of sepsis progression
Worse source control window
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.