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Immediate priorities
Initial stabilization
Airway compromise
Encephalopathy with loss of protective reflexes
Massive hematemesis with aspiration risk
Breathing failure
Hypoxemia
Increased work of breathing
Circulation threats
Hypotension or shock
Active GI bleeding
Sepsis pathway
Lactate trend in mmol/L
Blood cultures x 2 before antibiotics if no delay
Early recognition triggers
Cirrhosis with ascites
Fever
Abdominal pain or tenderness
Non-specific deterioration
Encephalopathy
AKI or rising creatinine
Hemodynamic change
New hypotension
New tachycardia
Time-critical procedure
Diagnostic paracentesis within 12 hours of presentation
Perform before antibiotics when feasible
Do not delay antibiotics in shock
Hemodynamic and monitoring targets
Monitoring and access
Continuous monitoring
Cardiac monitor
Pulse oximetry
IV access
Two large-bore peripheral lines
Central access if poor peripheral access or vasopressors needed
Urine output monitoring
Foley catheter for shock or AKI
Target urine output 0.5 mL/kg/hour
Resuscitation targets
Mean arterial pressure at least 65 mmHg in septic shock
Norepinephrine first-line vasopressor
Albumin favored over large-volume crystalloid for cirrhosis-related circulatory dysfunction
Consult and escalation triggers
Early specialty involvement
Hepatology or gastroenterology
Confirm prophylaxis plan
Evaluate for transplant pathway when appropriate
ICU
Vasopressor requirement
Rising lactate despite resuscitation
Source control pathway
If concern for secondary peritonitis, urgent surgery consult
Peritoneal signs
Polymicrobial Gram stain or culture
If biliary or intra-abdominal source on imaging, urgent interventional radiology consult
Drainable collection
Cholecystitis or cholangitis
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.