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Immediate stabilization and infection control
Initial priorities
Airborne isolation
N95 or higher for staff
Patient surgical mask during transport
Negative pressure room when available
Resuscitation triggers
Severe respiratory distress
Escalate to resuscitation bay
High flow oxygen or noninvasive ventilation if appropriate
Hemodynamic instability
IV access x2
Crystalloid bolus for shock physiology
Altered mental status
If concern for TB meningitis, immediate empiric therapy pathway
Massive hemoptysis pathway
If hemoptysis threatening airway or ventilation, activate airway team
If ongoing significant bleeding, interventional radiology for bronchial artery embolization
If suspected focal source, consider lung isolation strategies with anesthesia support
Immediate consultations
Infectious diseases
High suspicion for active TB
Immunocompromised host
Infection prevention and control
Airborne isolation logistics
Public health
Suspected or confirmed active TB reporting
Time critical high risk syndromes
TB meningitis
If suspected, do not delay treatment for imaging or LP when unstable
Pericardial tamponade from TB pericarditis
If shock with effusion, bedside ultrasound and urgent drainage pathway
Disseminated or miliary TB with sepsis
Broad sepsis evaluation and early antimicrobials including TB regimen when indicated
Key concepts
High level framework
Pulmonary TB contagiousness
Highest risk with cavitary disease and cough
Lower risk with isolated extrapulmonary TB without airway involvement
Diagnostic confirmation principles
NAAT supports rapid detection
Culture required for full drug susceptibility testing
Treatment principles
Multidrug therapy required to prevent resistance
Directly observed therapy recommended for many patients
Pitfalls
Common misses
Normal chest radiograph does not exclude TB
Early disease
HIV and other immunosuppression
Negative smear does not exclude contagious TB
Paucibacillary disease
Sampling error
Steroids without TB coverage can worsen unrecognized TB
Risk highest in TB meningitis and pericarditis without regimen
Fluoroquinolone monotherapy can partially treat TB and delay diagnosis
Masked symptoms
Resistance selection
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.