Guidelines 9

📘 GuidelineCh 6 · Emergency, Trauma, Acute Care & Surgical Critical Care⏳ Pending verification

Diagnosis and Treatment of Acute Appendicitis: 2025 Edition of the World Society of Emergency Surgery Jerusalem Guidelines

The 2025 Jerusalem update for acute appendicitis: 35 GRADE recommendations over 19 questions — risk scores and imaging first, antibiotics alone only for selected uncomplicated cases, laparoscopic appendectomy as the standard operation, and 2–3 days of postoperative antibiotics in complicated disease.

2025 Edition · World Society of Emergency Surgery (WSES)

📘 GuidelineCh 6 · Emergency, Trauma, Acute Care & Surgical Critical Care⏳ Pending verification

Guideline for the Diagnosis and Treatment of Appendicitis

SAGES' guideline for the diagnosis and treatment of appendicitis: imaging first, operative management suggested for both uncomplicated and complicated adult disease, flexible timing, and interval appendectomy after successful nonoperative treatment of complicated disease.

2023 · Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

📘 GuidelineCh 6 · Emergency, Trauma, Acute Care & Surgical Critical Care⏳ Pending verification

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

The 2021 Surviving Sepsis Campaign guideline for adults with sepsis or septic shock: immediate resuscitation, early antimicrobials and source control, an initial MAP target of 65 mmHg on vasopressors, and norepinephrine as the first-line vasopressor.

2021 · Surviving Sepsis Campaign — Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM)

📘 GuidelineCh 6 · Emergency, Trauma, Acute Care & Surgical Critical Care⏳ Pending verification

The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition, 2023

The sixth European guideline on major bleeding and coagulopathy after trauma: early repeated haemostasis monitoring, tranexamic acid as soon as possible and within 3 hours (1 g over 10 minutes, then 1 g over 8 hours), and rapid haemorrhage control.

Sixth Edition, 2023 · Multidisciplinary European Task Force (ESAIC, ESICM, European Shock Society, ESTES, EuSEM and NATA)

📘 GuidelineCh 6 · Emergency, Trauma, Acute Care & Surgical Critical Care⏳ Pending verification

Joint Trauma System Damage Control Resuscitation Clinical Practice Guideline, 2019 with June/August 2023 updates

The Joint Trauma System damage-control resuscitation CPG for massively haemorrhaging combat casualties: haemorrhage control first, whole blood or balanced components over crystalloid, early calcium, and — since the June 2023 update — a 2-g tranexamic acid bolus as close to injury as possible.

2019, with June/August 2023 updates · Joint Trauma System, Defense Health Agency / US military

📘 GuidelineCh 6 · Emergency, Trauma, Acute Care & Surgical Critical Care⚪ Superseded by Surviving Sepsis Campaign 2026 edition

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021

The 2021 Surviving Sepsis Campaign guideline (Domain 14 filing) — superseded by the 2026 edition per this record: immediate treatment, cultures before antimicrobials where feasible, an initial 30 mL/kg crystalloid for hypoperfusion with reassessment, and norepinephrine first-line.

2021 · Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM)

📘 GuidelineCh 6 · Emergency, Trauma, Acute Care & Surgical Critical Care⏳ Pending verification

Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2026

The 2026 Surviving Sepsis Campaign guideline for adults with sepsis or septic shock: NEWS/NEWS2, MEWS or SIRS rather than qSOFA alone for hospital screening, early cultures and lactate, at least 30 mL/kg crystalloid in the first 3 hours for hypoperfusion — calculated thoughtfully, with frequent reassessment.

2026 · SCCM and ESICM (international joint guideline)

📘 GuidelineCh 6 · Emergency, Trauma, Acute Care & Surgical Critical Care⏳ Pending verification

ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit

ESPEN's practical ICU nutrition guideline: assess nutritional risk, prefer early oral or enteral feeding when feasible, individualise parenteral nutrition, use indirect calorimetry where available, and approach energy and protein targets progressively rather than forcing full targets early.

2023 (practical, partially revised) · European Society for Clinical Nutrition and Metabolism (ESPEN)

📘 GuidelineCh 6 · Emergency, Trauma, Acute Care & Surgical Critical Care⏳ Pending verification

Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition

ASPEN's 2022 nutrition support guideline for the adult critically ill patient: because no consistent outcome differences were found, prescribe energy cautiously at 12–25 kcal/kg/day, favour enteral nutrition when feasible, and assume no advantage for exclusive or supplemental parenteral nutrition or higher doses.

2022 · American Society for Parenteral and Enteral Nutrition (ASPEN)

Live book 17

Candidate Shift — Acute Mesenteric Ischemia: Revascularize Before You Resect (Addendum Summary, Ch 4)At first suspicion of acute mesenteric ischemia, get biphasic CT angiography, heparinize, and restore SMA inflow before resecting borderline bowel — with a mandatory second look.Candidate Shift — Fournier's Gangrene & Testicular Torsion: Operate Now, Image Never First (Addendum Summary, Ch 7)Debride Fournier's gangrene within hours without waiting for imaging, and explore a high-TWIST-score scrotum immediately without delaying for Doppler ultrasound.Candidate Shift — Mammalian Bites: Irrigate, Debride, Leave Open — and Never Omit Rabies Immunoglobulin (Addendum Summary, Ch 7)Leave deep puncture, cat, hand/foot and fight-bite wounds open after irrigation and debridement, cover with amoxicillin-clavulanate, and give full rabies PEP including wound-infiltrated immunoglobulin for severe stray-animal bites.Candidate Shift — Traumatic Hemothorax: Smaller Tubes, Early VATS for Retained Blood (Addendum Summary, Ch 7)Drain traumatic hemothorax with a 28–32 Fr tube (14 Fr pigtail for simple pneumothorax or stable hemothorax), and clear a retained hemothorax with VATS within 3–5 days — not a second tube or a late thoracotomy.Practice Shift — Adhesive Small Bowel Obstruction: Exclusion-First Triage & the Prognostic Contrast Protocol (Table 4.1)Exclude strangulation on contrast CT before anything else in ASBO — then use water-soluble contrast as a prognostic test after decompression, never as a treatment claim or a stand-alone trigger for laparotomy.Practice Shift — Anticoagulant Reversal: Hemorrhage Control First, Agent by Local Protocol (Table 7.1, Row 4)Control the bleeding first and reverse drug-specifically under your local protocol — never wait for laboratory assays, and never let U.S. FDA status decide global availability or make 4-factor PCC a universal substitute.Practice Shift — Blunt Spleen & Liver Trauma: Separate Pathways, 'Stable' Is Not 'Low Risk' (Table 7.1, Row 3)Keep splenic and hepatic non-operative pathways distinct and enforce the institutional prerequisites behind them — a hemodynamically stable high-grade injury is not a low-risk injury.Practice Shift — Burns: Start at 2 mL/kg/%TBSA, Titrate to Urine Output, Excise Early (Addendum §12.1, Row 6)Resuscitate major burns at 2 mL/kg/%TBSA titrated to hourly urine output instead of unmonitored Parkland 4 mL/kg/%TBSA, perform bedside escharotomy when eschar restricts perfusion or ventilation, and excise tangentially with grafting within 24–72 hours — without prophylactic systemic antibiotics.Practice Shift — Massive Transfusion: Early Balanced 1:1:1 Components, Reported Honestly (Table 7.1, Row 1B)Start early balanced 1:1:1 component transfusion in predicted massive transfusion — and report PROPPR honestly: its co-primary mortality endpoints were neutral, so the case rests on the hemostasis and exsanguination endpoints.Practice Shift — Massive Transfusion: Monitor Ionized Calcium and Replace It Salt-Specifically (Table 7.1, Row 1D)Monitor arterial ionized calcium every 30–60 minutes during massive transfusion and replace it with salt-specific dosing below 1.0–1.1 mmol/L — do not run a massive transfusion protocol empirically and unmonitored.Practice Shift — REBOA: No Routine Emergency-Department Deployment (Table 7.1, Row 2)Do not deploy REBOA routinely in the Emergency Department where it may delay definitive hemorrhage control — selective use belongs in an operating room or hybrid suite, and only under strict institutional prerequisites.Practice Shift — SSRF, Damage-Control Triggers & Compartment Syndrome: Diagnose Clinically, Fix Flail Early (Table 7.1, Row 5)Fix ventilator-dependent flail chest with SSRF within 48–72 hours, trigger damage-control laparotomy on integrated physiological exhaustion — not a 'lethal diamond' score — and diagnose compartment syndrome primarily by serial clinical examination, with ΔP ≤30 mmHg as the manometry adjunct.Practice Shift — Tranexamic Acid: Two Indications, Kept Separate, Always Within 3 Hours (Table 7.1, Row 1C)Give tranexamic acid strictly within 3 hours of injury — and keep CRASH-2 (extracranial bleeding) and CRASH-3 (mild-to-moderate TBI) as two separate indications: never start it late, never extrapolate it across all TBI severities.Practice Shift — Trauma Resuscitation Blood-Pressure Targets: Split by Brain Injury (Table 7.1, Row 1A)Split blood-pressure targets by brain injury: permissive hypotension (SBP 80–90 mmHg) only as a brief bridge in torso hemorrhage without TBI — and never in TBI, where age-banded SBP ≥100–110 mmHg (MAP ≥80 mmHg) protects cerebral perfusion.Practice Shift — Uncomplicated Appendicitis: Appendectomy Standard, Antibiotics a Stratified Shared Decision (Table 4.1)Keep laparoscopic appendectomy the standard for uncomplicated appendicitis — offer antibiotic-first therapy only as a shared decision, stratified by appendicolith status, with CODA and APPAC reported separately.Stepwise Clinical Decision Pathway — Hernia & Acute GI (§4.2)Make the hernia decisions separately, select ASBO patients by exclusion first, and use shared decision-making for uncomplicated appendicitis.Stepwise Clinical Decision Pathway — Trauma & Acute Care (§7.2)Resuscitate with balanced transfusion, keep the two tranexamic acid indications separate, and do not deploy REBOA routinely.

Memory 38

The 6 FsCauses of abdominal distensionTWISTTesticular Workup for Ischemia and Suspected Torsion (score; the name is not a letter expansion)SHAVINGCauses of small-bowel obstructionABCThe 3 commonest causes of small-bowel obstruction3-6-9 ruleNormal bowel diameters on imaging (numeric rule)Cardinal features of intestinal obstructionPresentation of intestinal obstruction (feature list)AIMCauses of bowel obstruction in older childrenABCDEATLS primary surveyAMPLESecondary-survey / focused historySAMPLEFocused history in emergenciesATMISTTrauma handoverMISTTrauma handover protocolASHICEPre-hospital handoverFASTFocused Assessment with Sonography for Trauma (name-device; four windows)ATOM-FCThe "Lethal Six" — immediately life-threatening chest injuriesBeck's triadCardiac tamponade — the "Three Ds"Lethal triadTrauma physiology driving damage-control surgery (the "triad of death")Lethal DiamondThe lethal triad + ionised hypocalcaemiaLove – 15 – 30 – 40 — game overHaemorrhagic shock classes (ATLS)Cushing's triadRaised intracranial pressure (components)4 Hs & 4 TsReversible causes of cardiac arrestGCS maxima 4-5-6 (EVM)Glasgow Coma Scale component maxima (numeric anchors)NEXUS criteriaCervical-spine imaging decision criteriaqSOFAQuick SOFA — sepsis poor-outcome screenSIRS criteriaSystemic inflammatory response syndrome criteriaBUFALOThe Sepsis Six — actions within 1 hourRevised Trauma Score devices — "Three Bs" / "T-R-ISS-A"Revised Trauma Score — informal devices5 Ps of compartment syndromeSigns of compartment syndrome / irreversible ischaemiaDCSDamage Control Surgery (name-device; three stages)RUSHRapid Ultrasound for Shock and HypotensionHI-MAPThe RUSH protocol's five scanning areasFAST HUGS BIDICU daily reviewABCDEF bundleICU Liberation bundleDOPE / DOPERVentilated-patient deteriorationMACOCHADifficult-intubation risk score (ICU)Rule of NinesBurn %TBSA estimation (numeric rule)Parkland vs ATLS burn resuscitationBurns fluid resuscitation formulasRule of PalmsScattered / small burn size estimation