The most important new clinical guidelines — distilled and expanded with the reasoning behind each recommendation, for practice and for exams.
The first update in eight years retires the Type 1–5 numbering in favour of three clinical categories — primary, secondary and procedure-related MI — and formally endorses sex-specific troponin thresholds.
The Fourth Universal Definition (2018) split myocardial infarction into Types 1–5. In practice the numbering caused confusion — especially Type 2 MI versus plain myocardial injury — and didn't map onto how clinicians actually reason at the bedside. Unveiled at the ESC Congress 2026 and published simultaneously in the European Heart Journal and Circulation, the Fifth Universal Definition (a joint ESC/ACC/AHA/WHF task force) reframes the diagnosis around mechanism and clinical context rather than a number.
Troponin above the 99th-percentile upper reference limit with a rise and/or fall, plus at least one marker of ischaemia: ischaemic symptoms, new ischaemic ECG changes, pathological Q waves, imaging evidence of new loss of viable myocardium or a regional wall-motion abnormality, or intracoronary thrombus.
Think in three buckets — primary (plaque), secondary (supply–demand), procedure-related — layered on the injury-vs-infarction distinction, with sex-specific troponin cut-offs. The Type 1–5 numbers are out; the mechanism is in.
The first-ever AHA/ACC PE guideline replaces "submassive/massive" with a graded A–E classification (plus a respiratory modifier) that maps directly onto how aggressively to treat.
Until now, US practice used low / submassive / massive (AHA) while Europe used low / intermediate / high risk (ESC). Both lump very different patients together — a young person with a tiny subsegmental clot and a normotensive patient with a strained, failing right ventricle could both be "submassive." In Feb 2026 the AHA and ACC (with a dozen societies) issued a single evidence-based framework built around one insight: a patient can be in serious trouble even with a normal blood pressure, because the right ventricle can be failing before systemic hypotension appears.
Map the letter to the plan: A–B → DOAC, often at home; C–D → admit & anticoagulate (LMWH); E → reperfusion/ECMO. The "R" is the reminder that a normotensive, hypoxic patient is sicker than their blood pressure suggests.
Confirm hypertension out of the office, risk-stratify with the new PREVENT calculator, and treat most adults to <130/80 — earlier and more assertively.
This reaffirms the 2017 redefinition of hypertension as ≥130/80 (down from ≥140/90). That lower bar was controversial, but subsequent trials (SPRINT and others) have repeatedly shown fewer cardiovascular events with tighter control, so the guideline doubles down while adding better tools for deciding who to treat and how hard.
Diagnose on home BP, risk-stratify with PREVENT, and get most patients to <130/80 — starting stage 2 on a single-pill dual combination. Don't forget to screen stage 2 for primary aldosteronism.
Cholesterol is reframed as a lifelong, cumulative exposure — treat earlier, to target, guided by the PREVENT calculator.
The first ACC/AHA lipid guideline since 2018 moves away from betting everything on a 10-year risk number. Because LDL exposure is cumulative — every year of high LDL adds atherosclerotic burden — the new emphasis is lifetime risk, cumulative LDL and subclinical atherosclerosis. It adopts PREVENT (usable from age 30; gives 10- and 30-year risk) and supports coronary artery calcium (CAC), lipoprotein(a) and apoB for individualising decisions.
Think lifetime, not just 10 years: treat earlier, drive LDL to target for the risk band, and escalate beyond statins when needed. CAC and Lp(a) help decide the grey-zone (borderline/intermediate) patient.
Screen these high-risk patients actively for PAD — it stays silent until a foot ulcer or critical ischaemia forces the issue.
Diabetic neuropathy blunts the claudication that would otherwise warn of PAD, so disease is often first noticed as a non-healing ulcer or gangrene. The USPSTF found insufficient evidence to screen asymptomatic adults generally, but the 2024 ACC/AHA PAD guideline endorsed screening selected high-risk groups. This statement extends that to the diabetic population and pairs detection with modern medical therapy.
*Age ≥65, smoking, diabetes ≥10 years, microvascular disease, foot complications or other end-organ damage.
Feet + ABI at least yearly in diabetes. ABI ≤0.9 = PAD; >1.4 = calcified → check toe pressures. Then: stop smoking, LDL <55, SBP <120, supervised exercise, SGLT2/GLP-1, and consider low-dose rivaroxaban + aspirin.
ACS in young women is a distinct entity — frequently non-atherosclerotic — needing mechanism-specific treatment, not a reflex stent-and-DAPT.
Premenopausal women with ACS are understudied and often mislabelled as "non-cardiac chest pain." The AHA statement reframes them as a distinct group in whom non-obstructive and non-atherosclerotic causes predominate and female-specific factors (pregnancy-related conditions, hormonal influences) play a major role — driving diagnostic difficulty, treatment uncertainty and trial under-representation.
In a young woman with ACS, think SCAD, MINOCA, vasospasm — image beyond the angiogram and tailor therapy to the mechanism. SCAD is usually managed conservatively, not stented.
The UK approach — confirm with ABPM/HBPM, treat by age and ethnicity with the A/C/D ladder, and keep the <140/90 threshold (NICE has not adopted the US 130/80 cut-off).
NICE keeps a higher diagnostic threshold than the US ACC/AHA guideline and leans heavily on out-of-office measurement to avoid over-diagnosis from white-coat hypertension. Knowing both frameworks matters for MRCEM/UK practice, where NG136 is the standard.
NICE = confirm with ABPM/HBPM, threshold stays 140/90, and treat with A (ACEi/ARB) if young or diabetic, C (CCB) if older or Black African/Caribbean, then A+C, then add a thiazide-like diuretic, then spironolactone.
One ACS spectrum — the ECG and high-sensitivity troponin split STEMI (immediate reperfusion) from NSTE-ACS (risk-stratified early invasive), and everyone gets dual antiplatelet + anticoagulation.
The 2023 ESC guideline unified STEMI and NSTE-ACS into a single continuum, driven by how quickly you can open the artery and how high the risk is.
STEMI = clock starts, reperfuse fast (PCI <120 min). NSTE-ACS = hs-troponin + GRACE decide how urgently to catheterise. Ticagrelor/prasugrel > clopidogrel; oxygen only if hypoxic.
Follow AF-CARE: manage Comorbidities, Avoid stroke (anticoagulate by CHA₂DS₂-VASc), Reduce symptoms (rate/rhythm), and Evaluate/reassess.
The 2024 ESC guideline reorganised AF care around the AF-CARE pathway, stressing that risk-factor control and stroke prevention matter as much as rate/rhythm decisions.
Anticoagulate by CHA₂DS₂-VASc with a DOAC, control rate to <110, consider early rhythm control, and DC cardiovert the unstable patient. Treat the comorbidities that drive AF.
Classify by congestion and perfusion (wet/dry, warm/cold): most are 'wet & warm' — treat with IV diuretics and vasodilators; 'cold' needs inotropes.
Acute heart failure is a haemodynamic emergency; rapid classification directs whether the problem is congestion, low output, or both.
Sort by wet/dry & warm/cold: diuretics + vasodilators for wet-and-warm, inotropes for cold, CPAP for pulmonary oedema — and always hunt the CHAMPIT precipitant.
Post-MI mechanical complications (ventricular septal rupture, papillary muscle rupture, free-wall rupture/pseudoaneurysm) are rare in the primary-PCI era but remain among the most lethal cardiac emergencies. Survival depends on rapid echocardiographic diagnosis, early mechanical circulatory support in shock, and urgent multidisciplinary (heart-team) intervention.
With timely primary PCI these complications now occur in well under 1% of STEMI, but mortality remains extremely high, especially with cardiogenic shock. Most events cluster in the first days after infarction, and risk is higher with late-presenting, non-reperfused, first anterior infarcts. Recent AHA and AATS consensus documents standardise recognition and management; transatlantic debate persists over the optimal timing of ventricular septal rupture repair.
Think mechanical complication for any post-MI patient with a new murmur or sudden collapse; echo first, heart team fast, and support the circulation as a bridge to urgent repair.
Residual inflammatory risk is a modifiable driver of recurrent events in coronary disease. The statement supports hsCRP as a practical marker of residual inflammation and low-dose colchicine as an adjunct in selected secondary-prevention patients, while acknowledging genuine uncertainty about timing and patient selection.
A decade of translational and clinical work (CANTOS, LoDoCo2, COLCOT) established inflammation as a treatable component of atherosclerosis, acting largely through the NLRP3 inflammasome and the IL-1beta/IL-6 axis. This ESC/ACVC clinical consensus statement translates that evidence for everyday practice across acute and chronic coronary syndromes. It follows the 2024 ESC chronic coronary syndrome guidance that gave low-dose colchicine a (weak/IIb) recommendation.
Inflammation is a real, measurable (hsCRP) and modifiable residual risk in coronary disease; low-dose colchicine is a reasonable adjunct in selected patients, but the evidence is mixed - individualise.
Microvascular obstruction (MVO / 'no-reflow') persists in a large share of reperfused STEMI despite a patent epicardial artery and is a strong, independent predictor of adverse LV remodelling and heart failure. Prevention and early recognition matter more than any single rescue therapy.
Even with timely primary PCI, suboptimal myocardial reperfusion is common, driven by distal embolisation, ischaemia-reperfusion injury, microvascular spasm and intramyocardial haemorrhage. The result - the no-reflow phenomenon - impairs infarct healing and worsens prognosis. This ESC consensus statement synthesises pathophysiology, diagnosis and management to standardise an area with limited high-quality trial evidence.
No-reflow means the artery is open but the myocardium is not perfused; prevent it, recognise it (angiography, IMR, CMR), and accept that reversal options are limited and their outcome benefit unproven.
This SVS focused update refines a grade-based strategy for blunt thoracic aortic injury (BTAI): non-operative management for minimal (grade 1-2) injuries, TEVAR as the mainstay for higher grades, and repair timing driven by haemodynamic stability and competing traumatic injuries.
BTAI is a leading cause of death after blunt trauma, usually at the aortic isthmus. TEVAR has replaced open repair as first-line for most anatomically suitable injuries. This focused update revises the 2011 SVS guideline with 13 updated recommendations reflecting evidence accrued over the intervening years, published in the Journal of Vascular Surgery (March 2026).
Grade the BTAI: 1-2 medical, stable 3 delayed TEVAR, unstable/grade 4 emergent - and control blood pressure and heart rate while you decide.
In a congested AHF patient, a modest creatinine rise during effective decongestion is usually pseudo-worsening renal function and should not trigger premature diuretic withdrawal -- keep decongesting while congestion persists and natriuretic peptides fall.
Worsening renal function (a creatinine rise of about >=0.3 mg/dL) during diuresis is common, but its meaning depends on context. Venous congestion, not low cardiac output, drives most cardiorenal syndrome, so under-decongestion is the greater danger. Recent evidence (natriuresis-guided decongestion, ADVOR, PUSH-AHF) has refined how diuretics are titrated and escalated.
Don't stop diuretics for a small creatinine rise in a still-congested patient -- pseudo-WRF during decongestion is expected and prognostically benign.
Postoperative AF is the most common complication after cardiac surgery and drives longer stays, cost, and morbidity; the STS now endorses a proactive, phase-based approach favoring perioperative amiodarone and posterior pericardiotomy for prevention.
Postoperative atrial fibrillation (POAF) affects a large share of cardiac-surgery patients yet practice has varied widely. Using a PICO/GRADE framework across preoperative, intraoperative, and postoperative domains, the STS synthesized RCT and observational evidence into a single comprehensive document. The result is 15 graded recommendations meant to standardize prevention and treatment and to flag remaining evidence gaps.
Be more aggressive about POAF prevention - perioperative amiodarone (Class I) plus beta-blockers and posterior pericardiotomy (Class IIa) - and cardiovert unstable POAF.
Donor hearts are a scarce public resource, and the statement argues that the traditional sickest-first priority must be balanced against post-transplant utility, equity, and responsible stewardship.
The heart transplant allocation system is under pressure from rising demand, new technologies (durable and temporary mechanical support), and broader geographic sharing. This AHA statement, chaired by Prateeti Khazanie, reviews the ethics of past and current allocation systems and reframes allocation as an ongoing ethical - not purely medical - question. Its goal is to inform future, more transparent and equitable policy.
Modern heart allocation is shifting from pure 'sickest first' toward a balance of urgency, utility, and equity - stewardship of a scarce resource is now an explicit ethical mandate.
The first joint US PE guideline retires 'massive/submassive' and introduces a five-category (A-E) physiology-based classification to match therapy intensity to risk, while formalising PE response teams.
This is a de novo, multi-society guideline covering evaluation, treatment and follow-up of adults with acute PE. It replaces anatomy/clot-burden thinking with a scheme built on clinical severity, biomarkers, RV imaging, haemodynamics and respiratory compromise, so that decisions turn on physiological impact rather than clot size.
Category drives disposition and reperfusion: E gets advanced therapy, D may, and A/B often go home - all coordinated through a PERT.
Manage intra-operative haemodynamics around mean arterial pressure, keeping MAP above roughly 60 mmHg, and individualise fluids and cardiac-output targets to signs of perfusion rather than to fixed numbers.
Developed by 25 international experts across seven domains (arterial pressure, heart rate, stroke volume/cardiac output and more), the guideline responds to strong evidence linking intra-operative hypotension to organ injury. It reframes management toward personalised, perfusion-oriented goals instead of one-size-fits-all thresholds or maximised cardiac output.
Keep MAP above ~60 mmHg, treat the cause of hypotension, and tailor fluids/cardiac output to perfusion instead of maximising a number.
This statement, the first comprehensive AHA update since 2015, endorses the 2023 Duke-ISCVID criteria for greater diagnostic sensitivity and reinforces a multimodality imaging and multidisciplinary team approach to endocarditis.
Infective endocarditis remains highly lethal, and both microbiology and imaging have changed substantially since the 2000 modified Duke criteria and the 2015 AHA statement. The writing group incorporated the 2023 Duke-ISCVID diagnostic framework, newer molecular diagnostics, and advanced imaging, and updated antimicrobial guidance to reflect current evidence.
Suspected endocarditis = cultures before antibiotics, echo first (TEE if needed), 2023 Duke-ISCVID criteria, and an early multidisciplinary team decision on surgery.
This consensus offers a pathophysiology-based, standardized definition of cardiogenic shock built on three diagnostic pillars, aiming to speed recognition and treatment of a syndrome whose heterogeneous presentation delays diagnosis.
Cardiogenic shock carries very high mortality, yet its presentation is heterogeneous and its diagnosis has not been standardized, so treatment is often started late. The statement proposes explicit criteria to define the syndrome and situates them alongside the SCAI SHOCK severity stages.
Cardiogenic shock = end-organ hypoperfusion from a haemodynamic abnormality due to cardiac dysfunction -- hypotension is not mandatory, and SCAI C-E tracks severity.
The 2026 ESC guideline simplifies HF classification and reframes treatment into foundational medical therapy, additional medical therapy, and guideline-directed interventional therapy -- with the HFrEF 'four pillars' as the foundational base to start and up-titrate early.
Building on the flood of trial evidence since 2021, the guideline replaces the older GDMT language with a therapy taxonomy designed to stay durable as new drugs and devices arrive. It streamlines phenotype/staging and, notably, defines foundational therapy for HFpEF as well as HFrEF.
Start the four HFrEF pillars (beta-blocker, ACE-I/ARNI/ARB, MRA, SGLT2i) early -- and remember HFpEF now has foundational MRA + SGLT2i.
This first dedicated ESC/ERA cardiorenal guideline urges that every patient with cardiovascular disease be screened for CKD (eGFR + urine albumin-to-creatinine ratio), and that a foundational combination of a RAAS inhibitor, an SGLT2 inhibitor, and statin therapy be used to slow renal decline and cut cardiovascular risk.
CKD affects an estimated 100 million people in Europe and independently raises the risk of coronary syndromes, heart failure, arrhythmias, stroke, peripheral arterial disease, and sudden cardiac death, yet cardiac and renal care have historically been siloed. This is the first ESC guideline devoted to CVD in CKD, built around the 'STAMP on CKD' framework: Screen for disease, Triage/assess risk, Address CKD progression, Modify CVD interventions, and Plan multidisciplinary care. It was presented at ESC Congress 2026 and published online in the European Heart Journal in August 2026.
Screen every cardiac patient for CKD and build therapy on RAAS inhibition + an SGLT2 inhibitor (start at eGFR >=20) + a statin, adding finerenone or a GLP-1 RA in diabetes or heart failure.
This statement offers practical, consensus-based guidance for prescribing antiarrhythmic drugs in patients and situations poorly represented in clinical trials, making explicit that most of the advice rests on expert experience and mechanistic reasoning rather than high-quality randomized evidence.
Landmark antiarrhythmic-drug trials enrolled narrow populations, leaving clinicians without evidence for many everyday scenarios and special populations. Recognizing these gaps, HRS and PACES convened a diverse expert panel to identify common but understudied situations and to give the best available practical advice, pairing whatever evidence exists with pooled clinical proficiency and a stated rationale for each recommendation. It was published in Heart Rhythm in 2026.
When the trials do not cover your patient, this HRS/PACES statement gives structured expert consensus, not proof, so individualize the drug, dose, and monitoring setting and document your reasoning.
No new drugs or algorithm overhaul — but several practical refinements that change what you do at the bedside.
Remember the shifts: CPR before naloxone · manual over mechanical CPR · IV before IO · 200 J for AF cardioversion · shock polymorphic VT immediately · POCUS only if it doesn't stop CPR · TTM 36 °C ≥36 h.
Screen early, deliver the sepsis bundle fast, resuscitate to MAP ≥65 with balanced fluids and noradrenaline — then de-escalate.
Sepsis is life-threatening organ dysfunction from a dysregulated response to infection; septic shock adds a vasopressor requirement plus lactate >2 despite fluids. The Campaign frames care around rapid recognition and a time-critical bundle, with the latest emphasis on avoiding over-resuscitation.
Recognise fast → lactate, cultures, antibiotics, balanced fluids, noradrenaline to MAP ≥65 → then de-escalate antibiotics and remove excess fluid. Steroids for refractory shock.
IM adrenaline into the anterolateral thigh is the immediate, life-saving treatment — give it early and repeat after 5 minutes if needed.
Anaphylaxis is a severe, life-threatening systemic hypersensitivity reaction with rapid Airway/Breathing/Circulation compromise, usually with skin changes.
Adrenaline IM early and repeated is everything; fluids and oxygen support it. Antihistamines/steroids are adjuncts, not treatment. Two auto-injectors + allergy referral on discharge.
Activate the protocol early, give balanced blood products (roughly 1:1:1) and tranexamic acid, control the source, and keep the patient warm.
Uncontrolled haemorrhage kills through the 'lethal triad' of hypothermia, acidosis and coagulopathy — modern damage-control resuscitation targets all three while stopping the bleeding.
TXA early, blood in balanced ratios (1:1:1), permissive hypotension (not in TBI), stop the bleeding, and fight the lethal triad — warmth, calcium, correct coagulopathy.
Norepinephrine remains first-line and can be started peripherally to avoid delaying MAP restoration; balanced crystalloids are preferred over saline, and after an initial ~30 mL/kg either a restrictive or liberal fluid strategy is now acceptable, individualised to the patient.
This is a major refresh of the 2021 guidance, developed by a large international panel spanning many countries with substantial low- and middle-income representation. It contains around 129 statements, of which roughly 46 are new, and adds bedside quick-reference graphics and clearer strong-versus-conditional labelling. New trial evidence on fluid strategy, peripheral vasopressors and antimicrobial timing drove several changes.
Norepinephrine first (peripherally if needed), balanced crystalloids, individualised fluid volume, and antibiotics within 1 hour for probable sepsis or shock.
The paediatric update introduces graded definitions - probable sepsis, suspected septic shock, and septic shock with persistent hypoperfusion - and emphasises early lactate, prompt antimicrobials, point-of-care ultrasound and structured follow-up for the many survivors left with lasting morbidity.
This revises the first dedicated paediatric SSC guidelines (2020). A panel of around 68 international experts produced roughly 61 statements, applying to children from term birth (>=37 weeks) to 18 years with acute infection and organ dysfunction. New evidence and a push for practical, resource-aware bedside criteria drove the update.
Recognise early with lactate and the new tiered definitions, treat promptly with antibiotics and POCUS-guided support, avoid hyperoxia, and plan for post-sepsis follow-up.
Refractory septic shock is defined by persistent tissue hypoperfusion (raised lactate and/or prolonged capillary refill) in a fluid-unresponsive patient requiring a noradrenaline-equivalent dose > 0.5 mcg/kg/min, with critical-care ultrasound to confirm when mixed shock is suspected.
Until now there has been no agreed definition of when septic shock becomes 'refractory', hampering trials of rescue therapies and consistent bedside recognition. A multinational, multiprofessional panel (around 56 experts from 22 countries) used a structured five-round Delphi process during 2025, reaching consensus on 13 criteria across perfusion, organ dysfunction, adequate volume/fluid responsiveness and vasoactive drug use.
Refractory = fluid-unresponsive septic shock needing noradrenaline-equivalent > 0.5 mcg/kg/min with persistent lactate/capillary-refill abnormality; confirm it is not missed mixed shock.
These guidelines offer an evidence-based framework for triaging ICU admission when products, staff or beds are critically scarce, aiming to maximise survival while preserving ethical, equitable care - though the panel stresses the underlying evidence is largely low or very low certainty.
Pandemic experience exposed the lack of rigorous, evidence-based triage guidance for genuine crisis conditions. A 21-member multidisciplinary panel (physicians, nursing, advanced practice providers, respiratory therapists, ethicists, a lawyer and patient/family representatives) reviewed the evidence for triaging critically ill adults during crisis-level shortages of essential resources.
A framework for fair, survival-oriented ICU triage in true resource crises - but built on weak evidence, so it emphasises transparent process over rigid scoring.
A major expansion of UK transfer guidance with new chapters defining minimum equipment, medications, documentation and pre-transfer checklists, reinforcing that every acute hospital must be able to resuscitate, stabilise and transfer critically ill patients 24/7.
This is a substantial revision of the previous (4th) edition, reflecting changes in critical care transfer since the COVID-19 pandemic, including the growth of dedicated transfer services. It is endorsed by the Faculty of Intensive Care Medicine and the Health Services Safety Investigations Body, and is accompanied by new companion pathways such as maternal transfers.
Stabilise first, use the checklist, take the right kit, drugs and trained escort, and maintain ICU-standard monitoring throughout - transfer is intensive care on the move.
For life-threatening DOAC-associated bleeding, use agent-specific reversal where available - idarucizumab for dabigatran, and a factor Xa reversal strategy for apixaban/rivaroxaban (specific antidote or, where that is unavailable, prothrombin complex concentrate) - alongside standard haemorrhage control and resuscitation.
DOAC use is now widespread, so emergency physicians frequently face major or intracranial haemorrhage in anticoagulated patients, and the reversal-agent landscape has shifted (including changes in availability of specific factor Xa antidotes). This ACEP clinical policy addresses the critical questions around reversal and assessment in adult ED patients on DOACs.
Idarucizumab reverses dabigatran; for factor Xa inhibitor bleeding give the available specific antidote or PCC - and never rely on a normal PT/aPTT to exclude a DOAC effect.
This multidisciplinary consensus reaffirms that ED procedural sedation is safe when done systematically: do not delay sedation based on fasting time, monitor oxygenation and ventilation, and ketamine and propofol are both endorsed as safe in adults and children.
Part 2 of ACEP's Unscheduled Procedural Sedation Multidisciplinary Delphi Consensus Guidelines (approved by the ACEP Board of Directors 29 April 2026, published Ann Emerg Med Sept 2026) was developed with a 20-member panel across 14 organisations. It addresses clinical practice - assessment, monitoring, drug selection and recovery - across all settings and all ages.
Fasting time should not delay ED sedation; capnography plus pulse oximetry and clinical observation are core monitoring, and ketamine/propofol are the workhorse agents.
Part 1 sets the governance framework for unscheduled sedation: competency-based privileging, multidisciplinary institutional oversight, and continuous quality monitoring, applicable across specialties, settings and all ages.
Companion to Part 2, Part 1 (approved by the ACEP Board of Directors 29 April 2026, published Ann Emerg Med Sept 2026) addresses the underlying principles and oversight of procedural sedation - competencies, privileging and quality monitoring - as a scientific, evidence-based framework to inform hospital and ED sedation policies.
Safe sedation is a system: competency-based privileging, multidisciplinary oversight and quality monitoring, not just drug choice.
This consensus formalises quantitative lung ultrasound (LUS) scoring as a reproducible bedside tool to grade lung aeration and track change over time across adult, paediatric and neonatal ICUs.
LUS has been used qualitatively for years, but scoring methods and technique varied widely, limiting comparability and research use. ESICM (European Society of Intensive Care Medicine) and ESPNIC (paediatric/neonatal society) convened ~20 experts plus methodologists to address 14 prioritised clinical questions on technique and clinical application. The result standardises how the aeration score is generated and where it is clinically useful.
Quantitative LUS grades aeration region-by-region from 0 (normal) to 3 (consolidation) and is best used to follow trends, not as a stand-alone diagnosis.
When invasive ICP monitoring is unavailable, the B-ICONIC consensus recommends a multimodal non-invasive strategy: use at least two concordant nICP modalities plus clinical exam and imaging to guide ICP-directed therapy.
Invasive ICP monitoring is the reference standard but is unavailable in many centres, especially in low- and middle-income settings. A panel of 41 experts who routinely use non-invasive ICP (nICP) tools built practical guidance and management algorithms for TBI care without an intraparenchymal or ventricular device. It defines which modalities to combine and how to escalate or de-escalate therapy.
Without an invasive monitor, suspect raised ICP when at least two of ONSD >=6 mm, TCD PI >=~1.4, and a low NPi agree with the clinical and CT picture.
Gastric POCUS lets clinicians individualise aspiration risk in medically complex patients by imaging the antrum, grading it, and estimating gastric volume when fasting status is uncertain.
Fasting guidelines poorly predict actual gastric contents in many at-risk groups, and the surge in GLP-1 receptor agonist use has heightened concern about delayed emptying. ASRA Pain Medicine reviewed the evidence and issued expert practice recommendations for using gastric POCUS to guide decisions in medically complex patients undergoing regional anaesthesia and pain procedures. It targets seven populations: pregnant, obese, diabetic, GERD, emergency, enterally fed, and GLP-1RA patients.
In uncertain or high-risk patients, an empty antrum (Perlas 0) reassures, while grade 2 fluid, CSA >~340 mm2, >1.5 mL/kg, or any solid means treat as a full stomach.
SCCM suggests using critical care ultrasonography (CCUS) to guide management in shock and respiratory failure, and specifically favours ultrasound-guided volume management over usual care, citing a signal toward improved mortality.
CCUS has become central to ICU practice, and this focused update refreshes the prior SCCM recommendations with current evidence. An interprofessional panel of 36 (including two patient/family representatives) addressed five high-yield scenarios: cardiac arrest, sepsis/septic shock, acute dyspnoea/respiratory failure, volume management, and cardiogenic shock. The guideline assumes operators already have appropriate equipment, training and competency.
SCCM 2024 focused update: use CCUS to guide management in sepsis, respiratory failure and cardiogenic shock, and prefer ultrasound-guided over usual-care volume management.
A dedicated, protocol-driven ED observation unit is a best practice that shortens length of stay and reduces avoidable admissions while keeping short-stay patients under emergency-physician oversight.
ACEP policy supports observing appropriate ED patients in a dedicated observation area rather than in inpatient or acute ED beds. A 2026 interim practice update to ACEP's earlier resource paper reviews structure, staffing, billing, and expanding applications across chest pain, toxicology, geriatrics, psychiatry, and oncology. The model is a time-limited diagnostic and therapeutic trial, not a holding area.
Observation is a time-limited, protocol-driven trial under EM oversight -- not a parking spot for undecided admissions.
A minority of dying ICU patients wish to die at home or another meaningful place, and with careful multidisciplinary decision-making a planned, compassionate critical care transfer can honour that wish. Feasibility, safety and family support must be balanced against the patient's expressed preference.
Published July 2025 by a joint intensive care and palliative medicine group, this supplementary guidance fills a long-standing gap. Teams increasingly face requests to facilitate death outside the ICU but previously had little structured guidance on how to decide on and safely execute such transfers under time pressure and clinical uncertainty.
A planned transfer to a preferred place of death is a legitimate critical care intervention when an experienced MDT judges it safe, feasible and aligned with the patient's wishes.
UK residents who become critically ill abroad have a right to timely NHS care, and repatriation to the hospital serving their home should be treated with the same urgency as an internal network transfer. Where overseas care may be substandard, expedite repatriation.
Updated May 2025, this guidance sets out principles for coordinating the return of UK residents from overseas critical care units, where resources and standards of care vary widely and may fall below what is acceptable in UK units.
Treat international repatriation like an internal network transfer - consultant-led, ODN-coordinated, and generally within about 48 hours.
The first full rewrite since 2008 confirms death as the permanent loss of the capacity for consciousness combined with the permanent loss of the capacity to breathe, diagnosable by somatic, circulatory or neurological criteria, and tightens apnoea-test parameters and the recording of time of death.
Published January 2025, this Code updates the 2008 version for the first time. It harmonises the three criteria sets across all ages and clinical settings and clarifies the timing of observation, apnoea-testing thresholds and how the time of death is recorded.
Death is permanent loss of consciousness plus permanent loss of the capacity to breathe - confirm circulatory death after 5 minutes of asystole, and neurological death with two test sets meeting strict apnoea targets.
In sepsis or septic shock, give up to 30 mL/kg of IV crystalloid in the initial phase with frequent reassessment, then individualise - the evidence does not favour a blanket restrictive or liberal strategy in the optimisation phase. Most recommendations rest on very-low-certainty evidence.
Published in Intensive Care Medicine (March 2025), this is Part 2 of a three-part ESICM series (Part 1 covers fluid type, Part 3 covers fluid removal and de-escalation). An international panel used PICO questions and the GRADE approach across the phases of resuscitation.
About 30 mL/kg crystalloid up front in septic shock, then individualise - neither routine liberal nor routine restrictive fluids proved superior.
A framework for the ethically and medico-legally complex situation of patients with severe eating disorders referred to critical care for assisted feeding, sometimes under restraint and mental health legislation. Engaging the eating-disorder behaviours is as important as the physiological refeeding.
Issued August 2026 in response to repeated enquiries about managing severe eating-disorder patients who need assisted nutrition with restraint under mental health law. It addresses the complex ethical, medico-legal, clinical and logistical challenges and the sparse evidence base in this area.
Assisted nutrition under restraint in severe eating disorders is a joint critical care-psychiatry, law-bound intervention where gradual MEED-guided refeeding and behavioural engagement matter as much as electrolyte control.
Critical care is resource- and carbon-intensive, and this ANZICS/ICS toolkit gives multidisciplinary teams practical, evidence-informed strategies to cut environmental impact while maintaining high-quality patient care.
Endorsed by the ANZICS Board and the Intensive Care Society (UK) in March 2026, this guide builds on earlier 'Green Teams in the ICU' work. It shifts emphasis to the domains with the greatest impact potential - energy, travel, medical supplies, pharmaceuticals, diagnostics, and waste - and pairs case studies with actionable steps. It is aimed at clinicians, managers, educators, and sustainability leads to move units from intention to implementation.
Sustainable intensive care means less waste, less energy, greener anaesthetic and inhaler choices, and fewer low-value tests - delivered without compromising patient care.
For critically ill adults aged 65 and older, embed a geriatric model of care built on the 4Ms and do not use antipsychotics to prevent delirium; chronological age alone should not drive decisions.
Older adults make up a large and growing share of ICU patients but have historically been under-served by generic critical-care protocols. A 22-member interprofessional SCCM/ACCM panel used the GRADE framework across five PICO questions to align ICU practice with Age-Friendly Health Systems principles. The evidence base is sparse, so most guidance is conditional or consensus-based.
In older ICU patients, operationalise the 4Ms and avoid antipsychotics for delirium prevention - age by itself should not dictate care.
After ROSC, care is a bundle: find and treat the cause, avoid hypoxia and hyperoxia, maintain perfusion, and actively prevent fever rather than deep hypothermia, while delaying neuroprognostication.
The 2021 ERC-ESICM guidelines (updated 2025) consolidated post-arrest management into a structured pathway. The biggest shift followed the TTM2 trial: routine targeted hypothermia to 33 C was abandoned in favour of controlled normothermia with fever prevention, since 33 C showed no mortality or functional-outcome benefit over treating fever alone.
Prevent fever, not induce deep hypothermia - and never prognosticate too early.
The updated DAS algorithm shifts the emphasis from rescuing a failed airway to preventing failure and maximising first-attempt success, keeping the familiar linear Plan A-B-C-D pathway.
This is the first major revision of the 2015 DAS guideline, built from a 3-year systematic review of ~1,240 papers and a Delphi consensus, yielding roughly 65 recommendations. It reflects the routine availability of videolaryngoscopy and a stronger focus on human factors, preoxygenation and declaring failure early.
Optimise attempt one, cap attempts at 3+1, and cut the neck with a scalpel-bougie-tube the moment CICO is declared.
Neuromuscular blockade is a targeted, short-term rescue for patients with moderate-to-severe ARDS who stay hypoxaemic or dyssynchronous despite optimised ventilation and sedation - not a routine early continuous infusion for everyone.
After conflicting trials (ACURASYS suggested benefit, ROSE showed none versus light sedation), SCCM re-appraised the evidence. A meta-analysis of seven RCTs supported a reduction in 28-day mortality, and the panel framed NMBAs as a conditional, low-certainty option reserved for persistent hypoxaemia rather than blanket use.
Reserve paralysis for P/F < 150 with refractory hypoxaemia or dyssynchrony, keep it deeply sedated, and stop by ~48 hours.
After the acute resuscitation phase, actively de-escalate fluids and favor protocolized diuretic-driven fluid removal over usual care, rather than defaulting to a positive or neutral balance.
This is the third and final part of the ESICM fluid-therapy guideline series, addressing what to do once shock has stabilized. It was built from 13 RCTs with a literature search through February 2025 using GRADE methodology. The impetus is growing evidence that cumulative positive fluid balance and tissue edema worsen outcomes, so de-resuscitation is now treated as an active, deliberate phase of care.
In the recovery phase, de-resuscitate with a diuretic protocol and reserve ultrafiltration for genuine RRT indications, not fluid removal alone.
Shock is a clinical diagnosis of tissue hypoperfusion; assess it with capillary refill time and skin signs, and escalate to cardiac-output and venous-oxygenation monitoring in patients who do not respond to initial therapy.
These 2025 ESICM guidelines update guidance on diagnosing shock and monitoring hemodynamics in adult critically ill patients. An international panel used PICO questions with GRADE, issuing ungraded good practice statements (UGPS) where strong evidence was lacking. In total the panel issued 50 statements spanning clinical assessment, perfusion markers, cardiac-output monitoring, and fluid responsiveness.
Diagnose shock clinically (CRT, mottling, lactate) and reserve cardiac-output and venous-oxygenation monitoring for patients not responding to initial therapy.
This focused update to the 2018 PADIS guideline reinforces light sedation with dexmedetomidine over propofol when reducing delirium is a priority, adds anxiety as a new domain, and favors opioid-sparing analgesia, enhanced mobilization, and melatonin for sleep.
The SCCM task force updated the 2018 PADIS guidelines to incorporate newer evidence, reviewing pain, anxiety (a newly added topic), agitation/sedation, delirium, immobility, and sleep disruption in adult ICU patients. It uses GRADE and issues mostly conditional recommendations, reflecting evolving evidence in sedation and delirium since 2018.
Light, dexmedetomidine-favored sedation, opioid-sparing analgesia, early mobilization, and melatonin-based sleep care define the 2025 PADIS update.
For patients aged 80 and older, chronological age alone should never decide ICU admission; base decisions on frailty, comorbidity, functional status, and the patient's own preferences, and use time-limited trials when prognosis is uncertain.
Very old patients (age >= 80) are the fastest-growing ICU cohort, yet high-quality trial evidence is scarce because of their heterogeneity and complex geriatric syndromes. Because classical evidence-based methods fall short here, ESICM used a two-round Delphi consensus (28-member steering group, 110 experts) to produce consensus-based recommendations. Strong consensus required >= 90% agreement and moderate consensus >= 80%.
Judge the very old ICU patient by frailty, function, and preferences with time-limited trials, not by age alone.
GPICS V3 is the UK reference standard for planning and delivering adult intensive care, now framed around auditable minimum standards ('must-do' statements) covering infrastructure, workforce and processes. It reaffirms core safety staffing: 1:1 nursing for Level 3 patients and 1:2 for Level 2.
GPICS V3 (published January 2026) builds on the 2015, 2019 and 2022 (v2.1) editions, incorporating lessons from COVID-19, emerging evidence and changing practice. It is the first edition co-produced with patients and families, whose lived experience is embedded in the editorial board, and it adds material on sustainability and on equality, diversity and inclusion. The document was restructured so each chapter presents a minimum standard, recommendations for a quality service, and a background/explanation section to improve auditability and consistency.
GPICS V3 is the UK benchmark for what 'safe' intensive care looks like - if a unit cannot meet a minimum standard, that is an auditable safety gap, not a local preference.
This UK multi-society guideline gives the first national framework for emergencies in ECMO patients, stressing that standard advanced life support algorithms may not apply and that rapid recognition of arrest, team prioritisation and early circuit troubleshooting are the life-saving priorities.
Emergencies in patients on extracorporeal membrane oxygenation (ECMO) are complex because the altered circulation means conventional ALS may not be appropriate. Through collaboration between all UK ECMO centres and eight national societies, the current evidence was assessed and, using a modified Delphi consensus process, national guidance was produced. It was published in Intensive Care Medicine (2025) and is intended for all staff and all ECMO types in the UK, used alongside appropriate training.
On ECMO, the circuit is part of the patient - recognise arrest fast, troubleshoot the circuit early, and remember that standard ALS may not apply.
The panel makes one strong recommendation - liberalized family presence as the default in adult ICUs (upgraded from conditional in 2017) - plus 14 conditional recommendations and 2 best-practice statements to engage, support and communicate with families.
These 2024 SCCM guidelines (published in Critical Care Medicine, February 2025) update the 2017 family-centered care guidelines and are organised into four domains: engagement of families, support of family needs, communication support, and support of the ICU clinicians who provide family-centered care. Meta-analysis found liberalized presence increased family (and possibly patient) satisfaction and reduced anxiety and depression symptoms, with no signal of harm to mortality or length of stay - justifying the upgrade to a strong recommendation.
Open family presence is now the strong-recommendation default in the adult ICU - families are partners in care, not visitors.
The first major SCCM update since the 2008 consensus statement recommends proactive palliative care and/or ethics involvement, protocolized withdrawal of life-sustaining treatment with structured symptom management, and structured shared decision-making for adult ICU end-of-life care.
Published in Critical Care Medicine (December 2025; 53(12):e2734-e2746), these clinical practice guidelines update the 2008 American College of Critical Care Medicine consensus statement on end-of-life (EOL) care. They are motivated in part by evidence that at least ~20% of ICU patients have goals that are not medically attainable or a treatment plan misaligned with achievable goals. An accompanying editorial notes the recommendations rest largely on low-certainty evidence, so most are conditional.
Good ICU dying is planned, protocolized and multidisciplinary - proactive palliative/ethics input plus structured symptom control at withdrawal is the standard.
ICS delirium guidance prioritises routine screening with validated tools (CAM-ICU or ICDSC) and non-pharmacological, bundle-based prevention as first-line, reserving drug therapy for when patient or staff safety is at risk or a withdrawal state is contributing.
Released by the Intensive Care Society on 24 February 2025, this multiprofessional guidance updates earlier UK delirium recommendations and incorporates current evidence. Delirium affects a large proportion of critically ill patients (cited as up to ~74% of ventilated patients), is frequently underdiagnosed, and is associated with long-term cognitive impairment, increased mortality and significant burden on patients, families and staff.
Screen, prevent and de-trigger first - drugs are a last resort for safety, and antipsychotics do not prevent ICU delirium.
Time is brain — rapid CT, thrombolysis within 4.5 h (tenecteplase increasingly preferred), and thrombectomy for large-vessel occlusion out to 24 h in selected patients.
The guideline covers the first hours of ischaemic stroke, where reperfusion saves neurons. Speed and systems (prehospital routing, prenotification, door-to-needle targets) drive outcomes.
CT first to exclude bleed → thrombolyse (tenecteplase/alteplase) within 4.5 h with tight BP control → thrombectomy for LVO up to 24 h in selected patients. Always exclude hypoglycaemia.
Time-critical staged treatment — a benzodiazepine at 5 minutes, a second-line antiepileptic at 20 minutes, and anaesthesia by 40 minutes.
Convulsive status epilepticus (a seizure > 5 min or repeated seizures without recovery) becomes harder to stop and more damaging the longer it runs, so treatment is time-boxed.
Benzo → second-line AED → anaesthesia, on a 5/20/40-minute clock. Don't under-dose the benzodiazepine, and always check the glucose.
Thunderclap headache → urgent non-contrast CT (near 100% sensitive within 6 h); if negative but still suspicious, LP for xanthochromia or CT angiography.
Aneurysmal SAH and spontaneous intracerebral haemorrhage are time-critical haemorrhagic strokes where early diagnosis and BP/complication control change outcome.
Thunderclap headache = CT then LP. Secure the aneurysm early and give nimodipine for SAH; for ICH, lower BP to ~140 and reverse any anticoagulant fast.
Do not delay antibiotics — give ceftriaxone (plus amoxicillin for Listeria in the vulnerable) and dexamethasone as soon as meningitis is suspected.
Bacterial meningitis is rapidly fatal; time-to-antibiotics drives survival, so treatment must not wait for imaging or LP when those will be delayed.
Antibiotics first, imaging second — ceftriaxone (+ amoxicillin if vulnerable) and dexamethasone immediately; never let a CT or LP delay the first dose.
Treat the ruptured aneurysm early (ideally within 24 h) by a dedicated team, give oral nimodipine to all, and favour endovascular coiling over clipping when both are equally suitable. aSAH still carries a case-fatality of roughly 40%.
This 2026 joint guideline of the European Stroke Organisation, European Association of Neurosurgical Societies and European Society for Minimally Invasive Neurological Therapy updates management of aneurysmal subarachnoid haemorrhage using GRADE methodology. It covers aneurysm securing, prevention of rebleeding and delayed cerebral ischaemia, and systems of care. Survivors frequently have lasting functional, cognitive and emotional sequelae.
Early aneurysm securing (favouring coiling), universal oral nimodipine, and care in a high-volume neuro-ICU are the pillars; antifibrinolytics, statins and magnesium are not recommended.
Do not lower BP pre-hospital in suspected stroke. For thrombolysis keep BP <185/110 mmHg before and <180/105 mmHg during/24 h after; in ICH, early systolic reduction to <140 mmHg is suggested for small-to-moderate haematomas.
This 2025 update to the ESO blood-pressure guideline addresses eight clinical questions across acute ischaemic stroke and intracerebral haemorrhage, developed with GRADE methodology and systematic review. It reflects evidence from major BP-lowering trials (including INTERACT and ATACH-era data) and recent reperfusion-therapy studies.
No pre-hospital lowering; <185/110 pre-lysis and <180/105 peri-reperfusion for ischaemic stroke; early smooth systolic control toward <140 mmHg for small-to-moderate ICH.
Minimally invasive surgery appears to confer a mortality benefit, with functional benefit best supported for lobar haemorrhages. The clearest indication is early (<24 h) evacuation in ENRICH-type patients: lobar supratentorial ICH, ~30-80 mL, by a trained team.
This 2026 AHA science advisory updates the evidence on minimally invasive surgical (MIS) evacuation of supratentorial spontaneous ICH following the contemporary randomised trials ENRICH and MIND. ENRICH used a trans-sulcal parafascicular approach with a tubular retractor and neuronavigation; MIND used endoscopic aspiration. It refines patient selection, timing and platform choice relative to the 2022 AHA/ASA ICH guideline.
Early minimally invasive evacuation of a ~30-80 mL lobar supratentorial ICH by an experienced team is the clearest evidence-based indication; mortality benefit is supported, functional benefit mainly in lobar bleeds.
No single predictor reliably forecasts outcome after critical AIS - avoid premature prognostication and use multimodal assessment. Early neurological improvement within 24 h of revascularisation is a moderately reliable marker of good functional outcome.
This NCS/DGNI guideline (GRADE-based narrative systematic review) addresses neuroprognostication in critically ill adults with acute ischaemic stroke, focusing on the reliability of individual predictors and multivariate models used when counselling patients and surrogates. It emphasises timing, confounders, language during counselling and disclosure of uncertainty, given wide practice variation and the risk of self-fulfilling prophecy.
Prognosticate late and multimodally: only early post-revascularisation improvement is a moderately reliable good-outcome sign, and no single predictor should drive care-limiting decisions.
No individual clinical variable or prediction model reliably predicts in-hospital mortality in status epilepticus. STESS and EMSE should not drive prognosis for individual patients, and prognostic pessimism must not justify under-treatment.
This NCS/DGNI guideline (GRADE-based narrative systematic review) outlines principles of neuroprognostication in critically ill adults with status epilepticus and reviews the reliability of clinical predictors and scores for counselling surrogate decision-makers. It examines the Status Epilepticus Severity Score (STESS) and the Epidemiology-based Mortality score in SE (EMSE), among other predictors.
In status epilepticus, no score or single variable reliably predicts death - prognosticate cautiously, prioritise treating the cause and the seizures, and never let a poor predicted outcome justify under-treatment.
For hospitalised patients with intractable primary headache, ASRA advises structured IV multimodal therapy led by dopamine-receptor antagonists and magnesium rather than reflexive opioids, which are not recommended as routine abortive agents.
Inpatient IV headache care has long been highly variable and opioid-heavy despite weak supporting evidence. This ASRA Pain Medicine consensus (proposal approved 2023, published for 2026) is the first multidisciplinary practice advisory dedicated to IV abortive strategies in admitted patients, assembling neurologists, pain physicians, anaesthesiologists and a patient representative. It synthesises the evidence for antiemetic/neuroleptic infusions, magnesium, valproate and dihydroergotamine and standardises dosing and monitoring.
Inpatient intractable headache is treated with scheduled IV neuroleptic/antiemetic infusions plus magnesium and pre-medication for akathisia, not with opioids.
Status epilepticus is a time-critical emergency: give a full-dose benzodiazepine immediately, then load a full-dose second-line antiseizure medication early, because timing and adequate dosing matter more than which agent is chosen.
UK practice in status epilepticus (SE) had been inconsistent, with frequent benzodiazepine under-dosing and delayed second-line therapy. The Intensive Care Society convened acute medicine, neurology, intensive care and emergency medicine specialists to produce cross-specialty guidance for patients over 16, using ILAE definitions and covering stabilisation, investigation, drug therapy, sedation and critical-care transfer. Diagnosis of the underlying cause is emphasised, especially in refractory SE.
SE = seizure >=5 min: full-dose benzodiazepine now, full-dose second-line ASM (levetiracetam/valproate/(fos)phenytoin) early - speed and dose beat drug choice.
In seizure-naive adults having supratentorial neurosurgery, the NCS makes only a conditional recommendation: either prophylactic antiseizure medication or no prophylaxis is acceptable, reflecting low-quality evidence.
Antiseizure medication (ASM) prophylaxis after supratentorial surgery has long been practiced inconsistently. The NCS performed a systematic review and meta-analysis in adults with no prior seizures, structured around three PICO questions: ASM versus no ASM, agent choice (levetiracetam vs phenytoin/fosphenytoin), and duration (7 days or less vs more than 7 days). The overall evidence base was weak, so recommendations are conditional.
For seizure-naive supratentorial surgery, prophylaxis is optional (conditional, low-quality evidence) - individualize, prefer levetiracetam if used, and keep it short.
Treat diagnosed stroke-associated pneumonia (SAP) with prompt empirical antibiotics guided by local protocols, but do not use prophylactic antibiotics - prevention relies on positioning, mobilisation, nutrition and dysphagia management.
SAP is a common, outcome-worsening complication of acute stroke, yet practice has varied widely and the evidence base is thin. This ESO guideline standardises the approach to diagnosis and treatment and formally rejects routine preventive antibiotics after trials showed no benefit on SAP incidence or clinical outcomes. Because robust data are limited, many recommendations rest on expert consensus.
Prompt empirical antibiotics for diagnosed SAP - but no prophylaxis; prevention is positioning, mobilisation, nutrition and dysphagia management.
This guideline replaces the 2012 recommendations and, for the first time in AAN/AHS guidance, places CGRP-targeted therapies alongside traditional oral preventives, with selection driven by whether the patient prioritizes efficacy or tolerability.
Since 2012, gepants (oral CGRP antagonists) and anti-CGRP monoclonal antibodies have transformed migraine prevention. The updated guideline grades these newer agents against established options and emphasizes individualized, shared decision-making rather than a rigid step-therapy order.
Prevention is indicated at roughly 4+ migraine days/month; pick the agent by the patient's priority (efficacy vs tolerability), and CGRP therapies no longer require failing older drugs first.
Replacing the 2016 guideline, this 248-recommendation update frames recovery as a continuum and stresses early, intensive, organized interprofessional rehabilitation, prevention of secondary complications, and mental-health screening.
Rehabilitation evidence has grown considerably since 2016, spanning technology-enabled therapy, comorbidity management, and long-term participation. The guideline reorganizes care across five recovery phases and broadens scope to caregiver support, return to work/driving, fall/fracture risk, and telerehabilitation access.
Stroke recovery is a five-phase continuum: organized interprofessional rehab started early, complications prevented, and mood disorders screened and treated throughout.
Diabetes technology moves earlier and wider — CGM at diagnosis for insulin users, and automated insulin delivery reaches type 2.
Start CGM early, target time-in-range >70% (not just HbA1c), and pick drugs by the patient's comorbidities (GLP-1 for heart failure/MASH, SGLT2 for CKD/HF) rather than the sugar number.
A welcome update after >10 years — but most recommendations rest on low-certainty evidence, so let symptoms guide you, not cut-offs alone.
Anaemia in CKD is common (reduced erythropoietin, functional iron deficiency, inflammation, shortened red-cell survival). The previous KDIGO guidance was over a decade old; this update blends graded recommendations with "practice points" (expert opinion), with certainty ratings shown — and they are mostly "very low."
Screen with ferritin/TSAT, replace iron by the stage-specific thresholds (IV in dialysis), reach for ESAs at Hb ≤9–10, and never chase Hb above 11.5 — overshooting causes strokes, not benefit.
A dedicated ADA standard treating obesity as a chronic disease — structured assessment, effective GLP-1/GIP pharmacotherapy, and surgery, with weight-loss targets tied to organ benefit.
The ADA has split obesity care into its own standards, reflecting the arrival of highly effective incretin therapies. The emphasis is on obesity as a chronic, relapsing disease managed long-term — and on reducing weight stigma.
Treat obesity as a chronic disease: lifestyle for all, and offer GLP-1 / GIP-GLP-1 agents (BMI ≥27 with comorbidity or ≥30) or surgery (BMI ≥35), targeting ≥10–15% weight loss.
Refined AKI/AKD definitions, cause-directed work-up, supportive management (optimise haemodynamics, stop nephrotoxins), and no routine early dialysis — plus follow-up to catch progression to CKD.
KDIGO updates the AKI framework and formalises acute kidney disease (AKD) — the <3-month window that bridges AKI and CKD. Recent trials settled the long-running question of when to start dialysis.
Define AKI by creatinine/urine output, find and treat the cause, optimise volume and stop nephrotoxins, and don't rush to dialyse — start KRT for the classic emergencies. Follow survivors up for CKD.
Fix fluid and potassium first, clear ketones with fixed-rate insulin, and watch potassium and glucose closely; HHS is fluid-led with cautious insulin.
Diabetic ketoacidosis and the hyperosmolar hyperglycaemic state are the two hyperglycaemic emergencies — different tempos, overlapping principles.
DKA = fluids + fixed-rate insulin + potassium, glucose added at BG <14, no bicarbonate. HHS = fluid-led, gentle insulin, high clot risk.
ECG changes or K⁺ ≥ 6.5 mmol/L is an emergency — protect the heart with calcium first, then shift potassium into cells and remove it from the body.
Severe hyperkalaemia can cause fatal arrhythmia with little warning; management follows a fixed three-step logic.
Calcium to protect the heart → insulin-glucose + salbutamol to shift → binders/dialysis to remove. Always recheck glucose after insulin.
In suspected adrenal crisis, give hydrocortisone immediately — never wait for a cortisol result. Thyroid storm and myxoedema coma are clinical diagnoses needing prompt treatment.
These endocrine emergencies are easy to miss and rapidly fatal, but respond dramatically to early empirical treatment.
Adrenal crisis → hydrocortisone now, ask questions later. Thyroid storm → block (beta-blocker + antithyroid), then iodine + steroid. Myxoedema coma → thyroid hormone + steroid + warmth.
The five major liver societies (EASL, AASLD, APASL, ALEH, SOLDA) agree a single global definition of ACLF: liver failure (bilirubin ≥5 mg/dl and INR ≥1.5) developing on advanced chronic liver disease (≥F3 fibrosis / cirrhosis) together with one or more extrahepatic organ dysfunctions/failures, usually after a precipitant — graded 1–3 by the number of failing organs, with higher grades carrying higher short-term mortality.
ACLF is a life-threatening syndrome of acute deterioration, organ failure, systemic inflammation and high short-term mortality in a patient with chronic liver disease. This harmonisation initiative replaces competing regional definitions (CLIF-C, APASL/AARC, NACSELD) with one evidence-based framework for clinical practice, research and clinical-trial endpoints — developed by Delphi consensus (≥70% agreement) and aligned with the FDA/EMA.
Suspect ACLF when a patient with cirrhosis or advanced chronic liver disease develops jaundice + coagulopathy (bilirubin ≥5 mg/dl, INR ≥1.5) after a precipitant (most often infection). Grade by extrahepatic organ failures — 1 = one dysfunction, 2 = one failure, 3 = ≥2 failures — treat the trigger, support failing organs early, and assess transplant candidacy, because mortality rises steeply with grade.
Diagnose clinically, hunt and treat the precipitant, use lactulose first-line and add rifaximin to prevent recurrence — and do not protein-restrict.
Hepatic encephalopathy (HE) is reversible neuropsychiatric dysfunction in liver failure / portosystemic shunting, driven largely by ammonia. Most episodes are triggered by a precipitant, so finding it is central to management.
Treat the trigger, give lactulose to 2–3 soft stools/day, add rifaximin to prevent recurrence, and feed protein — don't restrict it.
Resuscitate, risk-score with Glasgow-Blatchford, endoscopy within 24 h, and transfuse restrictively (Hb 70) — variceal bleeds also need terlipressin and antibiotics.
Upper GI bleeding is common and the approach differs sharply between variceal and non-variceal causes.
Blatchford to triage, Hb 70 transfusion trigger, scope within 24 h. Variceal = terlipressin + antibiotics + banding; non-variceal = endoscopic haemostasis + PPI after scope.
Diagnose on any 2 of 3 (typical pain, lipase ≥ 3× ULN, imaging); give goal-directed fluids and analgesia, treat the cause, and avoid prophylactic antibiotics.
Most pancreatitis is mild and self-limiting, but early fluid strategy and cause-directed care shape outcomes in severe disease.
2-of-3 to diagnose, fluids that are goal-directed not torrential, feed early, no prophylactic antibiotics, and fix the gallstones (ERCP for cholangitis, same-admission cholecystectomy).
In acute variceal bleeding, combine a vasoactive drug, prophylactic antibiotics, and endoscopic band ligation within 12 hours; gastric fundal varices are best treated with cyanoacrylate injection rather than banding.
Variceal haemorrhage remains a leading cause of death in portal hypertension. ASGE guidance defines the role of endoscopy in screening, primary prophylaxis, and acute haemostasis, and has been reinforced by more recent AASLD and Baveno VII consensus that emphasise earlier risk stratification and pre-emptive TIPS. The approach differs for oesophageal versus gastric varices because of vessel calibre and shunt anatomy.
Drug + antibiotic + band within 12 hours for oesophageal varices; glue (cyanoacrylate) for gastric fundal varices; TIPS for failure.
Oesophageal perforation is a surgical emergency where early diagnosis (within 24 hours) and timely intervention drive survival; management is individualised across non-operative, endoscopic (stent/vacuum) and surgical routes based on stability, contamination and delay.
There is no widely adopted recent society guideline dedicated solely to oesophageal perforation from the STS; the most cited multidisciplinary emergency guidance is the WSES 'Esophageal emergencies' guideline, supported by recent systematic reviews. Perforation carries high mortality (historically up to 30%, now nearer 15%) because mediastinal and pleural contamination progresses rapidly to sepsis. Improved stents, minimally invasive surgery and endoscopic vacuum therapy have broadened options.
Early CT/contrast study, aggressive resuscitation and antibiotics, and prompt surgical or endoscopic control - delay beyond 24 hours sharply worsens outcome.
Risk-stratify with non-invasive tests, use carvedilol as the preferred non-selective beta-blocker to prevent decompensation and variceal bleeding, and refer early for TIPSS in refractory ascites or uncontrolled/high-risk variceal bleeding.
The BSG has updated UK guidance on portal hypertension and on TIPSS (with BSIR and BASL), building on the Baveno VII consensus which shifted management toward earlier detection of clinically significant portal hypertension (CSPH) and treating portal pressure rather than just varices. Non-invasive markers (liver stiffness, platelet count) now identify who can avoid endoscopy. Carvedilol has emerged as first-line because it lowers portal pressure more effectively than traditional beta-blockers.
Detect CSPH early, use carvedilol to prevent decompensation, and escalate to pre-emptive TIPSS in high-risk variceal bleeding.
Confirm the diagnosis with CT, and withhold routine antibiotics in low-risk, uncomplicated diverticulitis, reserving them for high-risk, immunocompromised, or systemically unwell patients.
The 2026 ACG guideline provides evidence-based recommendations for managing colonic diverticulitis largely in the outpatient/gastroenterology setting. It reflects a major shift away from reflexive antibiotics for uncomplicated disease, supported by randomised trials showing no benefit in selected low-risk patients. It also refines who needs interval colonoscopy and elective surgery.
CT to confirm, skip antibiotics in low-risk uncomplicated disease, and scope after complicated diverticulitis to rule out cancer.
Lactulose is first-line for overt hepatic encephalopathy (titrated to 2-3 soft stools/day), with rifaximin added for treatment of acute episodes and for prevention of recurrence; always hunt for and treat the precipitant.
The 2026 ACG guideline updates the diagnosis and management of hepatic encephalopathy (HE) in chronic liver disease, complementing AASLD guidance. HE is usually precipitated (infection, GI bleeding, constipation, electrolyte disturbance, dehydration, sedatives). Rifaximin's role has expanded from secondary prophylaxis to an early adjunct in acute overt HE based on trial data showing faster reversal, shorter admissions and lower mortality when combined with lactulose.
Lactulose titrated to 2-3 soft stools/day plus rifaximin for acute and recurrent overt HE - and always treat the precipitant.
Do not use tranexamic acid to treat acute GI bleeding - the HALT-IT trial found no reduction in death due to bleeding and a significant increase in venous thromboembolism (and seizures).
Earlier small trials and a Cochrane meta-analysis had suggested a mortality benefit from tranexamic acid (TXA) in GI bleeding, but the evidence was low quality. HALT-IT was a large international RCT (about 12,000 adults with significant upper or lower GI bleeding) designed to settle the question. It used a high-dose 24-hour regimen and overturned the earlier optimism, so current UK/NICE and international positions do not recommend TXA for GI bleeding.
HALT-IT put a stop to TXA for GI bleeding: no mortality benefit, more clots and seizures - so don't use it.
For symptomatic walled-off pancreatic necrosis, the panel makes conditional recommendations favouring endoscopic (transmural) intervention over image-guided drainage, and image-guided or minimally invasive approaches over open surgery - though all recommendations rest on very low certainty evidence.
Walled-off pancreatic necrosis (WON) is a late (typically >4 weeks) complication of necrotising pancreatitis; symptomatic or infected collections require intervention. This 2026 SAGES/AHPBA guideline, with an accompanying systematic review and meta-analysis, addressed four comparisons: image-guided vs endoscopic, image-guided vs surgical, endoscopic vs surgical, and pure endoscopic vs step-up approaches. The shift reflects the move away from early open necrosectomy toward minimally invasive, step-up strategies.
Step up, do not cut first: endoscopic transmural drainage is favoured over percutaneous, and both are favoured over open surgery - all on very low certainty evidence.
Falls in line with GINA — ICS/formoterol as reliever and maintenance; it is time to retire albuterol-only rescue.
SABA-only rescue treats the bronchospasm but ignores the underlying inflammation, and heavy SABA use is linked to worse outcomes and death. GINA has for years recommended anti-inflammatory reliever therapy (an ICS given with every reliever dose). This VA/DoD guideline brings US primary care into step (it does not cover severe/biologic asthma, which stays with specialists).
ICS/formoterol is now the backbone — reliever alone in mild asthma, MART in moderate–severe, add LAMA if still uncontrolled. If you're still handing out a SABA-only inhaler, update the plan.
Scenario-based rules for community settings: when to use adrenaline, and when adrenaline alone is enough vs when to call an ambulance.
There are no randomised trials of adrenaline in anaphylaxis (it would be unethical to withhold it), so this is expert consensus aimed at patients and carers at home. Adrenaline is the first-line, life-saving treatment; antihistamines and steroids are adjuncts that do not treat airway or circulatory compromise.
Any respiratory, cardiovascular/neuro, or moderate–severe GI feature = give adrenaline. Isolated mild skin/mucosal/GI symptoms can be observed. Call EMS if the patient is alone, far from help, needs repeat doses, or isn't settling.
Confirm with post-bronchodilator spirometry, group patients A/B/E, start most on LABA+LAMA, and let blood eosinophils decide on inhaled steroids.
GOLD grades airflow limitation but drives treatment by symptoms and exacerbation risk. The ABE assessment (which replaced ABCD) and eosinophil-guided ICS are the framework's core, with biologics now entering for the eosinophilic phenotype.
Spirometry to confirm (FEV₁/FVC <0.70) → group A/B/E → LABA+LAMA for most, add ICS if eosinophils high. Exacerbation = steroids ± antibiotics + O₂ 88–92% ± NIV. Stop smoking, vaccinate, rehab.
Score severity with CURB-65, match antibiotics and setting to severity, and don't reach for broad-spectrum cover unnecessarily.
CAP severity scoring guides where the patient is treated and how broadly they are covered, avoiding both under- and over-treatment.
CURB-65 sorts site and severity; amoxicillin for mild, broaden for moderate/severe, cover atypicals when suspected, and stop at ~5 days if improving.
Using GRADE, the ATS gives a strong recommendation for HFNC over standard oxygen in de novo acute hypoxaemic respiratory failure and a strong recommendation for NIV in acute hypercapnic failure, with structured advice on preoxygenation and post-extubation support.
Noninvasive respiratory support - high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) and CPAP - can avert intubation but risks delaying it if misapplied. This multidisciplinary ATS guideline (approved May 2026; AJRCCM 212(9):2135) addresses hypoxaemic and hypercapnic failure, preoxygenation before intubation, and post-extubation support.
HFNC first for hypoxaemic failure, NIV first for hypercapnic failure - and use HFNC/NIV to preoxygenate and to prevent reintubation, always with a low threshold to escalate.
The 2023 BTS guideline shifts spontaneous pneumothorax care toward a symptom-based, often conservative/ambulatory approach and standardises management of pleural infection and malignant effusion.
This guideline replaced the 2010 BTS pleural disease guidance after more than a decade of new evidence, and was published alongside a BTS Clinical Statement on pleural procedures in 2023. A dedicated BTS Quality Standard for Pleural Disease was subsequently developed (working group convened March 2024) to support implementation. Major drivers of change included trials supporting conservative management of pneumothorax and intrapleural enzyme therapy for pleural infection.
Treat spontaneous pneumothorax by symptoms (conservative when mild), drain pleural infection with a small-bore tube plus tPA/DNase for loculated collections, and always image with ultrasound before any pleural procedure.
Every patient with confirmed HAE should have on-demand therapy available at all times, treating attacks early, while long-term prophylaxis follows a treat-to-target approach aimed at complete disease control.
The 2025 WAO guideline updates the prior international WAO/EAACI guideline (2021 revision) and was developed by an international panel of experts from many countries, with explicit attention to worldwide disparities in access to therapy. It reframes management around a treat-to-target philosophy - aiming for no attacks, normal quality of life, and normalised disease burden - with shared decision-making and regular reassessment. Newer targeted therapies have expanded the prophylaxis options since earlier guidelines.
HAE swelling is bradykinin-mediated and unresponsive to antihistamines/steroids/epinephrine - every patient needs early on-demand C1-INH or icatibant, with treat-to-target long-term prophylaxis for those with significant burden.
Assess exacerbation severity while starting treatment immediately - repeated inhaled SABA, controlled oxygen, and early systemic corticosteroids - and before discharge always step up ICS-containing controller therapy because an attack is a red flag for the next one.
GINA is an annually updated global strategy report rather than a fixed guideline. It frames acute asthma management around rapid severity triage and prompt reliever therapy, and it has shifted maintenance care toward ICS-containing (anti-inflammatory) reliever strategies to reduce exacerbation risk. Discharge planning and early follow-up are treated as core parts of exacerbation care.
Repeated SABA plus ipratropium, early systemic steroids, and controlled oxygen to 93-95% get the patient through the attack - but the exam pearl is that no one leaves without an ICS-containing controller and early follow-up.
GOLD 2026 moves beyond a spirometry-centric model toward early diagnosis and multi-dimensional assessment, formally treating disease activity as a therapeutic target and using blood eosinophils to guide inhaled corticosteroid use.
GOLD continues to refine COPD care around personalized, exacerbation-focused management. The 2026 report keeps the ABE assessment scheme but sharpens it, integrates eosinophil-guided ICS decisions, and broadens assessment to include multimorbidity and disease activity.
GOLD 2026 ABE with eosinophil-guided ICS: A gets a bronchodilator, B and E get LABA+LAMA, and add ICS mainly when eosinophils are ~>=300 cells/uL.
Work <C>ABCDE — catastrophic haemorrhage first — with damage-control resuscitation and rapid transfer to definitive care.
Trauma deaths cluster early from airway loss and haemorrhage; a structured primary survey with simultaneous resuscitation prevents avoidable deaths.
Catastrophic bleeding before airway; decompress the chest, bind the pelvis, give blood + TXA, keep them warm, and get the significantly injured to CT and a trauma centre fast.
Use the NICE criteria to select a CT head within 1 hour or within 8 hours — and remember anticoagulation lowers the threshold to scan.
Most head injuries are minor, but a small number harbour a surgical bleed; NICE criteria identify who needs imaging and when.
Know the 1-hour vs 8-hour NICE CT triggers; being on an anticoagulant with any LOC/amnesia buys a scan on its own. Always give written safety-netting.
Treat single acute ingestions by the nomogram at 4 hours; give N-acetylcysteine empirically for staggered, late or unknown-time overdoses.
Paracetamol is a leading cause of acute liver failure yet is highly treatable if NAC is given in time.
Nomogram for a clean single ingestion; NAC empirically for staggered/late/unknown. Track INR/pH/creatinine and refer to a liver unit using the King's College Criteria.
Benzodiazepines are the mainstay — ideally symptom-triggered (CIWA-Ar) — and parenteral thiamine prevents Wernicke's encephalopathy.
Alcohol withdrawal ranges from tremor and anxiety to seizures and life-threatening delirium tremens; early, adequate treatment prevents escalation.
Benzodiazepines (symptom-triggered) control withdrawal; thiamine before glucose prevents Wernicke's; replace Mg/K/PO₄; DT needs high-dose benzos and close monitoring.
Rapid active cooling is the priority - cold or ice-water immersion cools fastest and should be used where available, aiming for a cooling rate of at least 0.155 deg C/min and core temperature below about 39 deg C within roughly 30 minutes. Antipyretics and dantrolene are ineffective and should be avoided.
Published in Critical Care Medicine (February 2025), this is the first SCCM guideline dedicated to heat stroke. The panel issued two strong recommendations, five good practice statements and one research-only statement covering both classic and exertional heat stroke.
In heat stroke, immediate cold-water immersion to a cooling rate of at least 0.155 deg C/min beats drugs - antipyretics and dantrolene have no role.
Emergency-department urine drug screens are presumptive immunoassays that rarely change acute management of the undifferentiated patient: a positive can reflect exposure hours to days earlier and results carry meaningful false-positive and false-negative rates, so treat the patient, not the screen.
This ADLM guidance replaces the 2003 NACB document (23 years out of date) and modernises ED drug-of-misuse testing for the fentanyl era. It updates recommended test menus, turnaround times, cutoffs, and reporting language, and stresses that immunoassay screens have inherent limitations that must be communicated to ED clinicians for correct interpretation.
The ED urine drug screen is a presumptive, delayed marker of exposure - treat the patient clinically and confirm before letting a screen change management.
Biennial mammography for average-risk women 50–74, with shared decision-making for younger and older women — deliberately more conservative than some other bodies.
Guidelines genuinely disagree here, and patients notice. The USPSTF (2024) lowered the start age to 40 (biennial); the American College of Radiology favours annual screening from 40. The ACP, synthesising the same systematic reviews, holds to starting at 50 and screening every 2 years, weighing the modest mortality benefit against false positives and overdiagnosis. All recommendations are low-to-moderate certainty and apply to average-risk people assigned female at birth.
ACP = biennial 50–74, individualised at 40–49 and ≥75. Know that this differs from USPSTF/ACR (earlier / annual) — the exam (and your patients) will ask why the advice varies.
Manage most patients non-operatively — a few exam tests, ultrasound if needed, then a stepped programme; surgery is a last resort.
Subacromial pain syndrome (SAPS, formerly "shoulder impingement") is non-traumatic, non-rheumatological shoulder pain that is worst when the arm is raised above the shoulder — it spans supraspinatus tendinosis, calcific tendinitis and degenerative cuff tears. Crucially, high-quality trials have shown subacromial decompression surgery adds little over placebo/exercise, so this multidisciplinary guideline (which included primary care) is firmly conservative.
Diagnose with a couple of exam manoeuvres ± ultrasound, then education + exercise, short-term NSAIDs/injections, barbotage for calcific disease. Decompression surgery adds little — reserve surgery for refractory cases.
In multimorbid patients, proactively case-find for sarcopenia and use muscle strength (handgrip or chair-stand) as the entry point to assessment, then treat with individualized exercise and nutrition rather than waiting for overt frailty.
Sarcopenia - loss of muscle mass and strength - is common and under-recognized in patients with multiple chronic conditions and drives disability and poor outcomes. EFIM's Multimorbidity Working Group critically appraised and adapted four high-quality clinical practice guidelines to produce recommendations tailored to internal-medicine practice. Eight PICO questions covered case-finding, screening, diagnosis, prevention, iatrogenic complications, and nutritional, exercise, and pharmacologic interventions.
Think of sarcopenia early in multimorbidity - screen with muscle strength (grip or chair-stand) and treat with individualized exercise plus nutrition.
The updated SMFM checklist frames AFE as a sudden cardiorespiratory collapse with consumptive coagulopathy near delivery, prioritising immediate high-quality resuscitation aligned with ACLS, prompt delivery, and aggressive DIC/haemorrhage management.
AFE is a rare, catastrophic syndrome of abrupt cardiorespiratory collapse during labour or soon after delivery, often followed by disseminated intravascular coagulation. This 2026 Special Statement updates the 2021 checklist with revised terminology and intervention criteria, closer alignment with current ACLS guidance, and integration of newer epidemiology and pathophysiology. It is intentionally focused on the first minutes of management on the labour-and-delivery unit.
AFE = abrupt collapse plus DIC around delivery; the wins are immediate ACLS, left uterine displacement, rapid delivery and aggressive coagulopathy management, not any single 'magic' drug.
This AHA statement stresses that pregnancy should not delay evidence-based stroke care: treat severe hypertension promptly, and offer IV thrombolysis and thrombectomy to eligible pregnant/postpartum patients when benefit outweighs risk.
Published 28 January 2026 in Stroke (2026;57:e127-e145) and endorsed by ACOG, the statement addresses prevention, rapid diagnosis, acute treatment and recovery of maternal stroke. Stroke complicates roughly 20-40 per 100,000 pregnancies and accounts for an estimated 4-6% of pregnancy-related deaths in the US, with hypertensive disorders implicated in nearly half of pregnancy-associated stroke hospitalisations.
Pregnancy is not a contraindication to standard stroke care - control severe hypertension fast and offer thrombolysis/thrombectomy to eligible patients.
Perinatal heart failure - including peripartum cardiomyopathy - is frequently missed because its symptoms mimic normal pregnancy, and delayed recognition drives preventable maternal death, arrhythmia, and stroke.
This AHA scientific statement addresses heart failure with reduced and mildly reduced ejection fraction arising from pregnancy through about one year postpartum, spanning both pre-existing disease and de novo cardiomyopathy such as PPCM. It was written because dyspnea, fatigue, and edema of normal pregnancy overlap with true heart failure, so diagnosis is delayed. The statement pushes for standardized definitions, better screening tools, and attention to maternal health equity.
In a pregnant or recently postpartum patient, treat unexplained dyspnea or edema as possible heart failure until echo and biomarkers say otherwise - early recognition saves lives.
The IDSA living guideline continues to prioritise early antiviral therapy for outpatients at high risk of progression - nirmatrelvir/ritonavir preferred - and immunomodulation for hospitalised patients needing oxygen, with attention to drug-drug interactions and renal dosing.
IDSA maintains a continuously updated ('living') COVID-19 treatment guideline using GRADE. Recent updates address antiviral treatment of mild-to-moderate disease in adults and focused comparisons of immunomodulators (e.g. baricitinib vs tocilizumab), reflecting an evolving virus, population immunity and shifting evidence.
High-risk outpatient with COVID to early nirmatrelvir/ritonavir (check interactions and renal function); hospitalised on oxygen to steroids plus an immunomodulator.
Confirm every suspected case with a parasitological test (RDT or microscopy) before treating, and treat severe malaria with IV artesunate for at least 24 hours, then complete a full 3-day ACT course.
WHO maintains malaria guidance as a continuously updated "living guideline," with the consolidated version most recently reissued on 13 August 2025 (superseding the 30 November 2024 version). The recommendations consolidate diagnosis, uncomplicated and severe treatment, chemoprevention and elimination guidance into one document. Parenteral artesunate replaced quinine as the standard of care for severe malaria on the basis of large trials (SEAQUAMAT, AQUAMAT) showing a mortality benefit.
Confirm parasitologically, treat uncomplicated disease with a 3-day ACT, and treat severe malaria with at least 24 hours of IV/IM artesunate (higher weight-based dose if <20 kg) followed by a full ACT course.
For severe acute pulmonary or disseminated histoplasmosis, start liposomal amphotericin B 3 mg/kg IV daily for induction, then step down to oral itraconazole for a total of at least 12 months. (The 2025 IDSA update covers only mild/moderate pulmonary disease and pulmonary nodules, so severe disease is still governed by the 2007 guideline.)
Histoplasma capsulatum is endemic to river valleys (classically the Ohio and Mississippi in the US) and can cause severe pneumonia or disseminated disease, especially in immunocompromised hosts. The IDSA 2007 guideline remains the authoritative source for severe/disseminated disease; a 2025 IDSA update deliberately addressed only asymptomatic nodules and mild-to-moderate acute pulmonary disease, leaving the severe-disease algorithm unchanged.
Severe histoplasmosis: liposomal amphotericin B 3 mg/kg induction, then itraconazole for at least a year.
This guidance replaces the old 'complicated vs uncomplicated' dichotomy with a risk-stratification framework, and supports a 14-day course for low-risk SAB with no deep-seated or metastatic focus after adequate work-up.
Released in September 2026, this is the first in a planned IDSA/ESCMID series on S. aureus bacteraemia and focuses on risk stratification, diagnostic evaluation (follow-up cultures, echocardiography, whole-body imaging) and duration of therapy. The panel judged the traditional complicated/uncomplicated split inadequate to guide work-up and treatment, favouring an individualised assessment of risk for deep-seated or metastatic infection and relapse. Future manuscripts will address specific MRSA and MSSA antibiotic management.
Risk-stratify rather than label: low-risk SAB with a clean work-up gets 14 days, but everyone gets follow-up cultures and a TTE.
Match the drug to the specific resistance mechanism: reserve newer beta-lactam/beta-lactamase-inhibitor agents and cefiderocol for true carbapenem-resistant organisms, and do not use them empirically for ESBL infections where carbapenems still work.
This living IDSA guidance document (updated in 2024, with a further 2026 refresh) replaces a formal guideline and is revised as new agents and data emerge. It covers ESBL-producing Enterobacterales, AmpC producers, carbapenem-resistant Enterobacterales (CRE), difficult-to-treat Pseudomonas aeruginosa (DTR-P. aeruginosa), carbapenem-resistant Acinetobacter baumannii (CRAB), and Stenotrophomonas maltophilia. It gives preferred and alternative regimens by organism, site, and susceptibility, and applies to adults and children (doses listed for adults).
Resistance mechanism plus infection site drives the choice - carbapenems for ESBL, avibactam/vaborbactam agents for KPC-CRE, add aztreonam for metallo-beta-lactamases, and sulbactam-durlobactam for CRAB.
Candida auris is a multidrug-resistant, environmentally persistent fungus, and this SHEA consensus fills a gap by giving pediatric-specific infection-prevention guidance across acute-care, non-acute, and congregate settings.
C. auris causes high morbidity and mortality and spreads readily in healthcare environments, yet prior guidance was largely adult-focused. A multidisciplinary SHEA expert panel used a structured Delphi consensus process, informed by literature and practical considerations, to produce pediatric recommendations. The statement was endorsed by APIC, ASM, IDSA, PIDS, PCCA, and Ronald McDonald House Global.
For pediatric C. auris, combine targeted screening, contact isolation, obsessive hand hygiene, and C. auris-active environmental cleaning - and loop in infection prevention and public health early.
In DOAC-associated life-threatening bleeding, give specific reversal first when available - idarucizumab for dabigatran, andexanet alfa for factor Xa inhibitors - and do not wait for DOAC level results before starting haemostatic treatment.
DOACs (dabigatran, rivaroxaban, apixaban, edoxaban) are now first-line for many indications, so emergency clinicians increasingly face DOAC-related major bleeding and urgent surgery. This 2024 ESAIC guideline synthesises evidence across the four agents to standardise when and how to reverse them, moving away from reliance on non-specific global coagulation tests.
Match the antidote to the drug (idarucizumab for dabigatran, andexanet alfa for factor Xa inhibitors), fall back to PCC/aPCC, and treat before the level comes back.
ASFA grades each condition by category (I-IV) and evidence grade to say whether therapeutic apheresis is first-line, adjunctive, of unestablished benefit, or ineffective/harmful - so the category label, not the diagnosis alone, drives whether to call the apheresis service.
The Ninth Edition is the reference framework for indications for therapeutic plasma exchange (TPE) and other apheresis modalities. It comprises 91 fact sheets and 166 graded, categorised indications, adding seven new fact sheets and updating several categories using systematic-review methodology. It exists to bring consistency and evidence grading to a field where many recommendations still rest on low-quality evidence.
Ask 'what ASFA category is this?' - Category I means start apheresis now, Category IV means do not.
The BSH concludes that for most patients with a factor Xa inhibitor-associated bleed, the risks of andexanet alfa appear to outweigh its benefits, driven by a significant excess of thromboembolic events, particularly ischaemic stroke.
Andexanet alfa is the only licensed specific reversal agent for apixaban- and rivaroxaban-associated life-threatening or uncontrolled bleeding, but it is not licensed for edoxaban, heparins, or reversal before urgent surgery. UK reimbursement is inconsistent: NICE (2021) supports use only in gastrointestinal bleeding in England, whereas NHS Scotland reimburses bleeding at any site. This statement responds to accumulating safety-signal and rebound-anticoagulation concerns.
For factor Xa inhibitor bleeding, the BSH considers andexanet's thromboembolic risk to outweigh benefit for most patients, positioning PCC plus standard care as the pragmatic default.
This ISTH guidance gives pragmatic advice on using coagulation factor concentrates (fibrinogen concentrate, PCC, rFVIIa, factor XIII) for surgically acquired coagulopathy, favouring targeted, viscoelastic-guided replacement over empirical plasma.
Factor concentrates have been increasingly incorporated into perioperative bleeding algorithms because of rapid availability, standardised dosing, low infusion volumes and pathogen inactivation, reducing reliance on plasma. This document updates ISTH's 2018 guidance to reflect newer trials and systematic reviews, focusing on major surgery including cardiac surgery.
Think fibrinogen first, then goal-directed PCC, with rFVIIa as rescue only - guided by viscoelastic testing rather than empirical plasma.
When TTP is suspected, send an urgent ADAMTS13 activity before starting plasma exchange; a severely low result (activity <10 IU/dL) confirms the diagnosis and should trigger reflex anti-ADAMTS13 antibody testing to separate immune (acquired) from congenital TTP.
This BSH guidance is a laboratory-focused companion to the 2023 BSH management guideline for TTP and thrombotic microangiopathies. It standardises how ADAMTS13 activity and anti-ADAMTS13 antibody assays are performed, reported and used for monitoring, because timely and correctly interpreted ADAMTS13 results drive urgent treatment decisions in a condition that is rapidly fatal if untreated.
Activity <10 IU/dL confirms TTP; a positive anti-ADAMTS13 antibody means immune (acquired) TTP, and a negative antibody with severe deficiency points to congenital TTP.
The safest approach depends on HIT phase: for elective cardiopulmonary bypass in a patient with a positive HIT functional assay, postpone surgery until the functional assay is negative; when surgery cannot wait, use a parenteral nonheparin anticoagulant (bivalirudin has the strongest supporting evidence).
Patients with HIT who need cardiac surgery are a high-risk group because unfractionated heparin is normally the anticoagulant of choice for cardiopulmonary bypass. This ISTH SSC guidance is based on a systematic review (about 30 included studies) of intraoperative strategies, and it frames choices around whether HIT is acute, subacute or remote and whether functional (platelet-activation) assays are still positive.
Delay elective bypass until the HIT functional assay is negative; when you cannot wait, bivalirudin is the best-supported nonheparin option despite its bleeding risk and lack of a reversal agent.
Treat preoperative anaemia and iron deficiency as modifiable risk factors: screen and correct them before elective cardiac surgery, and combine restrictive transfusion thresholds with a structured intraoperative blood-conservation bundle to reduce transfusion and its complications.
Preoperative anaemia affects up to about 50% of adults presenting for cardiac surgery and, along with red-cell transfusion, is linked to worse outcomes including acute kidney injury, stroke and death. This AHA scientific statement summarises current evidence on preoperative anaemia assessment, intraoperative blood conservation and special populations, positioning patient blood management as a multidisciplinary, patient-centred part of Enhanced Recovery After Cardiac Surgery (ERAS).
Correct anaemia and iron deficiency before surgery and pair a restrictive transfusion threshold with antifibrinolytics, viscoelastic-guided transfusion and autologous techniques to cut red-cell use.
Base peri-operative VTE prophylaxis on individualised risk assessment (procedure risk plus patient risk factors, e.g. a Caprini-type model) rather than a blanket approach, and use mechanical prophylaxis (especially IPC) whenever pharmacological prophylaxis is limited or contraindicated by bleeding risk.
This is the first major update (2024) of the 2018 European guidelines, rebuilt with a more rigorous methodology and expanded to new areas including plastic surgery, urology, non-ambulatory orthopaedic surgery and trauma. It reflects newer evidence on DOACs, aspirin and fast-track surgery, and harmonises prophylaxis timing with neuraxial anaesthesia safety. The recommendations are graded (GRADE-style, e.g. Grade 1B, 2C).
Peri-operative VTE prevention is individualised: risk-stratify every patient, lean on IPC when you cannot anticoagulate, prefer LMWH, and time pharmacological prophylaxis post-operatively around neuraxial blocks to protect the spinal cord.
The 2026 IDSA/PIDS update revises the landmark 2011 guideline and centers on parapneumonic effusion/empyema: small uncomplicated effusions in stable children can be observed rather than drained, and when drainage is needed, chest tube plus fibrinolytics is favored over surgery. Amoxicillin (ampicillin/penicillin inpatient) remains the core empiric therapy for the fully immunized child with uncomplicated CAP.
The original 2011 IDSA/PIDS pediatric CAP guideline was the field standard for over a decade. The 2026 revision is the first installment of a broader update, focusing on the diagnosis and management of pneumonia with parapneumonic effusion using newer evidence. Five of six effusion-related recommendations changed from 2011.
Small, stable effusion = observe; when you must drain, small-bore chest tube + fibrinolytics beats going straight to surgery.
Distinguish preseptal (eyelid erythema/edema, tenderness, normal eye movements) from orbital cellulitis (painful/limited extraocular movements, proptosis, chemosis, reduced acuity, or an afferent pupillary defect) - orbital signs mandate admission, IV antibiotics, imaging, and specialist involvement.
Left untreated, orbital cellulitis can cause vision loss, cavernous sinus thrombosis, and intracranial spread. This CPS statement gives practical, Canadian-context guidance for the healthy child, tailoring antibiotic choice to immunization status (Hib), local resistance, and clinical severity, and clarifying when imaging is truly needed.
Painful or restricted eye movements, proptosis, or vision change turn 'red swollen eyelid' into an emergency needing IV antibiotics, imaging, and a specialist.
The AAP replaced the vague term ALTE with BRUE and defined a lower-risk group who can be safely managed with minimal testing, brief observation, and shared decision-making rather than admission and an extensive work-up.
The old label 'apparent life-threatening event' (ALTE) implied severity that most events did not warrant and drove unnecessary testing and hospitalization. BRUE is a diagnosis of exclusion used only when a full history and exam find no explanation, letting clinicians risk-stratify instead of over-investigating.
If it fits the lower-risk BRUE criteria, resist labs and admission - observe briefly, consider an ECG, teach CPR, and arrange follow-up.
The AAP reaffirms the medical home as the preferred setting for nonemergency acute care, and sets standards so that when children are seen in urgent care, retail clinics, or direct-to-consumer telemedicine, the care is safe, pediatric-appropriate, and communicated back to the medical home.
Families increasingly use acute care outside their pediatrician's office for convenience, access, or cost, creating risks of fragmented, duplicated, or lower-quality care. This revised policy updates the 2017 statement, catalogs the modern 'medical neighborhood' (urgent care, retail clinics, DTC telemedicine, school-based health, EMS), and defines expectations to preserve continuity.
Care outside the medical home is fine when it is pediatric-ready and looped back to the child's own pediatrician - continuity is the safety net.
Injury is a leading cause of death and disability in Canadian children aged 1-19, and the CPS frames childhood injuries as predictable and preventable, urging clinicians to embed injury prevention into everyday care with a focus on equity, data, policy, and education.
Building on the CPS's 2012 statement, this 2026 framework updates mortality and hospitalization data across injury mechanisms and age groups. It positions injury prevention as a core child-health competency rather than an add-on, and highlights inequities (including for Indigenous children and youth) in injury burden.
Injuries are predictable and preventable - build brief, developmentally targeted safety counselling into every visit and advocate for protective policy.
Drowning is a leading cause of injury death in young children, and prevention requires layered protection - because no single measure is fully protective, the AAP stresses barriers, supervision, swim skills, life jackets, and CPR together.
This 2026 policy statement updates the AAP's 2019 guidance with new epidemiology and a stronger focus on inequities in drowning risk and swim access. Fatal drowning rates are higher among Native Hawaiian/Pacific Islander and Black children, and children with autism spectrum disorder or epilepsy carry elevated risk.
Layered prevention wins - a 4-sided isolation fence, touch supervision, swim lessons, life jackets, and caregiver CPR, because no single measure is foolproof.
Every office that cares for children should be ready for the common in-office emergencies -- respiratory distress, seizures, and anaphylaxis -- with a written plan, stocked equipment and medications, trained staff, and regular drills.
This statement updates the 2007 AAP guidance and is paired with a companion technical report. Office emergencies are uncommon but predictable, and preparedness (self-assessment, protocols, stocked kit, and mock codes) shortens response time and bridges care to EMS. It applies to both primary care and subspecialty pediatric offices.
An office emergency plan is only as good as your last drill -- practice, stock, and reassess annually.
Every ED, regardless of size, should meet defined pediatric readiness standards; higher ED readiness is associated with substantially lower mortality in critically ill and injured children.
This revision of the prior joint statement responds to the fact that most children are seen in general rather than children's EDs, where readiness is uneven. Meeting readiness standards could save an estimated more than 2,100 children's lives per year in the US. It adds emphasis on care coordinators, weight-in-kilograms, dosing tools, and mental health.
A high pediatric readiness score is one of the few ED-level factors independently linked to lower child mortality -- kilograms, coordinators, and QI are the backbone.
For all non-emergent neonatal intubations, give premedication with a vagolytic, a fast-acting opioid, and a short-acting muscle relaxant - it reduces adverse physiologic effects and improves intubation success.
Laryngoscopy and intubation are common in the NICU and are associated with bradycardia, hypoxemia, raised intracranial pressure, and pain. Evidence shows premedication blunts these effects and increases first-attempt success, so the CPS recommends it as standard for non-emergent intubations. The statement also addresses less invasive surfactant administration (LISA/MIST), where non-pharmacological measures are prioritized.
Non-emergent neonatal intubation should be premedicated with a vagolytic (atropine), a fast opioid (fentanyl, pushed slowly), and a short-acting relaxant (succinylcholine) under continuous monitoring.
End-of-life care across PICU, cardiac ICU and NICU rests on proactive advance care planning, early palliative care involvement, systematic symptom management, structured bereavement support and explicit attention to health equity.
End-of-life care for critically ill children and neonates has been highly variable and under-guided. This SCCM guideline used a GRADE evidence-to-decision framework and a systematic review of literature from 2000-2025 to define principles of practice for most children and families navigating end of life in an ICU. It yielded five conditional recommendations and one good practice statement spanning PICU, CICU and NICU settings.
Proactive advance care planning, early palliative care, systematic symptom control, bereavement support and equity are the pillars of pediatric and neonatal ICU end-of-life care.
In infants >=36 0/7 weeks with moderate-to-severe HIE, cooling to 33.5-34.5 C started within 6 hours of birth and continued for 72 hours reduces death or moderate-to-severe neurodevelopmental impairment. It is not recommended for mild HIE or preterm infants outside research.
This 2026 clinical report updates prior AAP guidance (2014) on therapeutic hypothermia for neonatal HIE. It reaffirms cooling as standard care for moderate-to-severe HIE at term while clarifying persistent uncertainties: whether to treat mild HIE, near-term infants (35 weeks), and infants presenting after the 6-hour window. It also reviews adjunctive therapies and concludes high-dose erythropoietin is not an effective add-on.
Cool term/near-term babies (>=36 weeks) with moderate-to-severe HIE to 33.5-34.5 C within 6 hours for 72 hours - not for mild HIE, preterm infants, or as a reason to add erythropoietin.
The first paediatric-specific NMB guideline calls for quantitative neuromuscular monitoring whenever any NMBA is given, confirming a train-of-four (TOF) ratio >=0.9 before extubation, and favours rocuronium/vecuronium reversed with sugammadex over neostigmine.
Until 2025-2026 no dedicated guideline addressed neuromuscular blockade in anaesthetised children, so practice was extrapolated from adults. This ESAIC/ESPA joint task force (approved 2024, published in the EJA) provides the first structured, child-specific recommendations on indications, monitoring, and reversal, emphasising objective monitoring and safe reversal to reduce residual paralysis.
Monitor objectively for every paralysed child, confirm TOF >=0.9 before extubation, and reverse rocuronium/vecuronium with sugammadex rather than neostigmine.
Adjunctive systemic corticosteroids appear safe in orbital cellulitis when given with appropriate antibiotics and may speed symptom resolution, but their effect on length of hospital stay remains unclear.
This Ophthalmic Technology Assessment was prepared by the AAO Oculofacial and Orbital Surgery Panel and approved by the AAO Board of Trustees on 21 February 2026, based on a PubMed literature search (August 2025). Nine studies met inclusion criteria (one level I, four level II, four level III), reflecting limited and heterogeneous evidence. It was published amid ongoing debate, including a 2026 pediatric meta-analysis that raised concerns about corticosteroid-associated adverse outcomes.
In orbital cellulitis, antibiotics (and drainage when indicated) come first; adjunctive systemic steroids appear safe and may hasten inflammation resolution, but the benefit is uncertain and pediatric data urge caution.
In acute angle-closure crisis, lower the IOP promptly with medical therapy, then perform laser peripheral iridotomy (LPI); treat the fellow phakic eye prophylactically, and consider lens extraction for angle-closure with markedly elevated IOP or glaucoma.
The Primary Angle-Closure Disease PPP defines the spectrum from primary angle-closure suspect (PACS) through primary angle closure (PAC) to primary angle-closure glaucoma (PACG), and covers acute angle-closure crisis (AACC). This most recent 2025 update in Ophthalmology follows the January 2021 edition and incorporates evidence such as the EAGLE trial (favoring clear lens extraction in some PACG/PAC eyes) and trials refining who benefits from prophylactic LPI. Dark-room dynamic gonioscopy remains the reference standard for diagnosis, supported by anterior-segment imaging.
Acute angle-closure is an ophthalmic emergency: break the attack medically, then secure the angle with laser peripheral iridotomy (or lens extraction), and don't forget prophylactic LPI in the fellow eye.
Universally screen youth 12 and older for suicide risk with a validated tool; those who screen positive get a structured brief suicide safety assessment, a safety plan, and lethal-means counseling.
Suicide is a leading cause of adolescent death, and this 2024 AAP clinical report reframes screening as universal rather than symptom-triggered. It integrates lethal-means restriction (especially firearms), collaborative safety planning, and linkage to evidence-based treatment. Screening in preteens 8-11 is advised when clinically indicated.
Screen everyone 12+, assess positives with a structured tool, and never skip lethal-means (firearm) counseling.
About this summary. These are independent educational summaries of major recent clinical guidelines and scientific statements, re-written and expanded in our own words for teaching and revision. They are a study aid, not a substitute for the full guideline documents or your local protocols. Guidelines from different bodies sometimes disagree (e.g. breast-screening age, BP targets) — always confirm thresholds, doses and indications against the primary source and your institution's policy before applying them to a patient.
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