{"id":7393,"date":"2026-06-20T02:44:00","date_gmt":"2026-06-20T02:44:00","guid":{"rendered":"https:\/\/gothi.gov.eg\/?page_id=7393"},"modified":"2026-06-20T02:47:14","modified_gmt":"2026-06-20T02:47:14","slug":"%d8%b7%d8%a8-%d8%a7%d9%84%d8%b7%d9%88%d8%a7%d8%b1%d8%a6","status":"publish","type":"page","link":"https:\/\/gothi.gov.eg\/?page_id=7393","title":{"rendered":"\u0637\u0628 \u0627\u0644\u0637\u0648\u0627\u0631\u0626"},"content":{"rendered":"\t\t
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  1. <\/li>\n<\/ol>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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    \u0637\u0628 \u0627\u0644\u0637\u0648\u0627\u0631\u0626\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t
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    \n\n \n\n \n <\/path><\/svg> <\/span>\n\n \n <\/path><\/svg> <\/span>\n \n <\/span>\n \n \n Managing Anaphylaxis in the Emergency Department Contents <\/span>\n\n <\/h5>\n\n
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    “last update: 28 Oct 2024”\u00a0\u00a0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0\u00a0 \u00a0\u00a0<\/span>Download Guideline<\/a><\/u><\/h5>\n<\/div>\n<\/div>\n<\/div>\n
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    \u00a0<\/div>\n<\/div>\n<\/div>\n<\/div>\n
    \n

    – Executive Summary<\/h3>\n
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    \u00a0<\/p>\n

    This guideline is the key for the initial management of anaphylaxis (a life-threatening condition compromising the airway, breathing, and\/or circulation) in the emergency department (ED), to be used by emergency physicians and any physician who works in the ED, whatever the specialty. It has been made in a simple concise way to go through in a quick stepping manner giving the clues to most critical points of such a critical condition in the ED.<\/p>\n

    The guideline was developed through adoption and adaptation methodology by a consensus of expert field group, Guideline Development Group (GDG)\u00a0of the Egyptian National Clinical Guidelines Centre, supporting the 2021 update of the Resuscitation Council United Kingdom (RCUK). Because of lacking randomized clinical trials, the certainty of evidence for these recommendations was moderate or less.<\/span><\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
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    We recommend<\/b><\/p>\n<\/td>\n

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    Strength<\/b><\/p>\n<\/td>\n<\/tr>\n

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    1- giving adrenaline as the first line of treatment<\/span><\/p>\n<\/td>\n

    		\n

    Strong<\/span><\/b><\/b><\/p>\n<\/td>\n<\/tr>\n

    \n

    2- early administration of adrenaline once symptoms of anaphylaxis are recognized or suspected<\/span><\/p>\n<\/td>\n

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    Weak<\/span><\/b><\/b><\/p>\n<\/td>\n<\/tr>\n

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    3- giving adrenaline by intramuscular route as the initial treatment of anaphylaxis<\/span><\/p>\n<\/td>\n

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    Strong<\/span><\/b><\/b><\/p>\n<\/td>\n<\/tr>\n

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    4- following the list of adrenaline doses according to age<\/span><\/p>\n<\/td>\n

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    Strong<\/b><\/p>\n<\/td>\n<\/tr>\n

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    5- repeating intramuscular adrenaline every 5-15 min in cases of refractory anaphylaxis<\/span><\/p>\n<\/td>\n

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    Weak<\/span><\/b><\/b><\/p>\n<\/td>\n<\/tr>\n

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    6- iv bolus of crystalloid in case of hemodynamic instability and in refractory anaphylaxis<\/span><\/p>\n<\/td>\n

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    Weak<\/span><\/b><\/b><\/p>\n<\/td>\n<\/tr>\n

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    7- against using antihistamines as initial treatment of anaphylaxis<\/span><\/p>\n<\/td>\n

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    Weak<\/span><\/b><\/b><\/p>\n<\/td>\n<\/tr>\n

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    8- against using corticosteroids in initial treatment of anaphylaxis<\/span><\/p>\n<\/td>\n

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    Weak<\/span><\/b><\/b><\/p>\n<\/td>\n<\/tr>\n

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    9 – giving inhalational beta2 agonist as part of treatment in the presence of wheezy chest<\/span><\/p>\n<\/td>\n

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    Weak<\/span><\/b><\/b><\/p>\n<\/td>\n<\/tr>\n

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    10- a minimum of 6 hours of observation after resolution of symptoms for all patients with a confirmed diagnosis.<\/span><\/p>\n<\/td>\n

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    Weak<\/span><\/b><\/b><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

    \u00a0<\/span><\/p>\n<\/div>\n<\/div> <\/div>\n\n <\/div>\n

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    \n\n \n\n \n <\/path><\/svg> <\/span>\n\n \n <\/path><\/svg> <\/span>\n \n <\/span>\n \n \n CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF MILD HEAD INJURY (MHI) IN ADULTS <\/span>\n\n <\/h5>\n\n
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    “last update: 4 Jan 2026”\u00a0\u00a0\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0\u00a0 \u00a0\u00a0<\/span>Download Guideline<\/a><\/u><\/h5>\n<\/div>\n<\/div>\n<\/div>\n
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    \u00a0<\/div>\n<\/div>\n<\/div>\n<\/div>\n
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    – Executive Summary<\/h3>\n
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    \u00a0<\/p>\n

    These recommendations promote selective CT imaging and safe disposition in adult mild head injury, and standardizing care with clear admission\/discharge criteria.<\/p>\n

    \u00a0<\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n
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    No.<\/b><\/p>\n<\/td>\n

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    Recommendations<\/b><\/b><\/p>\n<\/td>\n

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    Strength of recommendation<\/b><\/b><\/p>\n<\/td>\n<\/tr>\n<\/thead>\n

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    1.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/b>\u00a0<\/b><\/p>\n<\/td>\n

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    We recommend the Canadian CT Head Rule (CCHR) to guide CT use in adults with mild head injury not on anticoagulants or antiplatelets, to minimize unnecessary imaging. If CT imaging is not available, refer to an appropriate facility.<\/p>\n

    CT is indicated if any of the following are present:<\/p>\n

    \u00b7\u00a0Failure to reach a GCS score of 15 within 2 hours of injury.<\/p>\n

    \u00b7\u00a0\u00a0Suspected open skull fracture.<\/p>\n

    \u00b7\u00a0\u00a0Signs of basal skull fracture.<\/p>\n

    \u00b7\u00a0\u00a0Vomiting more than once.<\/p>\n

    \u00b7\u00a0\u00a0Age > 64 years.<\/p>\n

    The Canadian CT Head Rule (CCHR) is not applicable to patients younger than 16 years, those receiving anticoagulant therapy (blood thinners), or patients who experience a post-traumatic seizure.<\/p>\n<\/td>\n

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    Strong<\/b><\/p>\n<\/td>\n<\/tr>\n

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    2.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/b>\u00a0<\/b><\/p>\n<\/td>\n

    		\n

    We recommend performing a non-contrast head CT in patients over 60 years old who are present with loss of consciousness or post traumatic amnesia. If CT imaging is not available, refer to an appropriate facility.<\/b><\/p>\n<\/td>\n

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    Strong<\/b><\/p>\n<\/td>\n<\/tr>\n

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    3.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/b>\u00a0<\/b><\/p>\n<\/td>\n

    		\n

    We recommend performing a non-contrast head CT in intoxicated patients with mild head trauma who present with loss of consciousness or posttraumatic amnesia.\u00a0 If CT imaging is not available, refer to an appropriate facility.<\/b><\/p>\n<\/td>\n

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    Strong<\/b><\/p>\n<\/td>\n<\/tr>\n

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    4.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/b>\u00a0<\/b><\/p>\n<\/td>\n

    		\n

    We recommend performing a non-contrast head CT in anticoagulated patients with mild head injury, rather than relying solely on clinical decision tools to exclude imaging. If CT imaging is not available, refer to an appropriate facility.<\/b><\/p>\n<\/td>\n

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    Strong<\/b><\/p>\n<\/td>\n<\/tr>\n

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    5.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/b>\u00a0<\/b><\/p>\n<\/td>\n

    		\n

    We advise against routine repeating a non-contrast head CT in adults with mild head injury on anticoagulants or antiplatelets who remain at baseline neurologic assessment, if the initial CT is negative for hemorrhage.<\/b><\/p>\n<\/td>\n

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    Conditional<\/b><\/p>\n<\/td>\n<\/tr>\n

    \n

    6.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/b>\u00a0<\/b><\/p>\n<\/td>\n

    		\n

    We recommend admitting patients with mild head injury to hospital if clinical assessment identifies any risk factors or concerning features that warrant close observation or further management.<\/p>\n

    Admission is advised when one or more of the established admission criteria for mild head injury are present:<\/p>\n

    \u00b7\u00a0New, clinically important abnormalities on imaging (An isolated simple linear non-displaced skull fracture is unlikely to be clinically important unless the patient is taking anticoagulant or antiplatelet medication.)<\/p>\n

    \u00b7\u00a0\u00a0GCS score did not return to 15 (or pre-injury baseline) after imaging, regardless of the imaging results.<\/p>\n

    \u00b7\u00a0\u00a0Indications for CT scanning are present, but scanning cannot be performed within the appropriate time period, either because CT is unavailable or because the person is not sufficiently cooperative to allow scanning.<\/p>\n

    \u00b7\u00a0\u00a0Continuing worrying symptoms of concern to the clinician, such as persistent vomiting, severe headaches, or seizures.<\/p>\n

    \u00b7\u00a0\u00a0Other sources of clinician concern, including but not limited to drug or alcohol intoxication, other injuries, shock, suspected non-accidental injury, meningism, cerebrospinal fluid leak, or suspicion of ongoing post-traumatic amnesia.<\/p>\n<\/td>\n

    		\n

    Good Practice Statement<\/b><\/p>\n<\/td>\n<\/tr>\n

    \n

    7.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/b>\u00a0<\/b><\/p>\n<\/td>\n

    		\n

    We recommend discharging patients with mild head injury when clinical assessment and investigations identify no evidence of clinically important brain or cervical spine injury, provided that:<\/p>\n

    \u00b7\u00a0\u00a0CT scan of the head and\/or cervical spine is not indicated or has shown normal findings, and the Glasgow Coma Scale (GCS) has returned to 15 or the pre-injury baseline.<\/p>\n

    \u00b7\u00a0\u00a0There are no other factors that would warrant hospital admission. (refer to recommendation number 6)<\/p>\n

    \u00b7\u00a0\u00a0There is appropriate supervision at home or a suitable environment for continued observation in the community.<\/p>\n<\/td>\n

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    Good Practice Statement<\/b><\/p>\n<\/td>\n<\/tr>\n

    \n

    8.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/b>\u00a0<\/b><\/p>\n<\/td>\n

    		\n

    We advise against routine hospital admission in anticoagulated or antiplatelet-treated patients with mild head injury who have a normal neurological exam, a normal initial CT, and lack criteria warranting extended monitoring.<\/p>\n

    The criteria warranting extended monitoring and hospital admission are the same as those for patients who are not taking anticoagulant or antiplatelet therapy.<\/p>\n<\/td>\n

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    Conditional<\/b><\/p>\n<\/td>\n<\/tr>\n

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    9.\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0<\/b>\u00a0<\/b><\/p>\n<\/td>\n

    		\n

    We recommend providing written discharge instructions outlining red-flag symptoms and follow-up guidance to adults with mild head injury to improve early recognition of complications.<\/p>\n

    A.\u00a0Discharge instructions should include advice to:<\/p>\n

    \u00b7\u00a0Avoid activities that may increase the risk of recurrent head injury.<\/p>\n

    \u00b7\u00a0Maintain social contact and communicate with family or friends about recovery symptoms.<\/p>\n

    \u00b7\u00a0Use only medications approved by the treating physician for symptom control.<\/p>\n

    \u00b7\u00a0Limit screen time and exposure to loud noise before sleep, keep a consistent sleep schedule, and rest in a quiet, dark environment.<\/p>\n

    B.\u00a0Inform a trusted person about the injury and the warning signs to monitor for, as they may recognize symptoms before the patient does.<\/p>\n

    C.\u00a0Arrange a follow-up visit within 48 hours of discharge.<\/p>\n

    On discharge you should inform the patient and his\/her companion about red-flag symptoms:<\/p>\n

    \u00b7\u00a0A headache that gets worse and does not go away.<\/p>\n

    \u00b7\u00a0Significant nausea or repeated vomiting.<\/p>\n

    \u00b7\u00a0Unusual behavior, increased confusion, restlessness, or agitation.<\/p>\n

    \u00b7\u00a0Drowsiness or inability to wake up<\/p>\n

    \u00b7\u00a0Slurred speech, weakness, numbness, or decreased coordination.<\/p>\n

    \u00b7\u00a0Convulsions or seizures (shaking or twitching).<\/p>\n

    \u00b7\u00a0Loss of consciousness (passing out)<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<\/div> <\/div>\n\n <\/div>\n

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    \n\n \n\n \n <\/path><\/svg> <\/span>\n\n \n <\/path><\/svg> <\/span>\n \n <\/span>\n \n \n THE MANAGEMENT OF MASSIVE BLEEDING IN POLYTRAUMA PATIENTS <\/span>\n\n <\/h5>\n\n
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    “last update: 9 Feb 2026”\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0\u00a0Download Guideline<\/strong><\/u><\/a><\/strong><\/span><\/h5>\n<\/div>\n<\/div>\n<\/div>\n
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    \u00a0<\/div>\n<\/div>\n<\/div>\n<\/div>\n
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    – Executive Summary<\/h3>\n
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    \u00a0<\/p>\n

    This guideline provides standardized,\u00a0evidence\u2011based recommendations<\/b>\u00a0for the recognition and management of\u00a0massive bleeding in trauma patients<\/b>.<\/span><\/p>\n

    Key Principles<\/span><\/b><\/p>\n