Red Flags

Dr. Ahmed A. ElbashirED Consultant KFMCAssistant Prof. KSU

Objectives

• Discuss general principle in triage approach• Discuss approach to common complaint• To identify serious presentation

G General Principle

• Focused and systematic assessment• Assume the most serious scenario • Should have knowledge about red

flags in each complaint• Use only the available tools that can

help you in taking a decision• Ask for advice if you feel that you

need

General Red Flags

• Extremes of age• Symptoms or signs related to airway ,

breathing or circulation or affecting LOC• Sudden onset of a complaint• Short duration• Severe mechanism of injury in trauma• Decrease level of consciousness• Serious signs as diaphoresis , Tachypnea ,

and cyanosis • Abnormal vital signs

General Pain assessment

SeverityCharacterLocalization OnsetDurationRadiationAggravating and relieving factorsAssociated symptoms

Red Flags in Airway problems

Subjective :Difficulty of breathingLaryngeal pathologyAirway trauma or burnAcute onset anterior neck swellingAllergic reaction with SOBStrider Acute change in voice with SOB

Red Flags in Airway problems

Objective :Decrease LOCRespiratory distressStriderTachypneaSweating CyanosisAbnormal vital signs

Red Flags in Chest pain

Pain descriptionCardiac :Character : Pressure ,heaviness ,tightness , Localization : Substernal , and in the left Onset Acute recent or chronic with new changesDuration : If more than 20 min. significant Radiation : To the left arm , shoulder, jawAggravating , relieving factors may be by exertion Associated symptoms : Diaphoresis, nausea , Vomiting, SOB, syncope

Remember : Aortic dissection may occur in any age

Usually the pain is abruptly sudden &

acute , classically tearing and interscapular

Red Flags in Chest pain

Remember

Any patient with non traumatic chest pain ECG shall be done and interpreted

within 10 minutes

Red Flags in Chest pain

Other Risk indicators :AgePMH of IHD , HPT , DM , HyperlipidemiaRisk factors , smoking

Red Flags in Chest pain

Non Cardiac but seriousPulmonary Causes :• Pulmonary embolism Look for any

high risk criteria• Tensional pneumothorax , look for

signs of distress• Pain is usually sharp Localized and

increase with respiration

Red Flags in Chest pain

Criteria for high probability PE• Clinical Signs and Symptoms of DVT?• Immobilization at least 3 days, or

Surgery in the Previous 4 weeks• Previous, objectively diagnosed PE or

DVT?• Hemoptysis?• Malignancy Treatment within 6 month,?• Heart Rate > 100?

Red Flags in Chest pain

Tensional pneumothorax Severe respiratory distress or

tachypnea Distended neck veins Hypotension Hyperesonent chest percussion

Red Flags in Chest pain

• Old ages• Severe pain• Sudden onset• Short duration• Associated fever• Associated hypotension• Previous surgery

Red Flags in abdominal pain

Remember

Epigastric pain specially in elderly can be acute MI

Red Flags in abdominal pain

Red Flags in non traumatic back pain

AAA• Old ages• Previous history of Aortic aneurysm• Severe acute onset• Short duration• Associated abdominal pain• Week or Absent femoral pulses• Associated hypotension , or sweating

Red Flags in non traumatic back pain

Acute disc prolapse with cauda equinaAcute onset , short durationUrinary or bowel incontinence or

retentionApparent acute LL weaknessSensory level

• Old ages• Any decrease in LOC• Severe acute onset• Not a recurrent headache• Anticoagulant medications• Associated nausea or vomiting• Associated photophobia• Associated fever and no other symptoms of URTI• Neck rigidity• Any limb weakness

Red Flags in patients with headache

• Acute onset• decrease LOC • Old ages , no focus of infection• Associated headache neck pain no URTI• Photophobia• Neck rigidity• Chemotherapy• Hypotension

Red Flags in patients with fever

• Old age• Associated chest pain or SOB• Associated syncope• Any hypotension or hypoxia• History of IHD or arrhythmiasImportant tools for Triage decision making : ECG – Glucometer

Red Flags in patients with Palpitation

Elderly age Abrupt onset Duration more than few seconds Repeated episodes Occurrence during sitting or supine Associated symptoms, palpitation,

chest pain PMH

Red Flags in patients with Syncope

Objective assessment Bradycardia or tachycardia Hypotension or hypertension Pallor Sweating Focal neurological deficit Apparent bleeding

Red Flags in patients with Syncope

What is syncope

Transient loss of consciousness Followed by inability to maintain

postural tone Followed by rapid complete return to

baseline neurological function

Ischemic Limb : Old age Acute severe sudden pain No trauma Atherosclerotic diseasesExamine the limb for Color - Temperature - Pulsation

Red Flags in patients with Limb pain

Potential limb threatening : Compartment syndrome

• History of trauma or post cast• Hematoma became with increasing

pain• Increasing severe pain• Swollen tense limb• Painful passive stretching of tendons

Red Flags in patients with Limb pain

Hypoglycemia• Any decrease LOC• Palpitation• Sweating• Recent intake of insulin or glucose

lowering tabImportant tools for Triage decision making : Glucometer

Red Flags in Diabetic patients

Hyperglycemia• Any decrease LOC• Signs of dehydration• Any abnormal vital signs• TachypneaImportant tools for Triage decision making : Glucometer

Red Flags in Diabetic patients

Red Flags in Diabetic patients

Remember Glugocheck shall be done for any

patient with decrease LOC , Agitation , unexplained symptoms