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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
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