flag tables Flashcards
abdo pain red flags
- Severe pain.
- Abnormal vital signs.
- Pain radiating to the back.
- Loin or flank pain.
- Temperature > 40°C.
- Rigors.
- Female aged 14-50 years and last menstrual period (LMP) more than
four weeks ago. - Pregnant.
- Abdominal tenderness on palpation.
- Pain made worse by movement.
- Indigestion or epigastric pain.
- Persistent or recurrent vomiting.
- Aged < 5 years.
- Aged ≥ 65 years.
- Immunocompromised (for example on steroids or immunotherapy).
abdo pain orange flags
- Dysuria.
- Frequency or urgency of urination.
- Recent unplanned weight loss.
- Haematuria.
- Temperature 38-40°C but other vital signs normal.
- New onset of constipation in the elderly.
abdo pain green flags
Diarrhoea and vomiting with normal vital signs.
* Pain associated with menstruation.
* Recurrent constipation.
A patient with abdominal pain who calls an ambulance should usually be assessed in an ED, unless there is….
unless there is an obvious benign cause such as urinary tract infection, menstruation or recurrent constipation.
Abdominal pain radiating to the spine or flank may result from conditions such as….
pancreatitis, gastric or duodenal ulceration, cholecystitis, pyelonephritis, or a leaking abdominal aortic aneurysm.
An abdominal aortic aneurysm is usually asymptomatic prior to….
leaking. Although many references describe a pulsating mass, this may not be palpable. A leaking abdominal aortic aneurysm usually presents with abdominal pain that radiates to the back and signs of shock.
what is Rigors and what dose it indicate
Rigors indicate that bacteria may be present in the blood. episodes in which your temperature rises while experiencing severe shivering accompanied by a feeling of coldness.
Perforated bowel (for example from cancer, diverticular disease or ulceration) usually presents with
non-specific abdominal pain for 1-2 days followed
by signs of peritonitis (abdominal tenderness with pain made worse by movement).
All patients with upper abdominal (epigastric) pain should have a
12 lead ECG acquired, noting that a normal ECG does not rule out myocardial ischaemia.
falls red flags
- Clinically significant injury.
- Clinically significant pain.
- Abnormal vital signs.
- Signs of stroke.
- Seizure without a history of epilepsy.
- Headache.
- New onset of visual disturbance.
- Unable to mobilise.
- Unstable medical condition contributing to the fall.
orange flags for falls
- More than one fall in the last week.
- Postural hypotension.
- Seizure with a history of epilepsy.
- Recent change in medication.
- Minor injury requiring non-urgent treatment.
- New reduction in mobility but able to weight bear.
green flags falls
- Minor soft tissue injury not requiring medical treatment.
- Able to mobilise in a manner that is normal for the patient.
Have a raised index for suspicion of injury if the patient who has fallen is…
Has fallen a significant height, for example greater than one metre or five stairs in an adult, or
ū Is taking an anticoagulant or has a known bleeding disorder.
Postural hypotension is present if there is a fall of greater than
20 mmHg in the systolic BP or greater than 10 mmHg in the diastolic BP when standing.
falls risk assessment
- Ask the patient the following questions:
ū Have you slipped, tripped or fallen in the last year?
ū Do you need to use your hands to get out of a chair?
ū Are there any activities you’ve stopped doing because you are afraid of
falling? - Perform Romberg’s test.
- Perform a timed up and go test.
- Refer the patient to a falls referral pathway if:
ū The patient answered ‘yes’ to any of the questions, or
ū Romberg’s test is abnormal, or
ū The timed up and go test is abnormal, or
ū Personnel consider the patient is at risk of falling. - Examine the environment for hazards which may contribute to the risk of falling. Examples include rugs, mats, cords and poor footwear. Eliminate these hazards with the patient’s permission if feasible.
Romberg’s test
- Stand beside the patient and be prepared to assist if they stumble.
- Ask the patient to stand with their feet together, place their arms by their side, get their balance and then close their eyes.
- Observe how long the patient can maintain the stance. A patient with normal balance should be able to maintain the stance without stumbling for more than 15 seconds.
Timed up and go test
Seat the patient in a chair and mark a location three metres away. The patient should wear their regular footwear and use any regular walking aids.
* Give the patient the following instructions. “When I say go I want you to stand up, walk to the line, turn around, walk back and sit down again”.
* Begin timing on the word go and stop when the patient sits back down.
* The timed up and go test is abnormal if the time is longer than 12 seconds.
* During the timed up and go test observe the patient’s posture, gait and balance. Record any obvious abnormalities.
treatment of fever under 12 months
Clearly recommend that all children aged less than 12 months with a fever are transported to an ED by ambulance.
fever under 5 red flags
- Colour:
ū Pale or ashen.
ū Mottled.
ū Cyanosed. - Activity:
ū No response to social cues.
ū Difficult to rouse or does not stay awake when roused.
ū Weak cry.
ū Exhaustion. - Respiratory: ū Grunting.
ū Respiratory rate > 50/minute.
ū Moderate or severe chest indrawing.
ū SpO2 < 94% on air. - Circulation and hydration:
ū Reduced skin turgor.
ū Severe tachycardia.
ū Peripheral capillary refill time > three seconds.
ū Bradycardia (an extremely late sign). - Other:
ū Temperature > 40°C.
ū Neutropenia.
ū Chemotherapy within the last four weeks.
ū Pain in a single joint or a single muscle area.
ū Rigors.
ū Petechiae or purpura.
ū Neck stiffness.
ū Focal neurological signs.
ū Significant concern regarding neglect or non-accidental injury.
fever under 5 orange flags
- Colour: pallor reported by caregiver (but not seen by personnel).
- Activity:
ū Not responding to social cues normally.
ū Wakes only after physical stimulation.
ū Decreased activity.
ū Poor feeding. - Respiratory:
ū Nasal flaring.
ū Respiratory rate 40-50/minute.
ū Mild indrawing.
ū Crackles audible on auscultation.
ū SpO2 94-95% on air. - Circulation and hydration:
ū Dry mucous membranes.
ū Tachycardia.
ū Peripheral capillary refill time 2-3 seconds.
ū Reduced urinary output or frequency. - Other:
ū Sore throat.
ū Illness for longer than five days.
ū Non-weight bearing or not mobilising appropriately.
ū Immunocompromised (for example on steroids).
ū Help from a healthcare provider has been sought more than once
within 24 hours.
fever under 5 green flags
- Colour: normal colour of skin, lips and tongue. * Activity:
ū Responds normally to social cues.
ū Wakes easily and stays awake.
ū Strong/normal cry or not crying. - Respiratory:
ū Normal respiratory rate.
ū No signs of indrawing.
ū SpO2 ≥ 96% on air. - Circulation and hydration:
ū Normal skin and eyes.
ū Moist mucous membranes.
ū Normal heart rate.
ū Peripheral capillary refill time < two seconds.
Fever in patients aged five years and over red flags
- Significantly abnormal vital signs.
- Pain or tenderness in the flank or back.
- Rigors.
- Neutropenia.
- Chemotherapy within four weeks.
- Abdominal pain with tenderness on palpation.
- Pain in a single joint or a single muscle area.
- Severe muscle tenderness.
- Temperature > 40°C.
- Drowsiness.
- Severe or worsening headache.
- Neck stiffness.
- Petechiae or purpura.