pathways

Question 1

eye or eyelid problems

Answer 1

A problem with one or both eyes or eyelids. (The eye includes the eyeball, upper lids up to the eyebrow and the lower lids down to the rim at the top of the cheekbone).
DO NOT USE THIS PATHWAY WHEN THERE IS:
An eye injury in the last 7 days, triage the injury. Some dust, grit or minor debris in the eye, or something splashed in the eye, triage the injury.

Question 2

Ear discharge or ear wax

Answer 2

Discharge from an ear WITHOUT hearing loss. The discharge may be clear and watery, coloured or blood stained. Ear wax.
DO NOT USE THIS PATHWAY WHEN THERE IS:
pain in the ear (earache). Discharge from an ear WITH hearing loss (Hearing disturbance or Blocked Ear)

Question 3

Hearing disturbance or blocked ear

Answer 3

Any hearing problem WITHOUT earache. any hearing problem WITH discharge. Discharge may be clear and watery, coloured or bloodstained.
DO NOT UE THIS PATHWAY WHEN THERE IS:
Pan or discomfort in the ear (earache). Injury in the last 7 days, triage the injury.

Question 4

Wound problems, plaster casts, tubes and metal appliances

Answer 4

a problem with any wound that has been assessed by a nurse or doctor e.g. an injury, a burn or an operation. A problem with any tube or drain e.g. a nephrostomy, gastrostomy or jejunostomy. A problem with any line or plaster cast. A problem with a metal frame attached outside the body to hold a bone in place (external fixator).
DO NOT USE THIS PATHWAY WHEN THERE IS:
A wound in the last 7 days that has NOT been assessed by a nurse or doctor (use appropriate penetrating injury pathway). A wound that occurred more than 7 days ago that has NOT been assessed by a nurse or a doctor (use appropriate pain or swelling pathway). A problem with internal metalwork, e.g. a plate or screws in a bone, which is NOT visible from the outside (use the appropriate pain or swelling pathway)

Question 5

loss of taste or smell

Answer 5

Loss or altered sense of taste or smell, with or without fever.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Another symptom as well as loss or altered sense of taste or smell, triage he other symptom

Question 6

Nasal congestion

Answer 6

A blocked nose.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Sinusitis as the main problem (Sinusitis (declared)). cold or flu symptoms (cold or flu symptoms). Facial pain or swelling (face, neck pain or swelling)

Question 7

Nosebleeds without injury

Answer 7

A nosebleed.
DO NOT USE THIS PATHWAY WHEN THERE IS:
a nose injury in the last 7 days, triage the injury

Question 8

sinusitis (declared)

Answer 8

A problem with the sinuses.
DO NOT USE THIS PATHWAY WHEN THERE IS:
just a blocked nose with no discomfort in the face (nasal congestion). A facial injury in the last 7 days, triage the injury

Question 9

Accidental poisoning/inhalation

Answer 9

Injection, swallowing, breathing in or absorbed through patches aplied to the skin of a potentially poisonous or harmful substance. A probability that something has been taken accidentally or incorrectly (this includes ingestion of medication). Accidental overdose of insulin or diabetic medication in a known diabetic.
DO NOT USE THIS PATHWAY WHEN THERE IS:
A self-harm attempt (self-harm). Chocking on, swallowing or breathing in a solid object in the last 24 hours (Object, ingested or inhaled)

Question 10

Bringing up blood

Answer 10

Blood coming from the mouth. this may have been coughed up or vomited with or without abdominal pain. This also means vomit which appears to be dark brown or black like soil or coffee grounds.
DO NOT USE THIS PATHWAY WHEN THERE IS:
A nosebleed (nosebleeds without injury). Dental surgery in the last 7 days (dental problems). Bleeding from the mouth or gums (dental problems). Injury to the mouth in the last 7 days, triage the injury.

Question 11

Dental problems

Answer 11

bleeding from the mouth, teeth or gums. pain or discomfort in the teeth or gums. a crown, bridge, fillings, denture or brace problem. a broken tooth, or teeth not caused by any injury.
DO NOT USE THIS PATHWAY WHEN THERE IS:
sudden locking of the jaw (locked jaw). toothache following a dental injury, triage the injury. a sore throat (sore throat or hoarse voice) or earache (earache). cold or flu as the main problem (cold or flu symptoms). A probability that something has been swallowed or inhaled (object, ingested or inhaled)

Question 12

difficulty swallowing

Answer 12

Difficulty or an inability to swallow WITHOUT a sore throat. A sensation of a lump in the throat WITHOUT a sore throat.
DO NOT USE THIS PATHWAY WHEN THERE IS:
a sore throat (sore throat or hoarse voice). A probability that choking on, swallowing or breathing in a solid object in the last 24 hours has occurred (Object, Ingested or Inhaled)

Question 13

Face, Neck Pain or Swelling

Answer 13

Pain, discomfort and/or swelling in the face and/or neck. A lump on or under the tongue.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Just a blocked nose with no discomfort in the face (Nasal Congestion). Sore throat as the main symptom (Sore Throat or Hoarse Voice). Sinusitis as the main problem (Sinusitis (Declared)). An allergic reaction to something unknown (return to ‘main reason’ question and select Allergic Reaction). A facial or neck injury in the last 7 days, triage the injury. A whiplash (hyperextension) injury to the neck in the last 7 days, triage the injury.

Question 14

Hiccups

Answer 14

New or prolonged hiccuping with or without a fever.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Another symptom as well as hiccups, triage the other symptom.

Question 15

Locked Jaw

Answer 15

A problem opening or closing the mouth or jaw.
DO NOT USE THIS PATHWAY WHEN THERE IS:
A facial or neck injury in the last 7 days, triage the injury.

Question 16

Mouth Ulcers

Answer 16

An ulcer or ulcers inside the mouth or on the gums. Red or white patches inside the mouth.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Bleeding from the mouth (Dental Problems). Bleeding from the mouth, due to an injury in the last 7 days, triage the injury.

Question 17

Object, Ingested or Inhaled

Answer 17

Accidental swallowing of a solid object. A probability of something stuck in the throat. A probability of having choked on or inhaled a solid object or vomit.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Swallowing or breathing in of a potentially poisonous substance or taking something accidentally or incorrectly has occurred (Accidental Poisoning/ Inhalation). A deliberate taking, swallowing, inhaling or doing something with the intention of harming themselves (Self-Harm, via illness route). A drowning incident within 24 hours has occurred (Drowning incident within 24 hours in major trauma)

Question 18

Alcohol Intoxication

Answer 18

Alcohol intoxication, with or without vomiting, and triage is possible.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Any vomiting of blood (Bring up Blood). Choking on vomit whilst intoxicated (Breathing Problems, Breathlessness or Wheeze). An injury to the person who is drunk, triage the injury. Another specific symptom in a person who is drunk. A person who is too drunk and triage is not possible (Early Exit).

Question 19

Aura or Anticipated Fit/Seizure (Declared)

Answer 19

An aura experienced by a person with a known history of seizures or fits. A feeling of a imminent seizure.
DO NOT USE THIS PATHWAY WHEN THERE IS:
No past history of fits or seizures. No current experience of an aura. A migraine aura (Headache).

Question 20

Behaviour Change

Answer 20

A change in behaviour that is unusual. The change may be new, or existing unusual behaviour may be getting worse. New confusion. An auditory or visual hallucination. Behaviour that seems inappropriate. Unusual drowsiness.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Worsening of a known mental health problem (Mental Health Problems). A sudden faint or blackout (Falls, Faints or Blackouts or Unable to get up without injury). A deliberate taking, swallowing, inhaling or doing something with the intention of harming themselves (Self-Harm).

Question 21

Dizziness or Vertigo

Answer 21

Dizziness, light-headedness or vertigo - the “room spinning”.
DO NOT USE THIS PATHWAY WHEN THERE IS:
A sudden change of the level of consciousness (Falls, Faints or Blackouts or Unable to get up without injury). Intoxication with alcohol (Alcohol Intoxication).

Question 22

Earache

Answer 22

Pain or discomfort in the ear. (This includes pain inside the ear as well as pain in the outer ear).
DO NOT USE THIS PATHWAY WHEN THERE IS:
An injury in the last 7 days, triage the injury. A SMALL foreign body such as a splinter of wood or glass in the skin, triage the injury. A foreign body INSIDE the ear, triage the injury. A painful or swollen area on the face or neck (Face, Neck Pain or Swelling).

Question 23

Face, Neck Pain or Swelling

Answer 23

Pain, discomfort and/or swelling in the face and/or neck. A lump on or under the tongue.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Just a blocked nose with no discomfort in the face (Nasal Congestion). Sore throat as the main symptom (Sore Throat or Hoarse Voice). Sinusitis as the main problem (Sinusitis (Declared)). An allergic reaction to something unknown (return to ‘main reason’ question and select Allergic Reaction). A facial or neck injury in the last 7 days, triage the injury. A whiplash (hyperextension) injury to the neck in the last 7 days, triage the injury.

Question 24

Hair Loss

Answer 24

Hair loss on the scalp, face or any other area of the body.

Question 25

Headache

Answer 25

Pain or discomfort in the head. (A headache can affect the scalp, base of the skull, the temples and involve the area of the face around the nose and eyes).
DO NOT USE THIS PATHWAY WHEN THERE IS:
Cold or flu symptoms )Cold or Flu Symptoms). Sinusitis as the main problem (Sinusitis (Declared)). A painful or swollen area that ONLY affects the face or neck (Face, Neck Pain or Swelling). Swallowing or breathing in a potentially poisonous or harmful substance or taking something accidentally or incorrectly (Accidental Poisoning/Inhalation). A head injury in the last 7 days, triage the injury.

Question 26

Mental Health Problems

Answer 26

Worsening or a known mental health problem. Depression, agitation, restlessness or anxiousness. Anxiety, panic or stress. Development of phobias. A request for assistance with drug, alcohol or solvent misuse or withdrawal. DO NOT USE THIS PATHWAY WHEN THERE IS:
An available pathway for the main symptom.

Question 27

Tiredness (Fatigue)

Answer 27

A gradual feeling of lifelessness or lethargy. A gradual feeling of tiring easily.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Depression, agitation, restlessness or anxiousness (Mental Health Problems). Sudden onset of drowsiness (Behaviour Change). Inappropriate sleeping during the day (Behaviour Change). Difficulty sleeping (Sleep Difficulties).

Question 28

Tremor

Answer 28

A main symptom of tremor (shaking or trembling).
DO NOT USE THIS PATHWAY WHEN THERE IS:
Another symptom as well as tremor, triage the other symptom. A tremor (shaking or trembling) due to anxiety or panic (Mental Health Problems). Shaking due to exposure to a cold environment within the last 24 hours (Cold Exposure).

Question 29

Numbness or Unusual Feelings in the Skin

Answer 29

An unusual feeling in the skin in any area of the body including numbness, a burning sensation, tingling or pins and needles.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Swelling in the area.
Any pain other than burning pain. An injury in the last 7 days, triage the injury. New painless discolouration or coldness of an arm (Arm, Cold or Colour Change). New painless discolouration or coldness of an leg (Leg, Cold or Colour Change).

Question 30

Breast Problems

Answer 30

A lump in the breast or concerns about breast size or enlargement. (The breast includes the nipple, the breast tissue itself and the “tail” of the breast that extends up into the armpit). Pain or tenderness in the breast which may also be felt in the armpit. Discharge coming from one or both breasts.
DO NOT USE THIS PATHWAY WHEN THERE IS:
A breast operation within the last 7 days (Wound Problems, Plaster Casts, Tubes and Metal Appliances). Pain or swelling ONLY in the armpit (Arm Pain or Swelling).

Question 31

Breathing Problems, Breathlessness or Wheeze

Answer 31

A feeling of breathlessness or being unable to breathe properly. Noisy breathing or wheezing.
DO NOT USE THIS PATHWAY WHEN THERE IS:
A cough as the main symptom (Cough). Cold or flu symptoms (Cold or Flu Symptoms). An injury in the last 7 days, triage the injury. A probability that choking on, swallowing or breathing in a solid object in the last 24 hours has occurred (Object, Ingested or Inhaled). Swallowing or breathing in a potentially poisonous substance or taking something accidentally or incorrectly (Accidental Poisoning/Inhalation). A drowning incident within 24 hours has occurred (Drowning incident within 24 hours in major trauma).

Question 32

Cough

Answer 32

A main symptom of cough.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Coughing up of blood (Bringing Up Blood). Cold or flu symptoms (Cold or Flu Symptoms). A probability that choking on, swallowing or breathing in a solid object in the last 24 hours has occurred (Object, Ingested or Inhaled). Swallowing or breathing in a potentially poisonous substance or taking something accidentally or incorrectly (Accidental Poisoning/Inhalation). A drowning incident within 24 hours has occurred (Drowning incident within 24 hours in major trauma).

Question 33

Palpitations

Answer 33

A feeling that the heart is beating in an unusual way. (It may feel as though the heart is beating irregularly, more rapidly, slowly or differently from normal).
DO NOT USE THIS PATHWAY WHEN THERE IS:
A probability that something has been taken or inhaled accidentally or incorrectly (Accidental Poisoning/Inhalation).

Question 34

Abdominal Pain

Answer 34

Abdominal pain with or without other symptoms.
DO NOT USE THIS PATHWAY WHEN THERE IS:
An abdominal injury in the last 7 days, triage the injury.

Question 35

Catheter Problems

Answer 35

A problem with a urinary catheter. (This includes suprapubic catheters that drain urine through a tube inserted through the skin of the lower abdomen).

Question 36

Constipation

Answer 36

Constipation, with or without abdominal pain. (This means they are having fewer bowel movements than usual or are straining to pass small, hard motions).

Question 37

Diarrhoea

Answer 37

A main symptom of diarrhoea with or without abdominal pain.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Also vomiting (Diarrhoea and Vomiting). Bleeding from the back passage (Rectal Bleeding).

Question 38

Diarrhoea and Vomiting

Answer 38

Diarrhoea and vomiting with or without abdominal pain.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Only diarrhoea (Diarrhoea). Only vomiting and/or nausea (Vomiting and/or Nausea).

Question 39

Loss of Bowel Control

Answer 39

Loss of bowel control, with or without constipation. Loss of bowel control, with or without diarrhoea. Soiling or staining of the underwear. This may also be referred to as faecal incontinence.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Bleeding from the back passage (Rectal Bleeding). Lump/swelling inside or near the back passage (Rectal Pain, Swelling, Lump or Itch).

Question 40

Stoma Problems

Answer 40

A problem associated with a stoma of any type. (These include an ileostomy, a colostomy, a urostomy).
DO NOT USE THIS PATHWAY WHEN THERE IS:
A problem associated with a nephrostomy, a jejunostomy or gastrostomy (Use the Wound Problems, Plaster Casts, Tubes and Metal Appliances pathway).

Question 41

Vomiting and/or Nausea

Answer 41

Vomiting and/or nausea (feeling sick) with or without abdominal pain.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Vomiting any blood (Bringing up Blood). Diarrhoea and vomiting (Diarrhoea and Vomiting). Diarrhoea and nausea (Diarrhoea). Vomiting and/or nausea and they appear to be drunk (Alcohol Intoxication).

Question 42

Genital Problems MALE

Answer 42

A problem with the penis, testicles or scrotum, with or without abdominal pain.
DO NOT USE THIS PATHWAY WHEN THERE IS:
Difficulty passing urine (Urinary Problems). A foreign body INSIDE or AROUND the penis, triage the injury. An injury to the genitals, triage the injury. A physical or psychological problem relating to sexual activity or sexuality (Sexual Concerns).

Question 43

Sexual Concerns MALE

Answer 43

A physical problem relating to sexual activity or sexuality. A psychological problem relating to sexual activity or sexuality. A concern about acquiring a sexually transmitted infection, e.g. Chlamydia, Gonorrhoea, Syphilis or HIV/AIDS.
DO NOT USE THIS PATHWAY WHEN THERE IS:
A penile, testicular or scrotal problem (Genital Problems). A foreign body inside or around the penis, triage the injury. A penile discharge (Genital Problems). Possible pubic lice (Skin Problems).