Protocol Exclusion/ Red Flags Flashcards
Basic ECP principles
Emergency response (red) criteria not adequately reconciled
Emergency response (yellow) criteria not adequately reconciled
T1 protocol
Acute confusion
Obvious hospital intervention needed
Assessed as unsafe due to functional decline
Suspicion of ACS and visceral type pain
Acute abdominal pain unless specific ecp protocol
Lack if competency or compactly or lack of responsible person
Clinical significant headache or unexplained headache
Suspicion of CVA/TIA
Concerning history
Temperature >39.5 (no effect from antipyuretic) or <35.5
analgesia reference
Red flag
opioid analgesia taken prior to arrival
repeat caller
recent hospital admission
elderly/frail
exclusion criteria specific to ECP pathway
back pain
Exclusions
New neurological deficit (including saddle anaesthesia)
new bladder/bowel dysfunction
patients <16yrs
trauma aetiology
Red flags
ACI- ? serious pathology indicating need for further review
Possible fracture
1st episode <20 or >50 ( ? tumour or infection)
History of cancer
IVDU
Pain worse at night or supine
constitutional symptoms (fever weight change)
recent bacterial infection
immunosuppression
sensory alteration/weakness
new bladder/bowel dysfunction
thoracic pain
mammal bites
Exclusions
Bite to hand (over a joint), face, feet, perineum
?/confirm deep structural involvement
functional loss of affected limb/body part
obvious ED requirement
exposure/bite due to bat
Primary closure of wounds >6hrs old
paediatric with ? NAI
patient <6yrs
Redflag
Malnutrition
diabetes
immunocompromise
cancer
on corticosteroids
on immunosuppressants
on cytotoxic meds
concern regarding follow up
concern regarding ongoing wound care
human bite
closed fist injury
bites to hands with no joint involvement
inability to adequately irrigate wound
unknown immunisation status
catheter problems and urinary retention
Exclusions
urological surgery in previous 6 wks ( 2 wks for TURP)
first change of SPC
acute urinary retention <16yrs unless IDC/SPC insitu and suitable catheter size available
Redflag
history of urological surgery
history of bladder/prostate cancer
previous difficult insertion
haematuria
prostatism
spinal injury
chronic pain
exclusion
onset of new type/location of pain that is concerning
inability to relieve pain post reasonable attempts
chest/visceral type pain to the chest area
analgesia exclusions
Redflag
Pain presentation different to usual pain pattern
usual breakthrough regime not working
patient already receiving large opioid doses
unable to contact, not under GP/ pain specialist care
repeat caller with no active plan of care
community acquired pneumonia
exclusion
recent hospital admission for similar presentation
patient <16 yrs
patients >75, unable to be referred to care by specialist geriatric service
? sepsis
CORB score 2 or greater
immunosuppressed
cystic fibrosis
Redflag
lives alone
multiple co-morbidities
on home oxygen
CORB = 1
co-existing respiratory disease
recent respiratory illness
likely poor compliance with follow-up
possible zoonosis
smoker
> 65 yrs
COPD exacerbation
exclusion
<18 yrs
? sepsis
CORB 2 or greater
immunosuppressed
cystic fibrosis
Redflag
concerning social history
recent treatment for respiratory illness
current smoker
home oxygen
multiple co-morbidities
likely poor follow up
lives alone
CORB = 1
absence of COPD plan or access to GP/COPD community team
croup
exclusion
<3 months
? non croup aetiology
recent hospital admission for similar presentation
Redflag
acute onset
excessive drooling
parental concern
<6 months
co-morbidities
unknown immunisation status (HIB especially)
dislocations
exclusions
neurovascular compromise post reduction
? fracture
dislocations
exclusions
neurovascular compromise post reduction
? fracture
haemophilia
? NAI in child/elderly
<6yrs for all indications, except pulled elbow, then <1yr
significant trauma cause
dislocation to thumb/greater toe
Redflag
>65
osteoporosis
arthritis
1st dislocation
epistaxis
exclusion
nasal trauma with ? facial fracture
Redflag
taking anticoagulants/antiplatelets
advance age
liver failure
foreign body ?
nasal tumour
co-morbidities
Falls risk assessment
exclusions
red or yellow adult observation
T1 criteria
? medical cause for fall
require obvious ed intervention/assessment
Redflag
taking anticoagulants/antiplatelets
concern history needing further review/management
Fish hook
exclusion
deep structure involvement
wound into joint capsule
ocular or surrounding tissue
Redflag
immune compromise or increase infection risk
malnutrition/over nutrition/ meds alter immune response/ diabetes CKD liver disease
contamination with soil, or water with ? severe pathogens
history impaired wound healing
other non healing wounds present
fracutures
exclusions
neurovascular compromise
? complicated fracture involving compound fracture
fractures potentially involving growth plates F <15, M<17
Redflag
uncharacteristic pain
likely poor compliance with management plan
hand injuries
? scaphoid fracture or navicular fracture
gastroenteritis
exclusions
systemic compromise
severe dehydration despite treatment
constant worsening pain
melaena and or haematemesis
> 75yrs
pregnancy
absence of diarrhoea
symptoms >12hrs
bilious vomit in paediatric patients
Redflag
recent radiotherapy to abdo/pelvis
known neutropenia
inflammatory bowel disease (IBD)
abdominal distention
hypo/hyperglycaemia (consider ketones)
poor social support
pain out of character findings
age > 65yrs
type 1 diabetes
bile stained vomitus
gastrostomy tube management
exclusion
concern of infective process
concern of bowel obstruction
jejunal or PEJ tube displacement
PEG tube displacement
first change
Redflag
trauma or infection to stoma
single port tube
unable to replace in 1st attempt
Skin infection
Exclusion
? sepsis/systemic infection
history or resistant infection (treated in past 2 wks)
cellulitis of face, hand or upper limb
bilateral disease
current chemotherapy
recent hospital admission for similar
chronic ulcer present in area of cellulitis
<16yrs
Redflag
immunocompromise
steroid use
? poor compliance with follow up advice
diabetic
peripheral vascular disease
contamination with soil or water suggestive of severe pathogens
patient or family history MRSA/VRA or staphylococcus (boils)
soft tissue injury
exclusion
neurovascular impairment
suspected fracture (go to fracture pathway)
Redflag
hand injuries
uncharacteristic pain
positive ottawa test (go to fracture)
osteoporosis
peripheral vascular disease
urinary tract infection
exclusion
pregnancy
? sepsis/systemic infection
known urological abnormality
non catheterised males < 65 yrs
? pyelonephritis
acute confusion/rigors
<16 yrs
Redflag
immunocomprimised
recurrent UTI
> 75 yrs
Wounds (acute non bite)
exclusion
? deep structure involvement
loss of function
? NAI
cosmetic implication
<1 yr
deep penetrating wound, unable to adequate irrigate
Redflag
immunocompromised
diabetes
likely poor compliance with follow up
wound over joint
malignancy
hand injury
wounds to more then 1 body area
corticosteroid use
history impaired wound healing
minor penetrating wound
extremes of age
pretibial lacerations
delayed closure >6hrs
poor tissue quality
