Protocol Exclusion/ Red Flags Flashcards

1
Q

Basic ECP principles

A

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

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2
Q

analgesia reference

A

Red flag
opioid analgesia taken prior to arrival

repeat caller

recent hospital admission

elderly/frail

exclusion criteria specific to ECP pathway

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3
Q

back pain

A

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

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4
Q

mammal bites

A

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

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5
Q

catheter problems and urinary retention

A

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

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6
Q

chronic pain

A

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

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7
Q

community acquired pneumonia

A

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

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8
Q

COPD exacerbation

A

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

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9
Q

croup

A

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)

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10
Q

dislocations

A

exclusions
neurovascular compromise post reduction

? fracture

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10
Q

dislocations

A

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

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11
Q

epistaxis

A

exclusion
nasal trauma with ? facial fracture

Redflag
taking anticoagulants/antiplatelets

advance age

liver failure

foreign body ?

nasal tumour

co-morbidities

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12
Q

Falls risk assessment

A

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

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13
Q

Fish hook

A

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

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14
Q

fracutures

A

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

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15
Q

gastroenteritis

A

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

16
Q

gastrostomy tube management

A

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

17
Q

Skin infection

A

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)

18
Q

soft tissue injury

A

exclusion
neurovascular impairment

suspected fracture (go to fracture pathway)

Redflag
hand injuries

uncharacteristic pain

positive ottawa test (go to fracture)

osteoporosis

peripheral vascular disease

19
Q

urinary tract infection

A

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

20
Q

Wounds (acute non bite)

A

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