Red Flags Flashcards
red flag
definition
info obtained by hx or during exam that suggest might have serious problem OR
problem that may pose serious health issue to the pt causing paralysis or death
VFIRST
presenting as spinal pain
V=vascular
F= fracture
I=infection
R=radicular
S=spinal cord/brain
T=tumor
HPI/ROS red flags
- fever and/or sig weight loss
- pain at night/recumbent
- morning stiffness
- acute localized bone pain
- visceral pain
- radicular pain
symptoms not injury/activity related
-night pain/at rest
-temp over 100.4 for longer than 48 hours
-unexpected weight loss
-constant pain
-pain/weakness/numbness in arms/legs
symptoms injury/activity related
-recent trauma or heavy labor
-severe pain
-pain/weak/numb in arms/legs
fever/weight loss
significant if 10-15 lbs in a short time/not trying
=tumor or infection
-fever may be spondyloarthropathy
night pain/recumbent
neoplasm of the spine
-pain slowly after recumbent = arthritis
-pain at night = cancer
morning stiffness
if last for hours = inflammatory arthropathy i.e ankylosing spondylitis
if lasts 1/2 hour = osteoarthritis
acute/localized bone pain
if assoc w/ trauma = acute fracture
no trauma = fracture from bone demineralization (osteopenia) or tumor
-granulomatous processes replace bone calcium so fractures
-or bone cell death
visceral pain
look for viscero somatic reflexes or referred pain
ex- kidney stones, AAA, gall bladder disease, peptic ulcer, endometriosis
radicular pain
leg
leg pain radiate below knee w or w/o weak/numb/tingling from:
-mechanical pressure/inflamm on nerve roots
-along anatomic course of nerve
-disc or bone pathology
-nerve root compression from disc herniations (L4/5 = 5 root or L5/S1 = S1 root)
radicular pain
arm
-mechanical pressure/inflammation of cervical roots
-along anatomical course of nerve
-disc or bone pathology
ROS red flags
diagnoses
-lymphadenopathy
-dysphagia
-hemoptysis
-hematochezia/melana
-hematemesis
-hematuria
-saddle distribution numbness
ROS red flags
symptoms
-bowel/bladder aka urination retention or incontinence
-abdominal pain
-chest pain/jaw pain
-SOB
-visual changes
-headaches
PMH red flags
osteoporosis
AAA (abdominal aortic aneurysm)
cancer
prior spinal surgery
rheumatologic disease
genetic abnormalities
ETOH/drug use
under 18 or over 50
PSH red flags
AAA repair
coronary bypass/vascular sheets
cancer
organ transplant
abnormal vital signs
elevated temp, pulse, BP
irregular pulse
unplanned weight loss
abnormal physical exam
lymphadenopathy
organomegaly
pulsatile abdom mass
abnormal auscultations/percussions
painful palpation/rigidity
reflex/sensory changes
gait
joint instability
structural exam
-actue pain w/ active or passive motion testing
-spinal crepitus w/ ROM testing
-grossly limited active/passive ROM
-neuro symptoms
treatment red flags
-fail to subjective improve 2-3 treatments
-fail to objective improve 2-3 treatments
-gradually worsen w/ sound manual treat
-subject complaints not align with noted dysfunctions
next steps
workup- lab or imaging
specialist
OMM
