Red Flags

Question 1

What are red flags?

Answer 1

alert signs and symptoms (“danger signs”) that indicate a more serious underlying pathology

Question 2

Importance of red flags?

Answer 2

1. life saving
2. triage
3. appropriate referral

Question 3

Red flags for cough?

Answer 3

1. Breathlessness at rest or while talking
2. Respiratory rate >30 breaths per minute
3. Prominent use of breathing muscles
4. Coughing up >1 tbsp fresh blood
5. Agitation or confusion
6. BP <90/60

Question 4

How is SOB a red flag?

Answer 4

1. patient can become exhausted
2. impending respiratory collapse
   Note: sometimes SOB might be a baseline for example a severe COPD pt might not be a red flag

Question 5

How is hemoptysis a red flag?

Answer 5

1. Could portend serious blood loss (emergency!)
2. Or be the sign of one of the more worrying causes of cough

Question 6

Why is altered mental status a red flag?

Answer 6

This could represent impending inability to protect the airway!

Question 7

Causes of altered mental status?

Answer 7

1. Hypotension from shock?
2. Acid/base imbalance from respiratory state?

Question 8

Why hypotension is a red flag?

Answer 8

Shock: This patient could be undergoing circulatory collapse.
1. Septic shock: pneumonia?
2. Obstructive shock: pulmonary embolism?
3. Cardiogenic shock: acute CCF?

Question 9

Red flags in abnormal vaginal bleeding?

Answer 9

1. BP <90/60 or other signs of shock
2. Pregnant?
3. Recent abortion or miscarriage?
4. Post menopausal

Question 10

Signs of shock?

Answer 10

1. tachycardia
2. hypotension
3. altered level of consciousness
4. prolonged cap refill
5. hyper or hypothermia
   - Demonstrates concern for rapid bleeding which requires resuscitation and immediate intervention to stop bleeding

Question 11

How abnormal vaginal bleeding is a red flag in pregnancy?

Answer 11

1. Early in pregnancy <20 weeks → bleeding could be concerning for ECTOPIC, spontaneous abortion, gestational trophoblastic disease (molar pregnancy)
2. Later in pregnancy >20 weeks → placenta previa, placental abruption, trauma, preterm labor

Question 12

How abnormal vaginal bleeding is a red flag in recent abortion/miscarriage?

Answer 12

Bleeding following a miscarriage could be life threatening.
- Due to retained products of conception, atony, septic abortion.

Question 13

How abnormal vaginal bleeding is a red flag in post menopausal women?

Answer 13

Concern for possible endometrial hyperplasia or carcinoma which should be investigated within 2 weeks

Question 14

Red flags in abdominal pain?

Answer 14

1. Rebound tenderness, guarding, rigidity
2. Jaundice
3. Temperature >38oC
4. Failure to pass stool >24 hours
5. Failure to pass flatus >24 hours
6. Failure to pass urine >12 hours
7. Pregnancy
8. Chest pain
9. Bilious emesis
10. Trauma
11. History of HIV – lactic acidosis

Question 15

Red flags of lower back pain?

Answer 15

1. Temperature >38oC
2. Urinary incontinence
3. Faecal incontinence
4. Saddle anaesthesia
5. History of cancer
6. Unexplained weight loss
7. Age <18 or >50
8. History of HIV
9. Urinary retention
10. Recent trauma
11. Use of corticosteroids
12. Progressive motor weakness
13. Severe pain with hematuria

Question 16

Red flags in weight loss?

Answer 16

1. History of cancer
2. History of HIV
3. Night sweats, fevers, hemoptysis
4. Abnormal vaginal bleeding

Question 17

Red flags in headache?

Answer 17

1. sudden onset headache
2. worsening pattern headache
3. headache with systemic illness
4. focal neurological signs or symptoms
5. papiloedema
6. headache triggered by cough exercise or Valsavas manoueuvre
7. headache during pregnancy or post partum
8. new headache with hx of cancer/HIV
9. headache following trauma
10. headache with jaw claudication

Question 18

Red flags in GERD?

Question 19

Red flags in red eye?