Urgent/Emergent Referrals

Question 1

3 emergent referrals for neuromusculoskeletal presentations

Answer 1

CES
Dislocation
Fracture, open, unstable

Question 2

3 emergent referrals for visceral presentations

Answer 2

AAA
Abdominal pain, acute severe
Arrhythmias

Question 3

3 urgent referrals for neuromusculoskeletal presentations

Answer 3

AC joint dislocation
Compartment syndrome, acute
CES, certain presentations

Question 4

3 urgent referrals for visceral presentations

Answer 4

AAA, certain presentations
Arrhythmias, certain presentations
Bladder infection in pt at risk for renal infection

Question 5

Semi-urgent referrals for neuromusculoskeletal presentations

Answer 5

Fracture, scaphoid fracture
Septic arthritis
Tendon ruptures

Question 6

Semi-urgent referrals for visceral presentations

Answer 6

AAA

Strep throat

Question 7

CES signs and Sx of emergent referral

Answer 7

Signs:
rapid onset Sx (esp after trauma)
rapidly progressing
sig urinary retention

Sx:
LBP and/or leg pain
Urinary retention/incontinence
Saddle paresthesia
Sexual dysfunction
Anal sphincter weakness

Question 8

AAA signs and sx for emergent referral

Answer 8

Signs
Sudden change/increase in sx

Sx
Tenderness abdominal palpation
Palpable pulsating mass
Hypotension/signs of shock
Rapidly increasing severity of acute back or abdominal pain
Nausea/vomiting

Question 9

Acute severe abdominal pain signs and sx for emergent referral

Answer 9

Signs:
Worsening of sx

Sx:
Antalgia
Diaphoresis (excess sweating)
Ill appearance
Shortness of breath
Abdominal rigidity or other peritoneal signs
Cullen’s sign (bruising, edema around umbilicus)
Sig pain increase associated with ilipsoas sign or opturator sign
Murphy’s sign
Seat belt sign

Question 10

Diabetic crises that prompt emergent referral

Answer 10

Sx:
Fruity breath odor
Loss of skin turgor (pull posterior skin on hand up and it stays up and slowly goes down)
Dry mucous membranes
Tachycardia
Hypotension
Lethargy
Focal neuro signs (hemiparesis, hemianopsia)
Seizures

Question 11

Arrhythmias or altered pulses that prompt emergent referral

Answer 11

Signs
Rates <40 w/ or w/o Sx
Rates <60 w/ Sx
rates >120 w/ Sx
Rates >140 w/o Sx that do not respond to initial attempts to reduce tachycardia (e.g. carotid sinus massage)

Sx
Chest pain
Shortness of breath
LOC
Decreased BP
Signs of shock
CHF

Question 12

Compartment syndrome Sx that prompts urgent referral

Answer 12

Trauma: fracture, crushing injury, severe contusion, hemorrhage, vascular occlusion
Swelling, seen in acute
Bruising
Severe pain inconsistent with injury and is persistent and progressive
Pain is exacerbated by stretching involved muscles

After 12 hrs variable permanent mm damage can occur
After 24 hrs high probability of sig perm disability

Question 13

Thoracic outlet syndrome with evidence suggesting true vascular compromise prompts urgent referral

Answer 13

Swelling in hand or arm
Nonpitting edema
Cyanosis
Decreased radial pulse
Subclavian bruit