W22 Red flags in Healthcare Flashcards
What is a “red flag”?
- In a medical context, a red flag is a warning symptom, sign or test result that suggests a potentially serious underlying pathology
- Their presence or absence adjusts the probability of a serious condition – and therefore the threshold for further tests or referral
What are General red flags?
example?
Direct the clinicians to recognise a serious illness
even though the exact disease is not known, e.g. unexplained weight loss
What are Specific red flags?
Signal specific illnesses and present in specific
anatomical regions, e.g. ground coffee vomiting
Coffee granules in blood significance?
perforated ulcer in GI tract
Low back pain (for info)
- One of the most common presentations in primary care
- 1-4% is a fracture
- <1% is a cancer
- Despite the potential seriousness of the cause, cannot justify testing everyone for everything
Examples of red flags in low back pain
Fracture
* Prolonged use of corticosteroids
* Older age (>70 yrs)
* Hx of osteoporosis
* Mild trauma > 50yrs with osteoporosis
* Significant trauma at any age
Cancer
* Age <20yrs or >50yrs
* Previous Hx of cancer
* Unexplained weight loss
* Night pain not relieved by rest
* Failure to improve with Tx
* Lasts >4-6 weeks
What are the red flags for Cauda equina?
- Saddle anaesthesia
- Bladder/bowel dysfunction
- Motor weakness/sensory deficit
What are the red flags for an infection?
- Systemically unwell: fever, chills
- Recent bacterial infection
- Recent surgery
- Immunocompromised
What are examples of yellow flags?
- Belief that pain itself is harmful
- Sickness behaviours – extended rest
- Social withdrawal/lack of support
- Low mood/depression/anxiety
- Problems/dissatisfaction at work
- Compensation or benefit claims
- Overprotective family
- No active participation in treatment
- You are a pharmacist working in NHS 111 Wales and receive a call during your Sunday shift from a male patient asking for advice. He has been experiencing indigestion and nausea for the past 24 hours and none of the usual over-the-counter remedies have helped.
On questioning the patient further, you discover:
* The pain is described of a tightness and heaviness
* The pain is also affecting his shoulder and jaw
* He feels really sick
* Pain severity: 7-8/10
* Feels it’s making him come out in a cold sweat
* What are your thoughts?
Possible MI
Indigestion Vs Heart Attack
MI:
- Crushing, heaviness, tightness, pressure, aching in the chest
Arm, Jaw, lower back
SOB, Clammy, Cold sweat,
MI Male vs Female
Females are more likely to experience less common symptoms
Case 2
You are working in a community pharmacy when you are approached by someone asking for something for flu for her 17-year-old son. He was out at a party last night and was well then.
Upon questioning, symptoms are:
* lethargy
* feeling sick
* headache/aversion to bright light
* clammy, cold hands and feet
* muscle aches and pains
What are your thoughts?
How long have the symptoms lasted?
Hangover? Feeling sick
Flu?
Glandular fever?
Covid?
Migraine?
Meningitis? - Aversion to bright light, muscle aches, cold hands and feet, severe headache,
A patient’s partner has attended the community pharmacy for some flu preparations and more lateral flow tests for his girlfriend.
W = Patients girlfriend
W=
* Cant get out of bed
* Fever – hot & cold shivers / sweats
* Short of breath
* “doesn’t look right”
* Muddled
H = Started
yesterday afternoon as mild aches and pains but she seems to have gotten a lot worse
A = Regular paracetamol and ibuprofen has helped with the
fever but that’s about it
M=
* Nil from her GP
* Currently completing 28 day course of a blood thinning injection – started after knee surgery
Other info:
PMHx: nil, surgery 10 days ago on her knee following traumatic ski injury which resulted in complications
Possibly sepsis:
Sweaty skin, disorientation, shivering, high heart rate, extreme pain, short pain
You are working in a minor ailments clinic in general practice when a 45-year-old patient attends with pain in his left calf of about 12 hours’ duration.
* He can walk, but is limping significantly – the pain subsides when he takes a seat. He thinks he has pulled a muscle while running, which he puts down to bad running form due to tiredness after a long flight back from Singapore the day before.
* Upon questioning, he has no other symptoms of concern.
* He is a social smoker (around 10-15 cigarettes per week) and drinks around 10-14 units of alcohol weekly.
* You examine the leg; it is very warm to the touch.
* What are your thoughts?
Possibly Deep Vein Thrombosis (DVT)
Virchow’s Triad:
1. Hemodynamic changes/stasis
2. Hypercoagulability
3. Endothelial injury dysfunction
Red flags of DVT
A hx of DVT
Cancer
Age over 60
Male sex
Heart Failure
Red flags upon examination of DVT
Rubor- red
Calor- Warmth
You are a community pharmacist and Mr Williams (65 years of age), one of your regular customers, has requested a repeat prescription for a salbutamol inhaler for the third time this month.
You contact him by phone and on questioning he highlights:
* Worsening shortness of breath since lung cancer diagnosis
* Fatigued post chemotherapy
* Ongoing cough, occasionally coughing up blood
* Rib pain radiating around to his back
* He has recently doubled his water tablet dose because one of his
legs is more swollen than normal
* Mr Williams hasn’t notified anyone of his symptoms
because he assumed it was all linked to his lung cancer…
* What are your thoughts?
Pulmonary embolism
Wife has attended the community pharmacy with a urine sample from her husband. She is requesting some oral antibiotics for her husband who she believes has another urine infection.
On questioning the patients wife you discover:
- The patient is “all confused again”
- He keeps mumbling and slurring when he speaks and not making any sense
- And he’s become really clumsy – he couldn’t hold his cup of tea this morning and spilt it all over the place.
You test the patients urine sample using urinalysis sticks and there is not sign of infection.
What are your thoughts?
Stroke
FAST=
Face
Arms
Speech
Time
What are the 2 types of stroke?
Ischemic- lack of oxygen to the brain
Haemorrhagic- bleeding
What are the risk factors of a stroke?
What are some examples of red flag symptoms?
- Unexplained weight loss
- Difficulty in breathing
- Long duration of symptoms
- Recurring or worsening problem
- Severe symptoms (depends on the condition)
- Shortness of breath, tightness of chest, wheezing
- Blood / bleeding
- Suspected link with medication
- Recently returned from travel
