What Are Red Flags?
Chest Pain Red Flags
Immediate evaluation required for:
- •Substernal pressure with radiation to arm, jaw, or back
- •Associated diaphoresis, nausea, or shortness of breath
- •New onset with exertion
- •History of cardiac disease with changing pattern
- •Hypotension or signs of shock
- •Tearing or ripping pain (aortic dissection)
- •Unequal blood pressures in arms
- •Sudden onset with syncope
Headache Red Flags
The 'SNOOP' mnemonic for dangerous headaches:
- •S — Systemic symptoms (fever, weight loss) or Secondary risk factors (HIV, cancer)
- •N — Neurologic symptoms (confusion, weakness, vision changes, seizure)
- •O — Onset sudden ('thunderclap' — worst headache of life)
- •O — Older age (new headache after age 50)
- •P — Pattern change (progressive worsening, different from usual)
- •Also: Papilledema, neck stiffness, post-trauma, positional
Abdominal Pain Red Flags
Surgical emergency indicators:
- •Rigid, board-like abdomen
- •Rebound tenderness or guarding
- •Absent bowel sounds
- •Hemodynamic instability
- •Fever with peritoneal signs
- •Pulsatile abdominal mass (AAA)
- •Severe pain out of proportion to exam (mesenteric ischemia)
- •Bilious vomiting with distension (obstruction)
Respiratory Red Flags
Signs of respiratory emergency:
- •SpO2 <90% on room air
- •Severe respiratory distress (accessory muscle use, tripod positioning)
- •Inability to speak in full sentences
- •Cyanosis
- •Altered mental status with respiratory symptoms
- •Stridor (upper airway obstruction)
- •Unilateral absent breath sounds (pneumothorax)
- •Hemoptysis (massive or new)
Neurologic Red Flags
Emergent neurologic findings:
- •Sudden focal weakness or numbness (stroke)
- •Sudden speech difficulty (stroke)
- •Sudden severe headache (SAH)
- •Rapidly declining mental status
- •New seizure in adult
- •Signs of increased ICP (Cushing's triad: HTN, bradycardia, irregular respirations)
- •Cauda equina syndrome (saddle anesthesia, urinary retention, bilateral leg weakness)
Pediatric Red Flags
Warning signs in children:
- •Fever in infant <3 months
- •Bulging fontanelle
- •Inconsolable crying or lethargy
- •Petechial or purpuric rash with fever (meningococcemia)
- •Signs of dehydration (no tears, no wet diapers, sunken fontanelle)
- •Respiratory distress (nasal flaring, retractions, grunting)
- •Bilious vomiting in neonate (malrotation)
- •Non-blanching rash
Mental Health Red Flags
Psychiatric emergencies:
- •Active suicidal ideation with plan and means
- •Homicidal ideation
- •Command auditory hallucinations
- •Acute psychosis with agitation
- •Severe self-harm or recent attempt
- •Inability to care for self
- •Catatonia
- •Neuroleptic malignant syndrome (fever, rigidity, AMS with antipsychotic use)
Documenting Red Flags
When you identify a red flag, document: 1. The specific finding 2. Time identified 3. Who was notified 4. Actions taken 5. Patient response Example: "1420 — Patient developed sudden left-sided weakness. Dr. Smith notified immediately. Stroke alert called. CT head ordered STAT. Patient moved to resuscitation bay."
When in Doubt
If something feels wrong, trust your instincts. Document your concerns even if you can't pinpoint the exact problem: "Patient appears acutely ill, out of proportion to vital signs. Concerned for early sepsis vs. occult bleeding. Escalating to provider for immediate evaluation." Your clinical intuition, combined with documentation, can save lives.