Red Flags

Red Flags

Symptoms or conditions requiring immediate attention, indicative of non-mechanical conditions or pathologies of visceral organs.

Fevers, chills, or night sweats

Associated with systemic disorders like infections, may indicate serious health issues.

Unexplained Weight Loss

Could signal gastrointestinal disorders, hyperthyroidism, cancer, or diabetes.

Malaise or fatigue

Associated with systemic diseases, indicating general health status.

Unexplained nausea or vomiting

Requires medical evaluation, may point to various underlying conditions. GI, neurological, vertigo

Quadrilateral paresthesias

Indicate central nervous system involvement.

Shortness of breath

Can signal various conditions from anxiety, asthma, cardiac or pulmonary dysfunction.

Dizziness

Can have multiple meanings, including lightheadedness or body orientation issues. Blurry vision or weakness in the legs

Bowel and Bladder Dysfunction

May indicate cauda equina compromise, requiring urgent attention.

Severe pain

Sudden onset of severe pain without a clear cause may indicate serious issues like tumors.

Painful weakness

Often signifies significant pathology, such as nerve palsy or tissue rupture.

Radiculopathy

Neurologic symptoms involving multiple spinal levels, indicating potential serious conditions.

Myocardial Infarction (MI)

Complete blockage of blood supply to the heart muscle, leading to coronary artery occlusion.

Infection

Osteomyelitis, Cat-Scratch Disease, and tumors can present with fever, pain, and localized tenderness.

Deep Venous Thrombosis

Develops from venous stasis, causing leg swelling and clinical features like calf pain, tenderness, and edema.

Cervical Myelopathy

Compression on the cervical spinal cord

Cervical Instability

Inability of the spine under physiological loads to maintain its normal pattern of displacement so that there is no neurological damage or irritation, no development of deformity, and no incapacitating pain.

Cancer

Colorectal cancer, with risk factors and metastatic presentations, requires staging for prognosis assessment.

Pleurisy

Severe, sharp knife-like pain with inspiration, often associated with a recent or coexisting respiratory disorder.

Pneumothorax

Chest pain intensified with inspiration, ventilation, or expanding rib cage, along with hyperresonance upon percussion and decreased breath sounds.

Pneumonia

Pleuritic pain, fever, chills, headache, malaise, productive cough, and symptoms like referred shoulder pain.

Cholecystitis

Colicky pain in the right upper abdominal quadrant with right scapula pain, worsened by fatty foods, and unaffected by activity or rest.

Peptic Ulcer

Dull, gnawing pain in the epigastrium, relieved with food, localized tenderness, and symptoms like constipation, bleeding, and vomiting.

Pyelonephritis

Associated with urinary tract infection, enlarged prostate, kidney stones, and symptoms like chills, fever, and nausea.

Nephrolithiasis (kidney stones)

Sudden severe back or flank pain, chills, fever, nausea, renal colic, and symptoms of urinary tract infection.

Vertebral Compression Fractures

Collapse of vertebral body leading to severe pain, deformity, and height loss, common in osteoporosis patients.

Lumbar/Lower Back-related Tumor: Cancer/Metastasis to the Spine

Red flags include age over 50, history of cancer, unexplained weight loss, and failed conservative therapy.

Cauda Equina Syndrome

Symptoms include urine or fecal incontinence, saddle anesthesia, weakness in lower extremities, and sensory deficits in feet.

Colon Cancer

Red flags include age over 50, bowel disturbances, unexplained weight loss, family history of colon cancer, and pain unaffected by movement.

Pathological Fractures of the femoral neck

Seen in older women (>70) with hip, groin, or thigh pain, history of fall, severe constant pain worsened by movement.

Osteonecrosis of the femoral head

Associated with long-term corticosteroid use (e.g., in patients with rheumatoid arthritis, systemic lupus erythematosus, or asthma), history of avascular necrosis, trauma, and affects the femoral head.

Unexplained Weight Gain

Could be caused by congestive heart failure, hypothyroidism or cancer.

Pain at night that awakens the patient from deep sleep

Usually the same time every night; may indicate the presence of a tumor.

MI Symptoms

Chest Pain, Pallor, sweating, dyspnea, nausea, or palpitations; Lasting greater than 30 min and not relieved with sublingual nitroglycerin

MI Risk Factors

Previous history of coronary heart disease, hypertension, smoking, diabetes, and elevated blood serum cholesterol (>240 mg/dL)

MI Patient Demographic

Men aged over 40 y/o and Women >50 y/o

Different Symptoms of MI: Men

Left Shoulder, Fatigue, Shortness of breath, Cold Sweat, Chest pain, Nausea

Different Symptoms on MI: Women

Jaw pain, Left or Right side shoulder, Dizzy, Anxiety, Feelings of impending doom, Upper back pain

Osteomyelitis

acute or chronic inflammatory process of the bone and its marrow secondary to infection with pyogenic organisms or other sources of infection with pyogenic organisms or TB, fungal infections, parasitic infections, viral, syphilitic

Osteomyelitis Red Flags

Fever, Fatigue, Edema, Erythema, Tenderness over involved bone, reduced extremity use, constant pain

Spinal Stenosis

Spinal Stenosis is predominantly caused by cervical spondylosis (degenerative changes in the cervical spine) but can also be the result of traumatic (fractures and instability) and inflammatory conditions or caused by herniated discs or tumors.

What causes Cervical Myelopathy?

Any space occupying lesion within the cervical spine that narrows the spinal canal (spinal stenosis) has the potential to compress the spinal cord

Cervical Fractures

When a patient with neck pain reports of history, need to be alert for spinal fracture and the potential for cervical instability and/or spinal cord or brain stem injury. Canadian C-Spine Rule can be used to determine when to refer for radiography in individuals following trauma where fracture of the cervical spine is a concern.

Cervical Arterial Dysfunction (CAD)

Range from pre-existing underlying anatomical anomalies, vasospasm, atherosclerosis, through to giant cell arthritis (i.e. temporal arthritis) or arterial dissection

Cervical Arterial Dysfunction (CAD) Presentation:

Pain, Cranial nerve dysfunction (Horner’s Syndrome), Blindness, Stroke, Death

5 D’s

Dizziness, Drop Attacks, Diplopia, Dysarthia, Dysphagia

3 N’s

Nausea, Numbness, Nystagmus

2 A’s

Ataxia, Anxiety

Stable Angina Pectoris

Chest pain or pressure that occurs with predictable levels of exertion (if not, suspect unstable angina pectoris). Symptoms are also predictably alleviated with the rest or sublingual nitroglycerin (if not, suspect unstable angina pectoris)

Pericarditis

Sharp or stabbing chest pain that may be referred to the lateral neck or either shoulder; Increased pain with left side lying; Relieved with forward lean while sitting (supporting arms on knees or a table)

Back-related infection (Spinal Osteomyelitis): Bone Infection of the spine

Recent Infection (e.g., urinary tract or skin infection); Intravenous drug user/abuser; Concurrent immunosuppressive disorder

Angina pain not relieved in 20 mins

MI

Angina pain with nausea, sweating and profuse sweating

MI

Bowel or bladder incontinence and/or saddle anesthesia

Cauda Equina Lesion

Anaphylactic shock

Immunological allergy or disorder

Signs/symptoms of inadequate ventilation

Cardiopulmonary failure

Patient with diabetes who is confused, lethargic, or exhibits changes in mental function

Diabetic coma

Patient with positive McBurney’s point or rebound tenderness

Appendicitis or peritonitis

Sudden worsening of intermittent claudication

Thromboembolism

Throbbing chest, back, or abdominal pain that increases with exertion accompanied by a sensation of a heartbeat when lying down and palpable pulsating abdominal mass

Aortic aneurysm or abdominal aortic aneurysm