Red Flags

What do yellow flags signify?

 A cautionary or warning symptom

 Indicate the need to conduct a more formal observation/assessment

What do red flags signify?

 A symptom that is thought to be associated with a high risk of serious disorders such as infection, inflammation, cancer or fracture

 Requires immediate attention (additional questioning and/or brought to attention of PT and/or immediate medical attention)

The presence of one red or yellow flag is not always an indication of a significant problem.

True

Red flags that occur bilaterally are always a reason for concern and should be further investigated.

True

Why are red flags important to pay attention to?

Quicker and Sicker

 Faster DC from hospital

 Greater number of comorbidities

Natural history

 Longer survivor period for systemic diseases

Referral without thorough evaluation

Medical specialization

 Assuming general practitioner is addressing problem

 Only looking at symptoms that relate to their specialty

Progression of Disease

 Important symptoms weren’t present at initial

evaluation

How are flags found?

Past Medical History

Risk Factor Assessment

• Smoking, obesity, high risk recreational activities

Clinical Presentation

Assoc. Signs and Symptoms of Systemic Diseases

• Unusual skin color, clubbing of fingers, hematoma, effusion, numbness, tingling

General questions about: fever, irritability, insomnia, dizziness, compliance with meds and diet

Vital signs are not an important way to asses healthy and screen for systemic illness.

False

Examples of constitutional symptoms

 Fever

 Diaphoresis (unexplained perspiration)

 Night sweats

 Nausea

 Vomiting

 Dizziness

 Fainting

 Diarrhea

 Pallor

 Fatigue

 Weight loss

If a red or yellow flag (even one in isolation) is

observed or reported by patient, it must be

documented and reported to the supervising PT

True

PTA are not liable if red/yellow flags are present and not documented.

False

What are general signs of cardiovascular red flags?

Chest pain, sense of heaviness or discomfort in the chest

• Chest, neck, jaw, upper trap muscle, shoulder, arms (L>R)

• Location of referred pain coordinates to the spinal nerve segment . For example C5-6 innervate heart and diaphragm and also the shoulder.

• The heart and diaphragm can refer pain to the shoulder

Palpations are always an issue/

False. Some palpatios are caused by anxiety, caffeine, or meds and are within normal function. If long lasting, painful, or cause, SOB, they require medical attention.

What are some cardiovascular symptoms that are cause for concern?

 Limb pain during activity

 Discolored or painful feet

 Pulsating or throbbing pain, esp. in the back or

abdomen

 Peripheral edema; nocturia

 Sudden weight gain

 Persistent cough

 Fatigue, dyspnea, orthopnea, syncope

 Differences in blood pressure from side to side with position changes

 Positive finding on auscultation

*There is not always pain and CV pain can be confused with TMJ

Cardiovascular pathology pain can be relieved by changing position.

False

Statin-Induced side effects

 Symptomatic Myopathy (ms soreness, pain, weakness) myositis, weakness in several muscle groups

 Unexplained fever

 Nausea and vomiting

 Signs of liver impairment:

• Dark urine

• Bilateral carpal tunnel syndrome

• Spider angiomas

• Nail bed changes

• Ascites (accumulation of fluid in the abdominal cavity)