Red flags

yellow flags

—A cautionary or warning symptom

Indicate the need to conduct a more formal observation/assessment

red flags

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)

Why do we need to watch for red flags?

Quicker and Sicker

• Faster DC from hospital

• Greater number of comorbidities

Natural history

Referral without thorough evaluation

Medical specialization

Progression of Disease

Screen for Flags by Looking at..

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 to Ask:

Fever, chills, sweating

Appetite loss, vomiting,

Fatigue, malaise, weakness

Excessive, unexplained weight loss or gain

Insomnia

Irritability

Changes in vital signs

Change in voice

Dizziness, falls

Compliance with medication and diet

Vital Signs

are an important way to assess health and screen for systemic illness

Heart rate, blood pressure, respiratory rate, temperature

Constitutional Symptoms

group of physical symptoms that can affect a person's overall health and well-being.

• Fever

• Diaphoresis (unexplained perspiration)

• Night sweats

• Nausea

• Vomiting

• Dizziness

• Fainting

• Diarrhea

• Pallor

• Fatigue

• Weight loss

Documentation and Liability

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

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

Make sure to document presence of symptom and communicate with supervising PT

Having a negative experience when reporting concerns is not a reason to not report future concerns

Cardiovascular

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. Therefore, the heart and diaphragm can refer pain to the shoulder.

Cardiovascular conditions

Palpitations

• Can be caused be cardiac pathology or more benign issue such as anxiety, caffeine, medicine

• Some palpitations are w/in normal function, but if lasting for hours or combined with pain, shortness of breath, fainting, etc. immediate medical attention is required.

Limb pain during activity (claudication/ cramping)

Discolored or painful feet; swelling of hands or feet

Cardiovascular symptoms

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

Accumulation of fluid in the lungs, valve abnormalities, arrhythmias

Some important notes about cardiovascular pathology…

It does not always present with pain

Can be confused with TMJ pain (does the pain in the jaw come and go with activity)

There is often a lag time of 3-5 mins between onset of activity and mid thoracic or back pain

Is not relieved by change in position

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)