Cold/ red/ painful digits

Paralysis, fixed mottling or muscle tenderness = threatened/non-viable limb → emergency revascularisation or primary amp

Mastoiditis (post-auricular swelling/erythema pushing the pinna forward), intracranial spread, or a child who is systemi

Periorbital swelling/erythema, proptosis, painful/restricted eye movements or visual change → ORBITAL CELLULITIS; severe

Rest pain, gangrene, or rapidly deteriorating ischaemia = critical limb ischaemia → urgent vascular referral

Extensive mucosal involvement, skin pain, sheet-like detachment or systemic toxicity → reconsider SJS/TEN (a different,

Severe abdominal pain (intussusception), GI bleeding, hypertension or significant proteinuria (renal involvement)

Pituitary APOPLEXY (sudden severe headache, visual loss, ophthalmoplegia, hypotension) → emergency (steroids + neurosurg

Myxoedema coma (hypothermia, bradycardia, reduced consciousness, hyponatraemia) → emergency

Focal chest signs/consolidation, high CURB-65 features, or systemic sepsis → it's pneumonia → treat accordingly

Do not miss appendicitis — if in doubt, observe/image/operate

ANY of: proptosis, painful/restricted eye movements, reduced acuity/colour vision, RAPD, marked systemic illness → ORBIT

Digital ulceration/critical ischaemia → urgent treatment (secondary Raynaud's)

Obstructive causes (tension pneumothorax, tamponade, massive PE) need immediate mechanical relief, not just fluids

Acute chest syndrome (hypoxia + new infiltrate) → emergency (oxygen, analgesia, antibiotics, transfusion/exchange)

Fever, systemically unwell, unable to weight-bear, raised inflammatory markers → treat as septic arthritis until exclude

Central features (HINTS exam suggesting stroke — direction-changing nystagmus, normal head-impulse test, skew deviation)

Dendritic ulcer on fluorescein, vesicular lid rash, or marked photophobia/visual loss → HSV — refer same-day, do NOT giv

Life-threatening features (silent chest, SpO2 <92%, exhaustion, normal/rising PaCO2) → ITU/anaesthetic involvement — a n

NEW change in bowel habit, rectal bleeding, weight loss, anaemia, abdominal/rectal mass, age ≥50 → investigate for color

Anorexia red flags: BMI <13, rapid weight loss, bradycardia <40, hypotension, hypoglycaemia, prolonged QTc, hypokalaemia

Wet or gas gangrene with sepsis → surgical emergency: urgent debridement/amputation + broad-spectrum antibiotics + resus

Deterioration with new consolidation → secondary bacterial pneumonia (esp. Staph. aureus) → antibiotics

Red-flag sepsis / septic shock → SEPSIS SIX within 1 hour; lactate >2 (and especially >4) signals hypoperfusion

Young patient, bilateral, sensory loss, or other neurology → suspect MS or a structural lesion (atypical features) → MRI

Angioedema with airway or breathing compromise / anaphylaxis → IM adrenaline

Vernal/atopic keratoconjunctivitis with shield ulcer, photophobia and reduced vision → ophthalmology (sight-threatening)

Unilateral symptoms/bleeding → exclude a structural or neoplastic cause; poorly controlled rhinitis worsens asthma

Generalised peritonitis (perforation) → emergency

Hyperacute copious purulent discharge with rapid corneal involvement → gonococcal — emergency (corneal perforation risk)

Spread to periorbital/orbital cellulitis (lid oedema, proptosis, painful eye movements) → admit