Cough

Any stridor, drooling or tripod posture = impending airway obstruction → do NOT lie the patient down, examine the throat

Cardiogenic shock (hypotension + poor perfusion), exhaustion/falling consciousness → critical care, consider CPAP/ventil

Massive haemoptysis → emergency (bronchial artery embolisation)

Apnoea, grunting, marked recession, <50% feeds, sats <90%, dehydration → admit

Exacerbation with type 2 respiratory failure (CO2 retention, acidosis) → controlled oxygen (88–92%) + consider NIV (BiPA

Hypoxia / respiratory failure → oxygen + escalation (cross-ref respiratory failure); VTE risk → thromboprophylaxis

Severe: stridor at rest, marked recession, agitation/drowsiness, cyanosis → admit

Rapidly progressive GN — rising creatinine + active sediment ± haemoptysis (pulmonary-renal syndrome) → urgent immunolog

AIDS-defining illness (PCP, cryptococcal meningitis, cerebral toxoplasmosis, CMV retinitis) → urgent specialist treatmen

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

Acute exacerbation of IPF (rapid deterioration) → high mortality, specialist care

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

Haemoptysis/persistent cough/weight loss in a smoker → urgent 2-week-wait referral + urgent CXR (NICE NG12)

Complications: otitis media, pneumonia, encephalitis, (late) SSPE; immunocompromised/pregnant

Measles in pregnancy/immunosuppressed, or with encephalitis/pneumonia → severe; rubella exposure in a pregnant woman → u

Trismus + "hot-potato" voice + uvular deviation → quinsy; drooling/stridor/unable to swallow → epiglittitis/airway; unil

CURB-65 high (3–5) / sepsis → hospital/ICU assessment; respiratory failure → oxygen/ventilatory support

TB meningitis / disseminated (miliary) TB → urgent treatment; airborne isolation for suspected active pulmonary TB

Cardiac sarcoid (arrhythmia/heart block), neurosarcoidosis, or sight-threatening uveitis → urgent specialist treatment

Lactate >2, systolic BP <90 / MAP <65, reduced GCS, mottling, anuria → escalate to critical care

Following trauma with no posterior border visible, or with reduced vision/proptosis → exclude globe rupture/orbital inju

Visible haematuria, recurrent UTI, pain, palpable bladder/mass, or new symptoms >50y → exclude malignancy/retention befo

Pulmonary-renal syndrome (haemoptysis + AKI/active sediment) → rapidly progressive glomerulonephritis → emergency immuno

Apnoea/cyanosis in an infant; feeding difficulty → admit

Older patient with rapid weight loss and short history → exclude PSEUDOACHALASIA (tumour at the GOJ) with endoscopy

Exhaustion, cyanosis, falling GCS, silent chest = peri-arrest airway → immediate senior airway support

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

Frequent exacerbations → optimise inhaled therapy and address the eosinophilic component

New seizure in an adult, progressive focal deficit, raised-ICP features → urgent imaging; impending herniation

Massive haemoptysis or a pneumothorax (from bronchiectasis) → emergency