Decreased/ loss of consciousness

Respiratory acidosis (pH <7.35 with high PaCO2) → NIV; falling consciousness/exhaustion → ICU

Encephalopathy/cerebral oedema, hypoglycaemia, rising INR/lactate → transplant centre (King's College criteria)

Metastatic spinal cord compression (back pain + neurology) → emergency MRI + dexamethasone + oncology (cross-ref acute_c

Profound dehydration/hypovolaemic shock, reduced GCS, very high osmolality; high thrombosis risk

Reduced consciousness/seizure; sulfonylurea-induced hypoglycaemia is prolonged → admit/observe

Moderate-severe HIE → THERAPEUTIC HYPOTHERMIA (cooling) within 6 hours — the therapeutic window

Increased risk of breast cancer (gynaecomastia), osteoporosis, venous thromboembolism

Severe/complicated falciparum malaria (cerebral, hypoglycaemia, acidosis, AKI, high parasitaemia) → medical EMERGENCY →

A firm, fixed, eccentric breast mass with nipple change in a man → suspected-cancer pathway (not 'just gynaecomastia')

Apnoea/severe hypoventilation; re-sedation after naloxone wears off (esp. methadone/modified-release)

Advanced field loss / very high IOP at presentation → expedite specialist treatment

Falling GCS, a new fixed dilated pupil, Cushing reflex → impending herniation; neurosurgical emergency

Exhaustion, rising CO2 with acidosis, or peri-arrest → urgent ventilatory support (NIV/intubation) and critical care

Within the thrombolysis window, large-vessel occlusion, fluctuating/worsening deficit; exclude haemorrhage first

Severe alcoholic hepatitis (Maddrey discriminant function ≥32) → consider corticosteroids; high mortality

Non-blanching rash, septic shock, reduced GCS, focal signs/seizures → do not delay antibiotics; signs of raised ICP

Reduced consciousness, neurological signs, cardiac ischaemia, pregnancy → consider hyperbaric oxygen

Ischaemic CRVO → neovascularisation of the iris (rubeosis) and neovascular glaucoma at ~3 months ('100-day glaucoma') —

Decompensation (ascites/SBP, variceal bleed, encephalopathy) → admit/treat

Hypoactive delirium is easily missed; a new acute confusion is delirium until proven otherwise — find the cause

Proliferative disease (neovascularisation) → urgent panretinal photocoagulation (blindness risk)

Empyema (pleural fluid pH <7.2 / pus / low glucose / organisms) → CHEST DRAIN — antibiotics alone won't clear it

Reduced GCS, status epilepticus, raised ICP; delay in aciclovir worsens outcome

Hard, fixed, eccentric, rapidly growing mass with nipple change → male breast CANCER (refer)

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

AIDS-defining illness, very low CD4, seroconversion illness, needle-stick/exposure (PEP within 72h)

Visual field loss from a macroprolactinoma → urgent

Within the thrombolysis window (≤4.5h), large-vessel occlusion (thrombectomy), fluctuating deficit; exclude haemorrhage

Non-blanching rash, septic shock, reduced GCS, focal signs/seizures, raised-ICP signs → do not delay antibiotics

New severe pain/soft-tissue mass in Pagetic bone → exclude osteosarcoma