Facial/ periorbital swelling

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

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

Forehead sparing (central cause — stroke), bilateral palsy, other cranial nerves, vesicles (Ramsay Hunt), no recovery →

Airway/inhalation injury (early intubation before swelling), circumferential burns (escharotomy), large %TBSA, electrica

Carcinoid crisis (peri-procedure) → octreotide cover

Acute symptomatic hypocalcaemia (tetany, seizures, laryngospasm, long QT) → IV calcium gluconate

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

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

Arterial/venous thrombosis (stroke, MI, Budd-Chiari, splanchnic) or major bleeding

Any cranial nerve palsy, severe pain out of proportion, or failure of "otitis externa" to settle in a diabetic → emergen

Critical neonatal PS → prostaglandin (duct-dependent) + intervention

Ocular rosacea with eye pain or visual disturbance (keratitis) → ophthalmology; disfiguring rhinophyma

Stridor/airway compromise, cerebral oedema (severe headache, confusion) → emergency treatment

Scleroderma renal crisis: accelerated hypertension + acute kidney injury → urgent ACE INHIBITOR (the treatment of choice

Visual field loss (bitemporal hemianopia) / pituitary apoplexy → urgent

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

Severe hypercalcaemia (≥3.5 / symptomatic) → IV fluids + treat the cause; hypercalcaemia of malignancy → IV fluids then

Stroke/TIA from dissection → urgent stroke pathway; thrombolysis decisions need imaging confirmation

Facial nerve palsy, vertigo, severe headache or meningism = intracranial/labyrinthine complication → urgent ENT/neurosur

Persistent mouth ulcer/patch >3 weeks, hoarseness >3 weeks, unexplained neck lump, dysphagia, or a salivary lump with fa

Change in size/shape/colour, asymmetry, irregular border, bleeding, or the "ugly duckling" lesion → excise to exclude me

Numerous, large or facial mollusca in an adult → test for HIV/immunosuppression

SCID (severe combined immunodeficiency) in infancy → paediatric emergency (avoid live vaccines; needs transplant)

Pregnancy exposure (fetal hydrops/anaemia); sickle cell/hereditary spherocytosis (APLASTIC crisis); immunocompromised (c

Any asymmetric/unilateral sensorineural hearing loss → MRI to exclude this; brainstem compression if large

Lyme carditis (heart block) or neuroborreliosis → specialist treatment (IV ceftriaxone)

Severe nodulocystic/conglobate acne or scarring or major psychological impact → refer; acne fulminans (systemic upset, u

Haemodynamic compromise/obstructive shock, especially after trauma or in known dissection/post-MI → emergency echo + per

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

RED-FLAG features that mean refer/echo (NOT innocent): diastolic murmur, pansystolic, loud (≥grade 3)/thrill, harsh, abn