Fever

Sepsis, gangrene/perforation, empyema → urgent surgery

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

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

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

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

Eczema herpeticum — monomorphic punched-out painful erosions, unwell/febrile (HSV superinfection): same-day, oral/IV aci

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

Raised ICP, rapid deterioration, rupture into the ventricles; immunocompromise

Pain out of proportion, rapid spread, crepitus, dusky/necrotic skin, systemic toxicity → necrotising fasciitis (surgical

Secondary bacterial infection (GAS — necrotising fasciitis), pneumonitis, encephalitis (cerebellar ataxia), neonatal/imm

Maternal sepsis, fetal compromise — expedite delivery

Severe distress, rising respiratory/heart rate then a falling rate and drowsiness/cyanosis = exhaustion → impending obst

Complicated diverticulitis (peritonitis, abscess, perforation, obstruction, fistula) → same-day surgical assessment + CT

Systemic illness, rapid spread, periocular involvement (risk to sight) → same-day admission, IV aciclovir, ophthalmology

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

Intestinal perforation/GI bleeding (third week) → surgical emergency

Associated systemic disease — bilateral hilar lymphadenopathy (sarcoidosis), IBD symptoms, recent streptococcal infectio

Meningitis/encephalitis features, focal/prolonged seizure, age <6 months or >6 years, not returning to normal

Fever + RUQ pain + raised inflammatory markers → cholecystitis (inflammation), not simple colic

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

Dehydration from poor oral intake; rare neurological disease with enterovirus 71

Strongyloides HYPERINFECTION in the immunosuppressed (e.g. before starting steroids) → screen and treat first — it can b

Pregnancy (esp. third-trimester first episode → neonatal herpes risk), urinary retention, immunocompromise, disseminated

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

Fever in an asplenic patient = potential OPSI → urgent antibiotics and assessment (medical emergency)

SPLENOMEGALY → risk of splenic rupture (avoid contact sport for ~4–6 weeks); rarely airway compromise from massive tonsi

Heart failure from valve destruction, uncontrolled infection or large/embolising vegetations → early surgery

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