Reduced/ change in foetal movements

Acute anterior uveitis (painful red eye, photophobia) → same-day ophthalmology

B12-deficiency neurology (subacute combined degeneration) → urgent B12 replacement; do NOT give folate first

Urinary retention/incontinence, saddle anaesthesia, bilateral leg symptoms or reduced anal tone → IMMEDIATE MRI and emer

Late presentation; bilateral disease (subtle); irreducible dislocation

Foot ulcer with infection/ischaemia, or a warm swollen foot (Charcot) → urgent foot-protection/multidisciplinary team

Established Eisenmenger CONTRAINDICATES shunt closure (the shunt is now offloading the right heart) — the window was mis

Priapism >4 h = urological EMERGENCY → aspiration ± intracavernosal phenylephrine without delay (ischaemia → permanent e

Steroid use on an undiagnosed dendrite → geographic ulcer (sight-threatening) — fluorescein every red eye before steroid

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

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

Central prolapse → cauda equina syndrome (bilateral symptoms, saddle anaesthesia, bladder/bowel dysfunction) → emergency

Any contact-lens wearer with a red painful eye → assume microbial keratitis until excluded — same-day referral

Reduced vision/colour, RAPD, or proptosis = optic-nerve threat — emergency

UNILATERAL persistent OME in an ADULT → examine the postnasal space to exclude a nasopharyngeal carcinoma obstructing th

Perforation with vertigo/sensorineural loss after trauma → suspect ossicular/inner-ear injury (perilymph fistula) → urge

Rapidly progressive/ascending weakness (GBS), autonomic involvement, foot ulceration (diabetic insensate foot)

Bilateral disease → consider epiphyseal dysplasia/hypothyroidism; older child with acute slip = SUFE

TENSION pneumothorax (haemodynamic compromise, tracheal deviation) → IMMEDIATE needle/finger decompression then chest dr

BILATERAL symptoms, saddle anaesthesia, bladder/bowel dysfunction → cauda equina (emergency); progressive weakness; canc

Field loss, reduced acuity, or fundoscopic detachment/vitreous haemorrhage → same-day retinal-surgery referral

Persistent unilateral parotid enlargement/lymphadenopathy → exclude B-cell (MALT) lymphoma (markedly increased risk)

NEW squint or one with LEUKOCORIA / absent red reflex → exclude retinoblastoma and congenital cataract — urgent referral

Hypercyanotic 'tet' spell → knee-chest position, oxygen, morphine, IV fluids, beta-blocker/phenylephrine — can be life-t

Contact-lens wearer with disproportionate pain and a poor response to standard antibacterials → suspect Acanthamoeba — u

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

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

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

Regression of skills, or coexisting epilepsy, ADHD, anxiety, self-injury

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

Mania with risk to self/others, severe depression, or psychosis → urgent mental health assessment / admission