Vomiting

Painful red eye + haloes + nausea + fixed mid-dilated pupil = AACG — sight-threatening, refer immediately

Sepsis, gangrene/perforation, empyema → urgent surgery

ST elevation / new LBBB → primary PCI within 120 min of first medical contact (thrombolysis if PCI not available in time

Hypoglycaemia, coagulopathy, encephalopathy → fulminant hepatic failure; maternal and fetal emergency

Severe pancreatitis (Glasgow ≥3 / persistent organ failure) → HDU/ITU, high mortality

Refractory shock with low Na+ / high K+ / low glucose → give hydrocortisone without waiting for cortisol result

Symptomatic postural hypotension with falls; severe gastroparesis; coexisting cardiac autonomic involvement

Sepsis/mediastinitis → emergency resuscitation + surgery (high mortality, time-critical)

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

Neonatal salt-wasting adrenal crisis — hyponatraemia + hyperkalaemia + hypoglycaemia + shock is a medical emergency

Reduced consciousness, shock, K+ <3.5 before insulin, severe acidosis (pH <7.1) → HDU/ICU

E. coli sepsis in a jaundiced neonate on milk → consider galactosaemia

Strangulation (tender, irreducible, red, painful lump + obstruction/peritonism) → emergency surgery

Severe dehydration, ketonuria, hyponatraemia/hypokalaemia → admit; consider Wernicke’s (give thiamine)

Acute mesenteric ischaemia (pain out of proportion + raised lactate ± AF) → emergency surgery/revascularisation — high m

Strangulation/ischaemia (constant pain, peritonism, fever, raised lactate) → emergency surgery

Significant/ongoing bleeding → endoscopic therapy

Choriocarcinoma (malignant GTD), thyroid storm, early/severe pre-eclampsia before 20 weeks

Acute abdomen with an adnexal mass — emergency; delay risks ovarian loss

Severe dehydration, electrolyte derangement → resuscitate BEFORE surgery

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

Severe acidosis, very high levels, altered consciousness, seizures, renal failure → haemodialysis

It is a CLINICAL diagnosis → immediate surgical exploration; do NOT delay for an ultrasound — the testis infarcts within

Hypotension + multi-organ failure → emergency resuscitation/critical care

DKA (ketonaemia + acidosis + hyperglycaemia) → emergency (see acute care)

Shock, ongoing haematemesis, chronic liver disease (variceal), low Blatchford threshold for admission

Active variceal haemorrhage → major haemorrhage protocol; high mortality

Central features (HINTS exam suggesting stroke — direction-changing nystagmus, normal head-impulse test, skew deviation)

Apnoea/cyanosis in an infant; feeding difficulty → admit

Generalised peritonitis (perforation) → emergency