Any of the following is acted on immediately. Life-threatening emergencies are escalated to EMS first; provider notification and orders follow.
Red flags — act immediately
Heavy vaginal bleeding with light-headedness, pallor, or hemodynamic change → activate EMS.
Perineal or vulvar pain out of proportion with discoloration, crepitus, and systemic toxicity → necrotizing perineal infection — activate EMS (cross-reference External Genitalia).
Severe pelvic pain with fever → possible pelvic inflammatory disease, abscess, or ovarian torsion — urgent evaluation; escalate to EMS for hemodynamic change.
Any vaginal bleeding after menopause → malignancy until excluded; notify for urgent evaluation.
A post-operative vaginal-cuff dehiscence or significant hemorrhage → notify urgently; escalate to EMS for significant bleeding or evisceration.
A pessary that cannot be removed with erosion or a foul discharge → notify urgently.
