12. Red flags and emergency escalation
Escalation must follow the patient's orders and agency policy; the following are representative thresholds.
🚩 Red flags — escalate The six P's of acute limb ischemia — pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia — a limb-threatening emergency: activate emergency response (911) and notify the provider, and maintain the extremity per the patient-specific order while awaiting EMS. A sudden cold, pale, painful, pulseless extremity — possible acute arterial occlusion: activate emergency response. New unilateral calf swelling, warmth, tenderness, and erythema — possible deep-vein thrombosis: urgent provider notification; activate emergency response if signs of pulmonary embolism (dyspnea, chest pain, tachycardia) are present. Signs of major bleeding on anticoagulation (gastrointestinal bleeding, severe epistaxis, hematuria with clots, head injury) — emergency or urgent evaluation per severity. Rapidly spreading erythema, warmth, fever, or purulent ulcer drainage — possible cellulitis or infected ulcer: urgent provider notification. |
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