Escalation must follow the patient's orders and agency policy; the following are representative thresholds.
🚩 Red flags — escalate
Signs of opioid-related respiratory depression or unarousable sedation — hold the opioid, support the airway, and activate emergency response (911); administer naloxone if ordered and available.
New severe or sudden pain inconsistent with the known condition — urgent evaluation for an acute process.
Pain with a new neurologic deficit (for example new weakness, numbness, or bowel or bladder change suggesting cord compression) — urgent or emergency evaluation.
New severe chest pain or severe abdominal pain — escalate per the relevant Body System red flags and emergency criteria.
Uncontrolled pain causing acute functional collapse or inability to perform basic activities — provider notification for regimen change.
Signs of a serious adverse drug event (for example serotonin toxicity with certain combinations) — urgent evaluation.
