Escalation must follow the patient's orders and agency policy; the following are representative thresholds.
🚩 Red flags — escalate
Signs of an acute abdomen — a rigid, board-like abdomen, severe pain, rebound tenderness, or marked guarding — activate emergency response (911) for possible perforation or peritonitis.
GI bleeding — hematemesis, coffee-ground emesis, melena, or significant hematochezia — activate emergency response (911), especially in a patient on anticoagulation (see the Anticoagulation overlay).
Signs of bowel obstruction — severe distension, persistent vomiting, and no bowel movement or flatus with severe pain — urgent evaluation or emergency response per severity.
An ischemic stoma (dusky or black) or a significantly compromised stoma — urgent evaluation.
Severe dehydration from vomiting or diarrhea with hemodynamic change — urgent or emergency evaluation (detail in Hydration).
Signs of perforation or peritonitis — a rigid abdomen with systemic signs — activate emergency response (911).
