12. Red flags and emergency escalation
Escalation must follow the patient's orders and agency policy; the following are representative thresholds.
🚩 Red flags — escalate New or ongoing chest pain or pressure, or other suspected ACS symptoms (diaphoresis, dyspnea, radiation) — activate emergency response (911) promptly; administer prescribed nitroglycerin per the patient-specific order while awaiting EMS. Do not delay EMS to complete repeated doses. Acute severe dyspnea, pink frothy sputum, or SpO2 < 90% on usual settings — emergency evaluation for acute pulmonary edema. Syncope, near-syncope, or symptomatic hypotension — immediate safety intervention and provider escalation. New unilateral weakness, facial droop, or speech change — activate the stroke response (especially with atrial fibrillation or anticoagulation). SBP < 90 or > 180–200 with symptoms; HR > 120 sustained or < 50 with symptoms; or a new sustained irregular rhythm with symptoms — urgent provider notification per parameters. Heart-failure decompensation: weight gain > 2–3 lb/day or > 5 lb/week, new orthopnea or PND, escalating edema, or new crackles — provider notification and possible same-day intervention. Anticoagulation: signs of major bleeding (GI bleed, severe epistaxis, hematuria with clots, head injury) or thromboembolic signs — emergency or urgent evaluation per severity. |
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