12. Red flags and emergency escalation
Any of the following is acted on immediately. EMS is activated first for life threats; provider notification and orders follow. In older adults, new confusion is treated as a potential sign of serious infection.
Red flags — act immediately Fever, chills, new confusion, hypotension, or flank pain with a urinary source → urosepsis — obtain vitals and activate EMS / arrange urgent evaluation; elders often present with confusion rather than classic symptoms. Suprapubic distension with inability to void and pain, and catheterization is not possible → acute retention with obstruction — activate EMS / urgent provider for decompression. Absent catheter output with a distended bladder → obstruction; troubleshoot kinks and irrigate per order, and notify urgently if not resolved. Gross hematuria with clots, or any hematuria on an anticoagulant → notify the provider; apply the Anticoagulation overlay and monitor for clot retention. Decreasing urine output with rising weight, increasing edema, and dyspnea → acute kidney injury or fluid overload — notify urgently; for respiratory distress activate EMS (cross-reference Heart Failure overlay). A catheter site with purulence and fever, or rigors after catheter manipulation → catheter-associated infection; notify for evaluation and possible exchange. |
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