New severe or sudden pain with instability (chest pain, acute abdomen, a cold/pulseless limb, a suspected fracture) — assess and escalate/transfer per the clinical references.

Opioid oversedation / respiratory depression — declining respirations, sedation, or SpO₂ — hold the opioid, stimulate, support, consider naloxone per order, and escalate.

Pain unresponsive to the ordered regimen — notify the provider for re-evaluation rather than repeating ineffective doses.

Neuropathic red flags (new weakness, bowel/bladder change with back pain) — escalate for evaluation.