Clinical red flags: observations and conditions

Clinical   kit pic

Some patients are being left at home despite having a clinical red flag, so a thorough assessment is essential to identifying the right care for your patient. A red flag is a finding through your assessment that would raise concern over the patient being unwell or a sign of systemic illness or disease. These typically indicate that there is a requirement to provide further assessment or intervention at the point of your contact with the patient.  There are also some red flags that indicate serious pathophysiology that need urgent referral and follow (such as rapid weight loss).

It is important to also consider that some patients may normally have a red flag such as altered level of consciousness if they have dementia. Each patient should be assessed balancing what is normal for them.

There are several clinical red flags to look out for with every patient: please ensure these observations and conditions are not ignored in your clinical assessment.


  • Levels of response: AVPU – voice or below / GCS 14 or below / abnormal pupil response
  • Respiratory rate: adult (12 or over) below 10 or above 30 / a baby less than a year old above 40 or below 30 / a child of one – two years above 35 or below 25 / two – five-year-old above 30 or below 25 and a child of five to 11 years above 25 or below 20
  • Oxygen saturation: adults SpO2 below 94% in critical and serious illness or hypoxaemia / SpO2 below 88% in COPD or similar / children SpO2 below 95%
  • Heart rate: adult (12 or over) above 100 or below 60 / a baby less than a year old above 160 or below 110 / a child of one – two years above 150 or below 100 / two – five-year-old above 140 or below 95 and a child of five to 11 years above 120 or below 80 
  • Blood glucose: BM below 5 or above 15 
  • Blood pressure: adult (12 or over) above 180mmHg or below 90mmHg systolic 
  • Capillary refill: adult and child central cap refill three seconds and above 
  • Temperature: adult and child below 36°C or above 38°C 


  • Obstructed airway
  • Airway not being maintained by simple measures
  • Incident where spinal injury should be considered
  • Respiratory arrest
  • Sudden onset of shortness of breath
  • Respiratory distress (patient positions, speech, excessive muscle usage, muscle recession)
  • Respiratory depression
  • Asthma or respiratory condition not responding to patient’s medication
  • Respiratory rate or SpO2 outside of baseline observations
  • Cardiac arrest
  • Chest pain not relieved by patient’s medication or atypical presentation in patient with known cardiac history
  • Pale, clammy or mottling of skin
  • Traumatic chest pain
  • Recognition features of shock
  • Bleeding is more superficial
  • Cyanosis
  • Capillary refill, blood pressure and heart rate outside of baseline observations
  • Non-blanching rash
  • Post-electric shock
  • Decreased levels of consciousness not previously diagnosed e.g. dementia
  • Diabetic hypoglycaemia
  • FAST-test positive and onset within four and a half hours
  • Status epilepticus or fit in non-epileptic
  • Reduced sensation, power or movement
  • Abnormal pupil response


  • Paediatric patients
  • Obstetric patients
  • Patient in pain which is not relieved by entonox
  • Any HCP urgent that appears to have changed since original referral
  • Patient who is found to be hyper or hypothermic with other symptoms affecting ABCD
  • Baseline observations outside of normal limits
  • Patient suffering burns
  • Trauma patient suffering long bone, pelvic or thoracic trauma or other high mechanism of injury.

Published 22nd March 2015 

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