Warning Signs: Indications to Seek Urgent Medical Attention Among Adults
Mr. Sharath (name changed), a 30 year old gentleman, living with his parents, developed severe chest pain around 7AM while at home. He thought the pain was due to indigestion (Gastric) and self-administered some antacids at home. He also tried having a light breakfast. He postponed coming to the hospital till 11AM by when the pain had become unbearable. Rather than go directly to the Emergency Department, he chose to go to the Cardiologist in the OPD. On meeting the Cardiologist, an urgent ECG (adjacent room) was requested. He collapsed in the ECG room. Immediate Cardio-Pulmonary Resuscitation was initiated. He was immediately shifted to the Cardiac catheterization suite to attempt an Angiogram to open the blocked Coronary artery (blood vessel taking blood to the heart). The angiogram revealed a complete blockage of the main trunk of the Left Coronary artery. Repeated attempts to open the blocked blood vessel were unsuccessful and he was declared dead after 1 hour.
Patients often delay / postpone seeking medical attention. This is a well-recognized cause for negative or poor outcomes in critically ill patients admitted to hospitals. The poor / negative outcomes range from longer hospital stay, higher cost of care to death.
Warning signs are the symptoms that signal a possible life-threatening condition that requires immediate medical attention. These symptoms help distinguish a patient who should seek medical attention immediately from those who are manageable at home.
Warning signs not only apply to acute conditions like respiratory infections, chest pain, flu, trauma (falls, accidents, cuts etc.) diarrhoea, etc., they also signal critical deterioration in chronic conditions like cancer, heart failure, renal failure, liver failure etc. Awareness and detection of the warning signs, and seeking medical attention early has the potential to significantly improve the outcome and even survival from the illness.
For the ease of remembering the Warning Signs, they have been arranged in the order ABCDE –
A – Allergies and Alertness B – Breathing and Bleeding C – Cardiac / Chest pain
D – Dehydration E – Exhaustion F – Fever
A: Anaphylaxis (Severe Allergy): Allergic reactions happen in some individuals when their body (inside or surface) encounters a foreign substance (Allergen). Common allergens include pollen, bee venom, drugs, nuts etc. Contact with the allergen results in triggering the immune system in the individual. Majority of allergic reactions are mild and effect the skin, sinuses, respiratory tract, etc. Anaphylaxis is a very severe form of allergic reaction that can be life-threatening that requires immediate medical attention.
Warning signs of an Anaphylaxis that can develop rapidly include:
- Swelling of the face, lips, or throat
- Difficulty breathing or swallowing
- Hives, itching, or a sudden rash
- Dizziness or fainting or collapse
- ALERTNESS:
Change in alertness (wakefulness / behaviour) indicates involvement / impairment of the brain. These could result from infections, trauma (injury), stroke, etc.
Warning signs of significant impairment of the brain include:
- Drowsiness / Confusion / memory loss / agitation – new onset or worsening
- Giddiness – new onset or worsening
- Sudden changes in vision (blurred vision, inability to see in one / both eyes, seeing flashes of light, double vision etc.)
- Sudden or Severe Headache – often described as the worst headache of one’s life (Thunderclap Headache)
- Headache with vision changes, confusion, or difficulty speaking
- Weakness/numbness of any limb (upper / lower / both) on either side of the body
- Stiff neck
- Fits (Seizures) – focal or generalized
- Slurred speech
- BREATHING:
Changes in breathing indicate involvement of the lungs or breathing passages or both. These could result from infections (viral, bacterial, fungal etc.), injury, allergic reactions, worsening of existing diseases like asthma / COPD, cardiac conditions etc.
Warning signs of significant impairment of the lungs /breathing passages include:
- Fast (>24 breaths/minute) or shallow breathing or both – new onset / worsening
- Sudden / severe breathlessness (difficulty in breathing) – new onset / worsening
- Drowsiness or confusion associated with either of the above two conditions
- Severe Wheezing not responding to nebulizers – new onset / worsening
- Bluish / greyish discolouration of lips / fingers
- Severe persistent cough
- Significant blood coughed out following coughing
- Low SpO2 (Oxygen saturation of blood measured with a Pulse Oximeter) ≤95%
- Bleeding (significant)
Bleeding can either be external – does not stop with pressure (visible) or internal (apparent from blood during cough or blood in vomitus or blood in the stools) etc. Significant loss of blood can result in drop in blood pressure or shock which can be life threatening.
Warning signs of significant blood loss include:
- Significant loss of blood (> 200 ml blood loss)
- Signs of shock – pale skin, rapid heartbeat, and weakness
- Cardiac Chest pain (or discomfort or other Cardiac signs)
Cardiac Chest pain may indicate coronary artery blockage (heart attack) which causes injury or death of the heart muscle. Treatment for a heart attack is to try to restore blood supply to the heart muscle as soon as possible to prevent permanent damage / death of the muscle supplied by the blocked blood vessel.
Chest pain or discomfort, irrespective of age in adults, especially when it occurs suddenly, should never be ignored. The treatment Chest pain is often confused with “Gastric” pain. This is a significant cause for patients delaying seeking medical attention which results in significant number of young patients being brought dead to hospital.
Warning signs of Cardiac chest pain (Heart attack) or cardiac issues include:
- Sudden onset, central, crushing chest pain – could be severe / discomfort – persisting
- Chest pain that radiates to the jaw, left shoulder or back
- Chest pain that lasts more than 10 minutes
- Chest pain that is associated with sweating, breathlessness or giddiness
- Breathlessness or rapid breathing
- Irregular / feeble pulse
- Low SpO2 ≤95%
- DEHYDRATION (severe):
Dehydration can result from blood loss, severe diarrhoea / vomiting, inadequate intake of fluids, significant sweating, passing significant urine, etc. Severe dehydration can result in drop in blood pressure, decreased blood supply to vital organs like the brain / kidney etc which can result in temporary or permanent damage to these organs and even death. This requires urgent rehydration with intravenous fluids.
Warning signs of severe dehydration include:
- Diarrhoea / vomiting – more than 5 times
- Inadequate oral intake
- Increased thirst
- Dry tongue
- Dark coloured urine or decreased urine production
- Loss of skin tone
- Drowsiness
- EXHAUSTION (severe):
Severe exhaustion has been found to be one of the most important warning sign. It is an indication of impending failure of multiple organs (especially in severe infection secondary to bacterial, viral, etc. infections).
Warning sign of severe exhaustion includes:
- Inability to get out of bed or mobilize
- Severe body ache
- Inability to eat / drink
- Drowsiness
F. FEVER (high grade):
High grade Fever (>102F) that is resistant to standard doses of simple analgesics (Paracetamol) is a definite indication to seek medical help. Stronger analgesics (NSAID – non-steroidal) should be avoided without medical advice especially by patients with existing kidney disease, diabetics and patients with likely dehydration.
Warning signs of high grade fever include:
- Accompanied by stiffness of neck (inability to touch the chin to the chest)
- Accompanied by sensitivity to light
- Accompanied by headache
- Accompanied by rash that does not fade when pressed
*Caution: Warning signs discussed here are only for adults. Warningsigns in children and elderly are often significantly different from that of healthy adults. In view of the lower physiological reserves of the elderly, lower thresholds to seek medical attention should be used. ,
Conclusion: Awareness of the Warning Signs that warrant urgent medical attention is critical. Recognizing these signs and acting quickly can prevent serious complications, reduce the severity of an illness or injury, and even save lives. Always err on the side of caution—if something feels wrong or symptoms are severe and sudden, seeking medical help immediately is the best course of action. A stich in time saves nine.