10 conditions (and 20 red flag symptoms) that mean go to A&E
What is the purpose of A&E? A&E (accident and emergency) is for serious injuries and life-threatening emergencies only. It is also known as the emergency department (ED), emergency room (ER) or casualty.
Conditions that require A&E can loosely be divided into 5 groups:
- Chest problems
- Abdominal and back problems
- Brain and head problems
- Sepsis
- Other problems.
Within the 5 groups, there are 10 conditions that A&E is especially designed for. We will now go through them and their 20 red flag symptoms (in red) – i.e. important symptoms (that you should not ignore), that may indicate you have one of these conditions, and should go to A&E.
One. Chest problems
1. Chest pain
- Can be due to a heart attack (especially if chest pain spreads down the left arm, or into the jaw or back)
- Can also be due to a PE, pneumonia, pneumothorax (collapsed lung) or aortic dissection
2. Shortness of breath
- Especially if not able to get words out, choking or gasping
- Can be due to PE, asthma/COPD, arrhythmia or heart failure
Two. Abdominal and back problems
3. Abdominal pain or heavy bleeding or back pain
- Abdominal pain – especially if it is new, severe and of rapid onset (can be pancreatitis, perforated ulcer, appendicitis, ectopic pregnancy or obstructed bowel)
- Bleeding – may be vomited or coughed up, or rectal or vaginal
- Back pain – especially if new and severe (can be spinal cord compression or cauda equina syndrome, if legs weak or reduced sensation or loss of control of poo or wee)
Note. If a woman of child-bearing age .. are they pregnant (e.g. internal bleeding from ectopic pregnancy)?
Three. Brain or head problems
4. Weakness on one side of body, or facial drooping on one side, or difficulty speaking
- These are the three main ways a stroke presents
- The FAST acronym (Face, Arms, Speech, Time (to go to A&E) is a test to quickly identify if someone is having a stroke
5. New confusion (delirium), collapse or drowsiness or headache/loss of vision
- E.g. cannot be sure of own name or age, cannot get up after fall, or cannot be roused after shaking
- Many causes including prescribing errors, infection, body chemistry disturbance (e.g. diabetes or AKI) and strokes
- Headache can be due to meningitis, subarachnoid or brain haemorrhage – especially if associated with neck stiffness and disliking light
- Loss of vision has many causes – go to the nearest A&E with an ‘eye casualty’ (ring up first)
6. Seizure (epileptic fit)
- Shaking or jerking because of a fit, or being unconscious (cannot be woken up) post-fit
- If it goes on for more than 30 minutes this is called status epilepticus and needs treatment
7. Choking or rapid swelling
- Choking – on liquids or solids (can be due to something you have swallowed)
- Rapid swelling – of the lips, mouth, throat or tongue (this can be a severe allergic reaction, called anaphylaxis)
Four. Sepsis
8. Suspected sepsis (severe infection)
- Sepsis can present in a variety of ways:
- High temperature (fever) or low body temperature (hypothermia)
- Shortness of breath
- A high heart rate or weak pulse
- Confusion (new)
- Clammy or sweaty skin, cold, pale, or mottled skin, rash
- Extreme pain or discomfort, severe muscle pain
- Can be due to infection in: chest (pneumonia), brain (meningitis or encephalitis), abdomen (gall bladder), legs (cellulitis), viral infections (severe flu or COVID-19), bladder (urinary tract infection, UTI).
Five. Other problems
9. Severe injury or burns or suspected fracture
- After a serious accident (e.g. RTA or work) or assault
- Fractured neck of femur is common in the elderly
10. Suicide attempt
- By taking something or self-harming.
Summary
We have described 10 conditions (and 20 red flag symptoms) that mean go to A&E. We hope it has been helpful.
Other resources
What is a red flag symptom?
What are 10 red acute and chronic flag symptoms?
