CONFUSION

As the NHS points out
“Call 999 for an ambulance if someone suddenly becomes confused. Many of the causes of sudden confusion need assessment and treatment as soon as possible. In some cases, it may be life threatening.”

• Sudden confusion (delirium) Sudden confusion (delirium) – NHS
• Stroke Stroke – NHS
• Encephalitis Encephalitis – NHS
• Sepsis Symptoms of sepsis – NHS 
  For more information on sepsis see under Spotting Sepsis. 

Also consider confusion after a head injury as a reason to call 999

As the NHS suggests after a head injury
“Symptoms of a subdural haematoma can include:

• a headache that keeps getting worse
• feeling and being sick
• confusion
• personality changes, such as being unusually aggressive or having rapid mood swings
• feeling drowsy
• loss of consciousness

The symptoms can develop soon after a severe head injury (acute subdural haematoma), or very occasionally a few days or weeks after a more minor head injury (subacute or chronic subdural haematoma).”

If you develop the symptoms above any time after a minor head injury, you should also go to your nearest A&E department or call 999 for an ambulance as soon as possible.” Subdural haematoma Subdural haematoma – NHS

SPEECH problems

The NHS points out speech changes which can be found with a stroke or TIA
“Their speech may be slurred or garbled, or the person may not be able to talk at all despite appearing to be awake; they may also have problems understanding what you’re saying to them.”

If you think someone is having a stroke or TIA then call 999

• Stroke Stroke – NHS
• Transient ischaemic attack (TIA) Transient ischaemic attack (TIA) – NHS
• Guillain-Barré syndrome Guillain-Barré syndrome – NHS
• Sepsis Symptoms of sepsis – NHS 

SEIZURE

As the NHS points out
You should call 999 for an ambulance if you know it’s their first seizure or it’s lasting longer than 5 minutes.

• What to do if someone has a seizure (fit) What to do if someone has a seizure (fit) – NHS
• Epilepsy Epilepsy – NHS

WEAKNESS

As the NHS suggests
“Call 999 for an ambulance if you or someone else has paralysis or weakness that:

• starts suddenly
• starts after a serious injury, such as a fall or car crash
• causes problems with speech, breathing or swallowing”

As the NHS suggests with the weakness associated with a stroke
“Face – the face may have dropped on 1 side, the person may not be able to smile, or their mouth or eye may have dropped.
Arms – the person with suspected stroke may not be able to lift both arms and keep them there because of weakness or numbness in 1 arm.”

If you think someone is having a stroke or TIA then call 999

• Paralysis Paralysis – NHS 
• Transient ischaemic attack (TIA) Transient ischaemic attack (TIA) – NHS
• Stroke Stroke – NHS 
• Guillain-Barré syndrome Guillain-Barré syndrome – NHS

COLLAPSE

As the NHS suggests call 999
“Someone faints and they:

• cannot be woken up after 1 minute
• have severely hurt themselves from a fall
• are shaking or jerking because of a seizure or fit “
  Fainting Fainting – NHS , Anaphylaxis Anaphylaxis – NHS

FALLS

As the NHS suggests
“If you’re hurt or unable to get up, try to get someone’s attention by calling out for help, banging on the wall or floor, or using your personal alarm or security system (if you have one). If possible, crawl to a telephone and dial 999 to ask for an ambulance.” Falls Falls – NHS

SHORTNESS OF BREATH

Shortness of breath when combined with other symptoms or signs may indicate a serious condition. Some important examples included by NHS choices include:

HEART ATTACK

Call 999 if
“You’re struggling to breathe or you have sudden shortness of breath and:

• your chest feels tight or heavy
• you have pain that spreads to your arms, back, neck and jaw
• you feel sick or are being sick

You could be having a heart attack or a problem with your lungs or airway. Call 999 immediately as you need treatment in hospital. Heart attack Heart attack – NHS

HEART FAILURE

“The main symptoms of heart failure are:

• breathlessness after activity or at rest
• feeling tired most of the time and finding exercise exhausting
• swollen ankles and legs

Call 999 for an ambulance or go to your nearest A&E department as soon as possible if you have sudden or very severe symptoms.” Heart failure Heart failure – NHS

PALPITATIONS

 As the NHS suggests call 999
“If you have Heart palpitations (heartbeats that suddenly become more noticeable) and severe shortness of breath “

• Heart palpitations and ectopic beats Heart palpitations and ectopic beats – NHS (www.nhs.uk)
• Supraventricular tachycardia (SVT Supraventricular tachycardia (SVT) – NHS (www.nhs.uk)

PULMONARY EMBOLUS

Call 999 or go to A&E if:

• you have severe difficulty breathing
• your heart is beating very fast
• someone has passed out

These could be signs of a pulmonary embolism or another serious condition.

• Pulmonary embolism Pulmonary embolism – NHS 
• DVT (deep vein thrombosis) DVT (deep vein thrombosis) – NHS

PNEUMONIA

“Call 999 for an ambulance if you or someone you care for:

• are struggling to breathe
• are coughing up blood
• have blue lips or a blue face
• feel cold and sweaty, with pale or blotchy skin
• have a rash that does not fade when you roll a glass over it
• collapse or faint
• become confused or very drowsy
• have stopped peeing or are peeing much less than usual”

Pneumonia Pneumonia – NHS

SEPSIS

As the NHS suggests one of the symptoms of sepsis can be:

• difficulty breathing, breathlessness or breathing very fast

Call 999 if sepsis is a possibility.

• Sepsis Symptoms of sepsis – NHS 

For more information on sepsis see under Spotting Sepsis.

ANAPHYLAXIS

Call 999 for anaphylaxis for which symptoms might include “breathing difficulties – such as fast, shallow breathing and wheeze”

As the NHS suggests
“Anaphylaxis usually develops suddenly and gets worse very quickly.
The symptoms include:

• feeling lightheaded or faint
• breathing difficulties – such as fast, shallow breathing
• wheezing
• a fast heartbeat
• clammy skin
• confusion and anxiety
• collapsing or losing consciousness

There may also be other allergy symptoms, including an itchy, raised rash (hives); feeling or being sick; swelling (angioedema) or stomach pain.” Anaphylaxis  Anaphylaxis – NHS

OTHER CONDITIONS

There are a number of common conditions relating to the chest which may need an emergency response including
Asthma (includes when to call 999) – Asthma – Asthma attacks – NHS 

An overview of Shortness of breath including less serious causes of shortness of breath (such as panic attack) are included here: Shortness of breath Shortness of breath – NHS

Infections causing serious illness are not common but knowing what you are looking for can ensure you attend A&E at the right time.

HIGH TEMPERATURE

The association of a high fever with other symptoms can indicate a serious condition as covered below.

SEPSIS

As the NHS suggests for sepsis:
Call 999 if an adult or older child has any of these symptoms of sepsis:

• acting confused, slurred speech or not making sense
• blue, pale or blotchy skin, lips or tongue
• a rash that does not fade when you roll a glass over it, the same as meningitis
• difficulty breathing, breathlessness or breathing very fast
  They may not have all these symptoms. Sepsis Symptoms of sepsis – NHS 

For more information on sepsis see under Spotting Sepsis.

INFECTIONS WHICH ALWAYS NEED AN EMERGENCY RESPONSE

Some rare but important conditions always need an urgent response

• Meningitis Meningitis – NHS 
• Necrotising fasciitis Necrotising fasciitis – NHS
• Epiglottitis Epiglottitis – NHS 
• Toxic shock syndrome Toxic shock syndrome – NHS 

INFECTIONS WHICH CAN NEED HOSPITAL ASSESSMENT IN A&E IF SEVERE

When you should attend A&E is explained in more detail under each infection

• Pneumonia Pneumonia – NHS 
• Cellulitis Cellulitis – NHS

HEAT EXHAUSTION AND HYPOTHERMIA

Under and over Heating unrelated to infection
When to call 999 for

• Heat exhaustion and heatstroke Heat exhaustion and heatstroke – NHS
• Hypothermia Hypothermia – NHS

PAIN

Pain in certain situations or when combined with other symptoms or signs may indicate an emergency response is needed and calling 999. Some important examples from NHS choices include:

CHEST PAIN

As the NHS suggest
“Call 999 if you have sudden chest pain that:

• spreads to your arms, back, neck or jaw
• makes your chest feel tight or heavy
• also started with shortness of breath, sweating and feeling or being sick
• lasts more than 15 minutes
  You could be having a heart attack. Call 999 immediately as you need immediate treatment in hospital.” Chest pain Chest pain – NHS, Heart attack Heart attack – NHS

As the NHS suggests call 999 “if you have Heart palpitations (heartbeats that suddenly become more noticeable) and chest pain or tightness “

• Heart palpitations and ectopic beats Heart palpitations and ectopic beats – NHS
• Supraventricular tachycardia (SVT Supraventricular tachycardia (SVT) – NHS

HEADACHES

As the NHS suggests after a head injury:
“Symptoms of a subdural haematoma can include:

• a headache that keeps getting worse
• feeling and being sick
• confusion
• personality changes, such as being unusually aggressive or having rapid mood swings
• feeling drowsy
• loss of consciousness
  The symptoms can develop soon after a severe head injury (acute subdural haematoma), or very occasionally a few days or weeks after a more minor head injury (subacute or chronic subdural haematoma).”
  If you develop the symptoms above any time after a minor head injury, you should also go to your nearest A&E department or call 999 for an ambulance as soon as possible.” Subdural haematoma Subdural haematoma – NHS

As the NHS suggests
“a sudden severe headache unlike anything you’ve experienced before”, combined with some other symptoms may indicate a subarachnoid haemorrhage. These are expanded on here: Subarachnoid haemorrhage Subarachnoid haemorrhage – NHS

As the NHS suggests
“Symptoms of a ruptured brain aneurysm usually begin with a sudden agonising headache”. The other symptoms which may indicate a brain aneurysm are expanded on here: Brain aneurysm Brain aneurysm – Symptoms – NHS 

The NHS provides an overview of serious symptoms and signs which indicate you should attend A&E : Headaches Headaches – NHS

This includes
Meningitis Meningitis – NHS 

SEVERE ABDOMINAL PAIN

What symptoms might mean you have a serious cause for your abdominal pain and when should you call 999 or attend A&E rather than making an appointment with your GP. This is explained further here

• Appendicitis Appendicitis – Diagnosis – NHS
• Peritonitis Peritonitis – NHS
• Hernia (Read “When to seek medical attention” to understand if you have a hernia when you should attend A&E for a possible “strangulated” hernia) Hernia – NHS

TESTICULAR PAIN

As the NHS suggests
“Go to A&E immediately or call 999 if you have:

• sudden, severe pain in a testicle
• testicle pain along with feeling sick, being sick or pain in your tummy
• testicle pain that has lasted more than an hour or continues when you’re resting

These can be signs of a serious problem that needs to be treated in hospital as soon as possible.” Testicle pain Testicle pain – NHS 

BACK PAIN and CAUDA EQUINA

As the NHS suggests
“Go to A&E or call 999 if you have back pain and

• have weakness or numbness in both legs that’s severe or getting worse
• have numbness around or under your genitals, or around your bottom (anus)
• find it hard to start peeing, cannot pee or cannot control when you pee – and this is not normal for you
• do not notice when you need to poo or cannot control when you poo – and this is not normal for you
  These could be symptoms of a serious back problem that needs to be treated in hospital as soon as possible.”

• Sciatica Sciatica – NHS
• Back pain Back pain – NHS

From Patient info
Cauda Equina Syndrome Cauda Equina Syndrome | Symptoms, Treatment and Recovery | Patient

BROKEN BONES

Certain fractures should always be treated in A&E which is explained below

As the NHS suggests
“Always call 999 for very severe suspected breaks, such as a broken neck or back.”
“Go to your nearest A&E for a broken arm or leg. Call 999 for an ambulance if the injury to the leg seems severe or you’re not able to get to A&E quickly.”

• How do I know if I have broken a bone? How do I know if I’ve broken a bone? – NHS 
• Dislocated shoulder Dislocated shoulder – NHS
• Broken arm or wrist Broken arm or wrist – NHS
• Hip fracture Hip fracture – NHS
• Broken leg Broken leg – NHS

SKIN CHANGES (INCLUDING SEVERE ALLERGIC REACTION – ANAPHYLAXIS)

As part of some conditions there can be skin changes (changes in colouring, swelling, or rashes) which can indicate with the other symptoms that an urgent assessment at A&E is needed

BLUE SKIN OR LIPS (CYANOSIS)

As the NHS suggests
“Call 999 or go to A&E if:

• lips, tongue, face or skin suddenly turn blue”
  may also have:

• “Difficulty breathing
• Chest pain”
  Cyanosis can mean there’s not enough oxygen in your blood and as such can be caused by many serious conditions which can impact on oxygen transport including in the airways, lungs, and heart.

• Blue skin or lips (cyanosis) Blue skin or lips (cyanosis) – NHS

THE MENINGITIS RASH

As Meningitis Now suggests
“People with septicaemia may develop a red rash of tiny ‘pin pricks’, which can develop into purple bruising. This rash does not fade under pressure.”

• The meningitis glass test Meningitis Glass Test – Meningitis Rash Test | Meningitis Now
• Meningitis Meningitis – NHS 

SKIN CHANGES OF ANAPHYLAXIS (SEVERE ALLERGIC REACTION)

The skin changes of anaphylaxis on their own do not necessarily in themselves indicate a serious condition, it is the combination of the skin changes with the other symptoms of anaphylaxis (such as difficulty swallowing, difficulty in breathing and confusion) which can give the clue to anaphylaxis.

As the Anaphylaxis Campaign suggest the skin changes might include

• “Widespread flushing of the skin
• Nettle rash (otherwise known as hives or urticaria)
• Swelling of the skin (known as angioedema) anywhere on the body (for example, lips, face).”
  Signs and Symptoms Signs and Symptoms

From the NHS
Anaphylaxis  Anaphylaxis – NHS

SKIN CHANGES OF CELLULITIS

In the majority of cases cellulitis is treated just by your GP, but on occasions you should attend A&E. This is when the rash of cellulitis (examples shown in the article from NHS choices) is combined with other symptoms which may suggest sepsis.

As the NHS suggests:
“Call 999 or go to A&E now if you have cellulitis with:

• a very high temperature, or you feel hot and shivery
• a fast heartbeat or fast breathing
• purple patches on your skin, but this may be less obvious on brown or black skin
• feeling dizzy or faint
• confusion or disorientation
• cold, clammy or pale skin
• unresponsiveness or loss of consciousness
  These are symptoms of serious complications, which can be life threatening.” Cellulitis Cellulitis – NHS

SKIN CHANGES OF SEPSIS

In an ill person, call 999 if the skin changes of sepsis (highlighted below) occur

As the NHS suggests for sepsis:
Call 999 if an adult or older child has any of these symptoms of sepsis:

• acting confused, slurred speech or not making sense
• blue, pale or blotchy skin, lips or tongue
• a rash that does not fade when you roll a glass over it, the same as meningitis
• difficulty breathing, breathlessness or breathing very fast
  They may not have all these symptoms. Sepsis Symptoms of sepsis – NHS 

For more information on sepsis see under Spotting Sepsis.

VOMITING

Vomiting on its own does not necessarily indicate a very serious condition but on occasions when they are combined with other symptoms or signs this can mean attendance at A&E is required.

VOMITING BLOOD (HAEMATEMESIS)

As patient info suggests
“You should call an ambulance or go directly to the nearest emergency department if you bring up (vomit) blood.”
Vomiting Blood Vomiting Blood (Haematemesis) | Causes, Help and Treatment | Patient

From the NHS
Vomiting blood (haematemesis) Vomiting blood (haematemesis) – NHS

DEHYDRATION

As the NHS suggests
“Dehydration means your body loses more fluids than you take in. If it’s not treated, it can get worse and become a serious problem.”

In the adult population the elderly population are most at risk of dehydration.
“Call 999 or go to A&E if:

• you’re feeling unusually tired
• you’re confused and disorientated
• any dizziness when you stand up does not go away
• you have not peed all day
• your pulse is weak or rapid
• you have fits (seizures)
  These can be signs of serious dehydration that need urgent treatment.”

The following articles suggest how you can reduce the risk of dehydration:
Dehydration Dehydration – NHS, Diarrhoea and vomiting Diarrhoea and vomiting – NHS 

DIABETIC KETOACIDOSIS (DKA)

As the NHS suggest
“DKA mainly affects people with type 1 diabetes, but can sometimes affect people with type 2 diabetes. If you have diabetes, it’s important to be aware of the risk and know what to do if you get DKA.
You can get DKA if you have high blood sugar (hyperglycaemia) and a high level of ketones in your blood or urine.”

The NHS expands on the symptoms and diagnosis in their article
Diabetic ketoacidosis Diabetic ketoacidosis – NHS – NHS

 As the NHS suggest
“Go to your nearest A&E immediately if you think you have DKA, especially if you have a high level of ketones in your blood or urine. DKA is an emergency and needs to be treated in hospital immediately.”

OTHER SERIOUS CONDITIONS WHICH CAN HAVE VOMITING OR FEELING SICK (NAUSEA) AS A SYMPTOM

Importantly it is the other symptoms which indicate a serious condition, so look for these other symptoms.

Vomiting does not necessarily need to be part of the following serious conditions but can be:

• Symptoms of a heart attack Symptoms of a heart attack – NHS 
• Meningitis Meningitis – Symptoms – NHS
• Sepsis Symptoms of sepsis – NHS
• Appendicitis Appendicitis – Diagnosis – NHS
• Peritonitis Peritonitis – NHS
• Subdural haematoma Subdural haematoma – NHS
• Feeling sick (nausea) Feeling sick (nausea) – NHS

BLEEDING

Call 999 if you have severe bleeding that cannot be stopped.

Bleeding in certain situations or when combined with other symptoms or signs may indicate an emergency response is needed and calling 999. If you are not sure call 111. Some important examples include:

NOSEBLEED

As the NHS suggests if “your nosebleed lasts longer than 10 to 15 minutes or seems excessive” you should attend A&E. The reasons to attend A&E with a nose bleed are expanded on in the following article: Nosebleed Nosebleed – NHS 

COUGHING UP BLOOD

As the NHS suggests
“Call 999 or go to A&E immediately if:

• you’re coughing up more than just a few spots or streaks of blood
• you’re coughing up blood and finding it hard to breathe, have a very fast heartbeat or have pain in your chest or upper back
  These symptoms could be a sign of a more serious problem like a blood clot in the lungs (pulmonary embolism).” Coughing up blood Coughing up blood – NHS, Pulmonary embolism Pulmonary embolism – NHS 

VOMITING BLOOD (HAEMATEMESIS)

As patient info suggests
“You should call an ambulance or go directly to the nearest emergency department if you bring up (vomit) blood.” Vomiting Blood Vomiting Blood (Haematemesis) | Causes, Help and Treatment | Patient

From the NHS
Vomiting blood (haematemesis) Vomiting blood (haematemesis) – NHS

BLEEDING FROM THE BOTTOM

As the NHS suggests
“Go to A&E or call 999 if:

• you’re bleeding non-stop
• there’s a lot of blood – for example, you see large blood clots in the toilet”
  Bleeding from the bottom (rectal bleeding) Bleeding from the bottom (rectal bleeding) – NHS

From Patient info
Rectal Bleeding Rectal Bleeding (Blood in Stool) | What to do | Causes and Treatment | Patient

BROKEN BONES

Certain fractures should always be treated in A&E which is explained below

As the NHS suggests
“Always call 999 for very severe suspected breaks, such as a broken neck or back.”
“Go to your nearest A&E for a broken arm or leg. Call 999 for an ambulance if the injury to the leg seems severe or you’re not able to get to A&E quickly.”

• How do I know if I have broken a bone? How do I know if I’ve broken a bone? – NHS 
• Dislocated shoulder Dislocated shoulder – NHS
• Broken arm or wrist Broken arm or wrist – NHS
• Hip fracture Hip fracture – NHS
• Broken leg Broken leg – NHS

HEAD INJURY

Injuries which include certain features should also be assessed in A&E which is elaborated on here:

• Head injury and concussion Head injury and concussion – NHS
• Subdural haematoma Subdural haematoma – NHS

From Patient info and NICE
Head Injuries

• Head Injury Advice | Patient
• Head injury | Health topics A to Z | CKS | NICE

BURNS

As the NHS suggests
“Go to a hospital accident and emergency (A&E) department for:

• large or deep burns bigger than the affected person’s hand
• burns of any size that cause white or charred skin
• burns on the face, hands, arms, feet, legs or genitals that cause blisters
• all chemical and electrical burns”
  Burns and scalds Burns and scalds – NHS

ACID AND CHEMICAL BURNS

As the NHS suggests
Call 999 and ask for urgent help for the following
Acid and chemical burns  Acid and chemical burns – NHS

EYE INJURIES

Though as explained in the article, minor eye injuries can be treated at home, any serious injury (including high speed injuries with power tools, hammers and lawn mowers) should be assessed in an eye casualty so call 999 for urgent help (remember they can tell you where your closest open eye casualty is)
Eye injuries Eye injuries – NHS

OVERDOSE

As the NHS suggest
“Call 999 in a mental health emergency including if someone has seriously injured themselves or taken an overdose”
When to call 999 When to call 999 – NHS

POISONING

As the NHS suggest
“If they’re showing signs of being seriously ill, dial 999 to request an ambulance or take them to your local A&E department.”
Symptoms associated with serious poisoning include:

• being sick
• dizziness
• sudden, noticeable heartbeats (palpitations)
• breathing difficulties
• uncontrollable restlessness or agitation
• seizures (fits)
• drowsiness or loss of consciousness”
  Poisoning Poisoning – Treatment – NHS

Some common eye symptoms which need to be assessed in an eye casualty have been listed in the local self-referral subsection, (see “Serious symptoms and signs which require assessment in an eye casualty as an emergency” ) found under

• optician