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
• Encephalitis Encephalitis – NHS

CONFUSION AND SEPSIS

As the NHS suggests for sepsis:
For a baby or young child with sepsis you may notice

• “Not responding like they normally do, or not interested in feeding or normal activities”
  For an older child with sepsis, you may notice
• “Acting confused, slurred speech or not making sense”

The NHS choices article expands on the symptoms and signs of sepsis. If you think your child has sepsis call 999. 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

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

As the NHS points out in most cases of high temperature “you can usually look after your child or baby at home. The temperature should go down over 3 or 4 days.“
There are occasional situations when a high temperature is combined with other symptoms and you should then attend A&E.
“Call 999 if your child:

• has a stiff neck
• has a rash that does not fade when you press a glass against it (use the “glass test” from Meningitis Now)
• is bothered by light
• has a fit (febrile seizure) for the first time (they cannot stop shaking)
• has unusually cold hands and feet
• has blue, pale or blotchy skin, lips or tongue
• has a weak, high-pitched cry that’s not like their normal cry
• is drowsy and hard to wake
• is extremely agitated (does not stop crying) or is confused
• finds it hard to breathe and sucks their stomach in under their ribs
• is not responding like they normally do, or is not interested in feeding or normal activities”

There is more information about controlling a temperature and also when you should go to your GP for an assessment in the article “High temperature” (e.g., Temperature over 38 if under 3 months, temperature over 39 if age between 3-6 months)

• High temperature (fever) in children High temperature (fever) in children – NHS
• Meningitis Meningitis – NHS 

SEPSIS

As the NHS suggests for sepsis:
Call 999 or go to A&E if a baby or young child has any of these symptoms of sepsis:

• 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 (you may notice grunting noises or their stomach sucking under their ribcage), breathlessness or breathing very fast
• a weak, high-pitched cry that’s not like their normal cry
• not responding like they normally do, or not interested in feeding or normal activities
• being sleepier than normal or difficult to wake
  They may not have all these symptoms.

Call 999 if an 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 
• Epiglottitis Epiglottitis – 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

SHORTNESS OF BREATH

Shortness of breath when combined with other symptoms or signs may indicate a need to call 999 or go to A&E. Some important examples included by NHS choices include:

BRONCHIOLITIS

As the NHS suggest
“Most cases are mild and clear up within 2 to 3 weeks without the need for treatment, although some children have severe symptoms and need hospital treatment.”
“While it’s unusual for children to need hospital treatment for bronchiolitis, the symptoms can get worse very quickly.”

Call 999 and ask for an ambulance if:
your child has difficulty breathing or exhaustion from trying to breathe (you may see the muscles under their ribs sucking in with each breath, they may be grunting with the effort of trying to breathe, or they may be pale and sweaty)

• they’re breathing very fast
• you’re unable to wake your child or, if woken up, they do not stay awake
• their breathing stops for a long time, or there are regular shorter pauses in their breathing
• their skin turns very pale or blue, or the inside of their lips and tongue are blue (cyanosis)”
  Bronchiolitis Bronchiolitis – NHS 

The term given to “muscles under the ribs sucking in with each breath” is called intercostal recession and this can be clearly seen in the attached link which includes a number of the other common signs of serious respiratory distress  Signs of Respiratory Distress in Children – Physiopedia

CROUP

As the NHS suggests
“Croup is a common childhood condition that mainly affects babies’ and young children’s airways. It’s usually mild. “
However, on rare occasions when you might need to attend A&E it is worth understanding what to look for

Call 999 if:

• your child is struggling to breathe (you may see their tummy sucking inwards or their breathing sounds different)
• their skin or lips start to look very pale or blue
• they’re unusually quiet and still
• they suddenly get a very high temperature or become very ill
  Croup Croup – NHS 

Stridor with Intercostal recession and abdominal movement can clearly be seen in the attached link which includes a number of the other common signs of serious respiratory distress  Signs of Respiratory Distress in Children – Physiopedia

PNEUMONIA

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

• are struggling to breathe
• 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 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.

SEIZURE

As the NHS suggests
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
• Febrile seizures Febrile seizures – NHS 
• Epilepsy Epilepsy – 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

WEAKNESS

As the NHS suggests
“Call 999 for an ambulance if someone 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”
  Paralysis Paralysis – NHS , Guillain-Barré syndrome Guillain-Barré syndrome – 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 included by NHS choices include:

HEADACHE AFTER a HEAD INJURY

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 your child develops 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

HEADACHE OVERVIEW

NHS choices provide an overview of serious symptoms and signs associated with a headache which indicate you should attend A&E

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

• has a head injury – for example, from a fall or accident
• has a headache that came on suddenly and is extremely painful

Your child has an extremely painful headache and:

• sudden problems speaking or remembering things
• loss of vision
• feel drowsy or confused
• has a very high temperature and symptoms of meningitis
• the white part of the eye is red

Also call 999 or go to A&E if your child is under 12 and has any 1 of the following:

• a headache with vision problems or difficulty speaking, swallowing, balancing or walking
• a headache with drowsiness or a persistent lack of energy
• a headache that starts within 5 days of a head injury

From the NHS

• Headaches Headaches – NHS 
• Meningitis Meningitis – NHS 

SEVERE ABDOMINAL PAIN

What symptoms might mean your child has a serious cause for their 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

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 

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, rashes) which can indicate with the other symptoms that attendance at A&E is required immediately.

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 of Anaphylaxis | Anaphylaxis Campaign

From the NHS
Anaphylaxis  Anaphylaxis – NHS

SKIN CHANGES OF CELLULITIS

In the majority of cases of cellulitis, these can be 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 child, call 999 if the skin changes of sepsis (highlighted below) occur

As the NHS suggests for sepsis:
Call 999 if a baby or young child has any of these symptoms of sepsis:

• 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 (you may notice grunting noises or their stomach sucking under their ribcage), breathlessness or breathing very fast
• a weak, high-pitched cry that’s not like their normal cry
• not responding like they normally do, or not interested in feeding or normal activities
• being sleepier than normal or difficult to wake
  They may not have all these symptoms.

Call 999 if an 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.

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 general population babies, children are more at risk of dehydration.
Take your baby or child to the GP urgently or go to A&E if they:

• seem drowsy
• breathe fast
• have few or no tears when they cry
• have a soft spot on their head that sinks inwards (sunken fontanelle)
• have a dry mouth
• have dark yellow pee or have not had a pee in last 12 hours
• have cold and blotchy-looking hands and feet

The articles below also 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.” NHS expands on the symptoms and diagnosis in their article
Diabetic ketoacidosis Diabetic ketoacidosis – NHS – NHS

As NHS choices 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:

• 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. An example includes:

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.

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
• 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