PT Clinical Follow‑Up Guide — ED Screening with Mobility Flags

PT Clinical Follow‑Up Guide — ED Screening

Symptom → Follow‑Up Questions → Screening → Consults → Diagnostics → Diagnosis → Mobility Flags

Chest Pain

Follow‑Up Questions	Screening Results to Review	Consults	Diagnostics	Possible Diagnoses
Onset (sudden/gradual)? Exertional/rest? Radiation (jaw/arm/back)? Pleuritic/positional? Associated SOB, diaphoresis, nausea?	Vitals, 12‑lead ECG (≤10 min), high‑sensitivity troponin, SpO₂, glucose.	Cardiology; Pulmonology; Gastroenterology.	Serial troponins; CXR; D‑dimer → CTPA if indicated; Echocardiogram.	ACS; Pulmonary embolism; Pneumothorax; Pneumonia; GERD; Musculoskeletal.

Mobility Red Flags

Active chest pain at rest or new ischemic ECG changes.
Hemodynamic instability (SBP < 90 mmHg, MAP < 65, new arrhythmia requiring treatment).
SpO₂ < 90% despite supplemental O₂ or rising O₂ needs.
Severe dyspnea at rest or suspected PE without stabilization.

Mobility Yellow Flags

Chest pain resolved but evaluation ongoing (ECG/troponin pending).
Mild exertional desaturation (drop to 90–92%)—pace and monitor.
Known CAD with recent symptoms—short bouts, telemetry if available.
Orthostatic lightheadedness—guard, slow transitions.

Shortness of Breath (Dyspnea)

Follow‑Up Questions	Screening Results to Review	Consults	Diagnostics	Possible Diagnoses
Acute vs chronic? Wheeze/cough/fever? Orthopnea/PND/edema? DVT/PE risk? Chest tightness?	Vitals, SpO₂/ABG as indicated, ECG, peak flow/FEV₁ if available.	Pulmonology; Cardiology.	CXR; BNP; CBC; D‑dimer → CTPA if indicated; Echocardiogram.	Asthma/COPD; Pneumonia; PE; Heart failure; Anemia.

Mobility Red Flags

Rest dyspnea with accessory muscle use or inability to speak in full sentences.
SpO₂ < 90% on ≥4 L/min O₂ or rapidly increasing O₂ requirement.
RR > 30/min, cyanosis, or new severe wheeze not responsive to treatment.
Suspected/unstable PE or acute decompensated HF.

Mobility Yellow Flags

Exertional desaturation to 90–92%—interval rests and titrate O₂ per orders.
RR 24–30/min but stable—low‑intensity, monitor RPE and SpO₂.
Recent bronchodilator or diuretic dose—time session after effect onset.
Mild wheeze or crackles with stable vitals—short, supervised ambulation.

Abdominal Pain

Follow‑Up Questions	Screening Results to Review	Consults	Diagnostics	Possible Diagnoses
Location/migration? N/V, fever, jaundice, urinary sx? Bowel habits? Pregnancy risk?	Vitals, abdominal exam, UA, pregnancy test when applicable.	General Surgery; Gastroenterology; Urology.	CBC; Lipase; RUQ US or CT A/P; HIDA if biliary equivocal.	Appendicitis; Cholecystitis; Pancreatitis; Bowel obstruction; Renal colic.

Mobility Red Flags

Rigid abdomen, rebound tenderness, or suspected peritonitis.
GI bleeding (hematemesis, melena) or hemodynamic instability.
Severe uncontrolled pain (≥8/10) or intractable vomiting.
Concern for AAA or bowel obstruction.

Mobility Yellow Flags

Moderate pain 4–7/10—pre‑medicate if ordered, use log‑roll and abdominal support.
Orthostatic symptoms from volume loss—short sessions with close guard.
New jaundice or pancreatitis workup—avoid Valsalva/straining.
NPO status—time therapy to avoid nausea; seated activities first.

Headache

Follow‑Up Questions	Screening Results to Review	Consults	Diagnostics	Possible Diagnoses
Sudden/thunderclap? Fever/neck stiffness? Neuro deficits? Jaw claudication, visual change? Post‑trauma?	Vitals, focused neuro exam, fundoscopy if available.	Neurology; Infectious Disease; Rheumatology (GCA).	CT head; LP if SAH/meningitis suspected; ESR/CRP; Temporal artery biopsy if indicated.	SAH; Meningitis; Migraine; Temporal arteritis; Post‑traumatic headache.

Mobility Red Flags

Thunderclap headache pending emergent workup.
Meningeal signs with fever or altered mentation.
Acute focal neuro deficits or uncontrolled hypertension with neuro changes.
Recent head trauma with concern for ICH.

Mobility Yellow Flags

Severe photophobia or migraine—dim lights, low‑stimulation mobility.
Post‑LP headache—avoid upright endurance; gradual elevation.
Mild residual dizziness—guard for balance loss.
ESR/CRP elevated but stable—short, symptom‑limited sessions.

Fever

Follow‑Up Questions	Screening Results to Review	Consults	Diagnostics	Possible Diagnoses
Localizing sx (urinary, respiratory, GI, skin)? Travel/exposures? Devices? Immunosuppression?	Temp trend, HR/BP, exam clues (rales, CVA tenderness, rash).	Infectious Disease; Internal Medicine.	CBC; Blood/urine cultures; CXR; UA/urine culture; source‑directed tests.	Pneumonia; UTI/pyelonephritis; Sepsis; Cellulitis; Viral URI.

Mobility Red Flags

Suspected sepsis with hypotension, tachypnea, or acute AMS.
Temp > 39.5 °C with rigors and instability.
New oxygen need or SpO₂ < 90% at rest.
Rapid clinical deterioration or neutropenic fever pending clearance.

Mobility Yellow Flags

Persistent fever > 38 °C with tachycardia—short bouts, hydration focus.
Dehydration risk—monitor orthostatics and fatigue.
Immunosuppressed but stable—avoid crowded areas, clean equipment.
Post‑antipyretic—schedule during symptom nadir.

Dizziness / Syncope

Follow‑Up Questions	Screening Results to Review	Consults	Diagnostics	Possible Diagnoses
Positional trigger? Palpitations? Hearing loss/tinnitus? Neuro sx (ataxia, diplopia)? Prodrome vs sudden LOC?	Vitals, orthostatics, ECG, glucose, Dix–Hallpike result if done.	Cardiology; Neurology; ENT (vestibular).	Holter/telemetry; Echo; MRI/vascular imaging; Vestibular testing.	Arrhythmia; BPPV; Vasovagal syncope; Posterior stroke/TIA.

Mobility Red Flags

Syncope with injury or unknown cause and unstable vitals.
Arrhythmia on monitor or prolonged QT awaiting stabilization.
Acute cerebellar/brainstem signs (new ataxia, diplopia, dysarthria).
Orthostatic drop with severe symptoms (systolic ↓ ≥ 20 mmHg with presyncope).

Mobility Yellow Flags

Positive orthostatics but stable—gradual upright tolerance, compression if ordered.
BPPV—perform canalith maneuvers first; ambulate after symptom control.
Vasovagal history—train counter‑pressure and hydration.
Mild residual disequilibrium—use gait belt and close guard.

Altered Mental Status / Encephalopathy

Follow‑Up Questions	Screening Results to Review	Consults	Diagnostics	Possible Diagnoses
Baseline cognition? Time course? Infection/meds/alcohol? Focal deficits? Seizure or trauma?	Vitals, glucose, neuro exam, collateral; tox screen if available.	Neurology; Critical Care; Toxicology.	CMP; Ammonia; Toxicology panel; CT head; EEG as indicated.	Stroke; Hypoglycemia; Sepsis‑associated encephalopathy; Hepatic/uremic; Intoxication/withdrawal.

Mobility Red Flags

GCS ≤ 12 or rapidly fluctuating consciousness.
Airway compromise risk or severe agitation unsafe for mobilization.
New focal deficits suggesting acute stroke pending workup.
Uncontrolled seizures or profound hypoglycemia not corrected.

Mobility Yellow Flags

Hypoactive/hyperactive delirium—1:1 supervision, simplify tasks, short bouts.
Mild hepatic/uremic features—monitor cognition and balance.
Recent sedative/antipsychotic dosing—assess arousal and orthostatics.
Sleep‑wake reversal—schedule during optimal alertness window.

Back Pain

Follow‑Up Questions	Screening Results to Review	Consults	Diagnostics	Possible Diagnoses
Trauma? Fever/IVDU/cancer/weight loss? Night pain? Neuro deficits, saddle anesthesia, incontinence/retention?	Focused neuro exam; red flags (fever, neuro deficits, severe unrelenting pain).	Orthopedics/Spine; Neurosurgery; Oncology; Vascular (AAA concern).	MRI (neuro deficits/red flags); CT/X‑ray (trauma); ESR/CRP (infection); Aortic imaging if indicated.	Strain; Disc herniation; Vertebral fracture; Epidural abscess; Malignancy; AAA.

Mobility Red Flags

Cauda equina features (saddle anesthesia, new incontinence/retention).
Progressive motor weakness or severe neuro deficit.
Fever with spinal tenderness (suspected infection) or unstable fracture.
Suspected rupturing AAA.

Mobility Yellow Flags

Severe pain limiting tolerance—use log‑roll, neutral spine, bracing if ordered.
Radicular pain without deficits—pacing and neural tension precautions.
Osteoporosis with minor trauma—avoid high‑load, no end‑range flexion.
Analgesic timing—treat during peak effect.

Extremity Injury / Limb Ischemia

Follow‑Up Questions	Screening Results to Review	Consults	Diagnostics	Possible Diagnoses
Mechanism (fall/crush/twist)? Deformity/bleeding? Pain out of proportion? Pulse/sensation/motor/cap refill?	Neurovascular status (5 Ps), compartment signs, integrity of splint/cast.	Orthopedics; Vascular Surgery; Plastics for complex soft tissue.	X‑ray; Doppler/ABI; CTA if arterial occlusion; CT for complex fractures.	Fracture/dislocation; Compartment syndrome; Acute limb ischemia; Crush injury.

Mobility Red Flags

Absent pulses, pallor, paralysis, or severe pain out of proportion (acute ischemia).
Suspected compartment syndrome (pain with passive stretch, tense compartments).
Open/unstable fracture or uncontrolled bleeding.
Rapidly worsening neuro deficit in the limb.

Mobility Yellow Flags

Diminished but Dopplerable pulses—elevate per orders, avoid dependent positioning.
Stable fracture in splint—follow weight‑bearing and ROM precautions.
Marked swelling—monitor for compartment evolution; gentle AROM only.
Analgesia dependent—coordinate timing; avoid Valsalva.

Alcohol / Drug Intoxication

Follow‑Up Questions	Screening Results to Review	Consults	Diagnostics	Possible Diagnoses
What/when/how much? Polysubstance? Co‑ingestions (APAP)? Suicidality? Withdrawal risk? Trauma?	Vitals, neuro status, glucose; airway/breathing; CIWA cues if alcohol.	Toxicology; Psychiatry; Social Work.	Serum ethanol; Comprehensive tox screen; CMP; ECG; targeted levels.	Alcohol intoxication/withdrawal; Opioid toxicity; Sedative‑hypnotic or stimulant toxicity; Mixed overdose.

Mobility Red Flags

Depressed consciousness or airway compromise risk.
Hemodynamic or respiratory instability; new hypoxia.
Severe withdrawal (refractory agitation, hallucinations, seizures, DTs).
Unknown/mixed overdose pending stabilization.

Mobility Yellow Flags

Mild–moderate intoxication with poor safety awareness—close guard, simple commands.
CIWA elevation but treated—short bouts; minimize stimuli.
Recent sedation or naloxone reversal—monitor for re‑sedation/recurrence.
Psych risk—ensure sitter/precautions per policy.

Dehydration / Volume Depletion

Follow‑Up Questions	Screening Results to Review	Consults	Diagnostics	Possible Diagnoses
Intake vs output? Vomiting/diarrhea? Heat exposure/exertion? Diuretics? Orthostasis/syncope? CKD/CHF?	Vitals (tachycardia, hypotension), orthostatics, mucous membranes, urine output.	Internal Medicine; Nephrology (AKI/electrolytes).	BMP (BUN/Cr, electrolytes); Serum osmolality; CK if heat illness/rhabdo suspected.	Hypovolemia; Heat illness; Electrolyte imbalance; Pre‑renal AKI.

Mobility Red Flags

SBP < 90 mmHg or symptomatic orthostasis with presyncope/syncope.
Anuria or severe oliguria; new confusion.
Suspected heat stroke (core temp > 40 °C, AMS).
Severe electrolyte disturbance with arrhythmia or weakness.

Mobility Yellow Flags

Orthostatic lightheadedness—slow graded elevation, frequent rests.
Low PO intake—hydrate per orders; consider shorter, more frequent sessions.
Mild–moderate electrolyte abnormalities—avoid high‑intensity work.
Recent IV fluids—reassess vitals mid‑session.