What symptoms require immediate medical attention?

Symptoms Requiring Immediate Medical Attention

Call 9-1-1 immediately if you experience chest discomfort lasting more than 5 minutes, severe shortness of breath, syncope, or symptoms accompanied by cold sweats, nausea, vomiting, or a sense of impending doom. 1, 2

Cardiac Symptoms Requiring Emergency Response

Chest-Related Warning Signs

• Chest pain or discomfort lasting >20 minutes at rest requires immediate emergency transport by ambulance 1, 2
• Chest symptoms that interrupt normal daily activities indicate a potentially serious condition 1
• Symptoms may present variably as chest pain, oppression, dyspnea, heavy chest, or even slight discomfort—all warrant urgent evaluation if persistent 1
• Radiation of discomfort to the arm, jaw, neck, or back increases concern for acute coronary syndrome 1

Critical Accompanying Symptoms

Do not wait if chest symptoms occur with: 1

• Cold sweats
• Nausea or vomiting
• Fainting or near-fainting (syncope/presyncope)
• Anxiety or sense of impending doom

The 5-Minute Rule for Cardiac Symptoms

• If you have known heart disease or cardiac risk factors and develop chest discomfort, take one nitroglycerin dose if previously prescribed 1
• If symptoms are unimproved or worsening after 5 minutes, call 9-1-1 immediately—do not take additional nitroglycerin first 1, 2
• For patients without known cardiac disease experiencing new chest symptoms, call 9-1-1 if symptoms persist beyond 5 minutes 1, 2
• While waiting for emergency services, chew 162-325 mg of non-enteric-coated aspirin unless allergic 1

High-Risk Features Requiring Immediate Emergency Department Evaluation

• Hemodynamic instability (low blood pressure, rapid heart rate) 1, 2
• Recent syncope or presyncope (fainting or near-fainting) 1, 2
• Severe dyspnea (shortness of breath) or palpitations 1, 2
• Chest discomfort >20 minutes duration at rest 1, 2

Neurological Emergencies

Seizure-Related Warning Signs

Activate emergency services for: 1

• First-time seizure in any individual
• Seizures lasting >5 minutes (status epilepticus risk)
• Multiple seizures occurring without return to baseline mental status between episodes
• Seizures occurring in water
• Seizures with associated traumatic injuries, difficulty breathing, or choking
• Seizure in an infant <6 months of age
• Seizure in pregnant individuals
• Failure to return to baseline within 5-10 minutes after seizure activity stops

Stroke Warning Signs

Seek immediate emergency help for: 3

• Sudden weakness or slurring of speech
• Difficulty breathing or swelling of face/throat (possible anaphylaxis)
• Any sudden neurological change

Severe Abdominal Emergencies

Surgical Emergencies

Immediate surgical assessment required for: 1

• Signs of complete intestinal obstruction
• Severe abdominal pain suggesting ischemic bowel
• New onset or unexplained severe pain in cancer patients (consider tumor recurrence)

Medication-Related Emergencies

NSAID Warning Signs

Stop medication and seek immediate medical care if: 3

• Difficulty breathing, swelling of face or throat (anaphylactoid reaction)
• Any type of rash or fever develops (serious skin reactions including Stevens-Johnson Syndrome, toxic epidermal necrolysis, or DRESS syndrome)
• Signs of GI bleeding: black tarry stools (melena), vomiting blood (hematemesis), or severe epigastric pain
• Symptoms of liver toxicity: nausea, fatigue, lethargy, jaundice, right upper quadrant tenderness, or flu-like symptoms
• Shortness of breath, unexplained weight gain, or edema (heart failure)

Infection and Sepsis Concerns

When to Suspect Serious Infection

Urgently seek medical evaluation if acute illness with infection is associated with: 1

• Abnormal vital signs (fever or hypothermia, rapid heart rate, rapid breathing)
• Change in mental state, dizziness, or confusion
• Severe muscle pain or extreme shivering
• Poor urine output
• Clammy/sweaty skin, new rash, or mottled/discolored skin
• Feeling very unwell or sense of impending doom

Critical Pitfalls to Avoid

Common Mistakes That Delay Life-Saving Care

• Do not wait for symptoms to disappear—symptom resolution is a poor indicator of risk 1
• Do not drive yourself or have family drive you with suspected cardiac symptoms—call 9-1-1 for ambulance transport 1
• Do not assume gradual onset means less serious—many heart attacks begin with gradual rather than abrupt pain 1
• Women and elderly patients frequently present atypically with dyspnea, fatigue, or nausea rather than classic chest pain 2
• Do not take more than one nitroglycerin before calling 9-1-1 if symptoms are unimproved or worsening 1

Less Serious Symptom Characteristics

Pain is less likely to be serious if it: 1

• Varies with respiration or body position
• Changes with food intake
• Is well-localized to a specific spot on the chest wall
• Is accompanied by local tenderness to palpation