2. Red Flags

Hey! In this episode, we're going to cover what a red flag is, examples of red flags, and why they're absolutely essential to your clinical practice. For quick reference:
Pop Quiz Question: 1:52
Past Medical History: 2:14
Risk Factors: 3:07
Clinical Presentation: 3:38
Associated Signs and Symptoms: 6:22
For more information about Red Flags, check out "Differential Diagnosis for Physical Therapists: Screening for Referral" by Goodman & Snyder.

The purpose of this podcast is to provide useful, condensed information for exhausted, time-crunched Physical Therapists and Student Physical Therapists who looking to build confidence in their foundational knowledge base and still have time to focus on other important aspects of life. 

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Transcript

 Hey, welcome back to PT Snacks Podcast. This is Kasey, where we focus on learning bite-sized foundational concepts in physical therapy a little bit at a time so you can invest in yourself and still have time to live your life. So our topic today is on red flags, which why red flags? Why are they important? Well, first let's talk about what is a red flag. So think of a red flag as something that can be a warning for something that is not appropriate for physical therapy that may come up when you're interviewing a patient. So if we go back to the question why, it seems kind of obvious, right? If they aren't appropriate for physical therapy, should they be in physical therapy? No. But they're obviously having issues, right? Otherwise, they wouldn't be coming to see a medical professional. So help them out so they can get to the right pr- specialty. Okay, so one note before we go over different types of red flags. One red flag in isolation shouldn't be something that screens out refer me. But if they start having three or more, then you may wanna consider if the cluster means that the patient needs a medical referral, which means you should probably remember more than one, which in that case, you can just listen back on the podcast and we'll get you covered. So while we go over these, keep in mind this is just an overview. You should be asking yourself, why would it make more sense for some of these to point towards something s- more systematic? Which ones don't make sense? Are these things that you look at when you are doing an evaluation? So we're gonna be covering a lot of information, so if you need to listen back, do it. I'll try and add time markers in the show notes so it's easy to find, but I would hit pause after each section and just make sure that you can at least recall five of them before you move on. So before we begin, the, uh, pop quiz question of the day is, what are constitutional signs? Moving back to red flags. What are some examples of red flags? So I'm going to break it down into sections. They're going to be past medical history, risk factors, clinical presentation, and then associated signs and symptoms. So red flags for past medical history are things like personal family history of cancer, recent infection, joint pain or back pain. So infection, things like mono, an upper respiratory infection, strep, staph, UTI, measles, hepatitis, um, recurrent colds or flu with a cyclical pattern. You're looking at have they had any recent trauma or even with older adults who have osteopenia or osteoporosis, you're also trying to take into account minor trauma. Take a look and see if they have a history of immunosuppression. So things like have they been taking a lot of steroids or organ transplant or do they have HIV? And then also looking at if they have a history of injection drug use. So you're trying to monitor for if they have an infection. So that's past medical history. Moving on to the next section of risk factors. Now, for those, we're looking at things like do they have substance use or abuse, tobacco use, age, gender, BMI, exposure to radiation, alcohol use, sedentary lifestyle, race and ethnicity, domestic violence, hysterectomy, occupation. So all things to take into account. So we've already done past medical history, risk factors. Now we're moving on to clinical presentation. This is where it gets a little trickier. You're looking at things like, is there an insidious onset? Did the pain just happen out of nowhere and they don't know why it happened in the first place? Are their symptoms unrelieved by physical therapy? Or maybe their symptoms get better after like a physical therapy session, but then it just goes right back to being worse again. Have they had any significant weight loss or gain without effort? So things like 10% of a client's body weight in less than three weeks. That's what we're talking about here. Are their symptoms gradual, progressive, or cyclical? Is it unrelieved by rest or a change in position where no position is comfortable? Or maybe they used to have a position of comfort or things like heat used to feel good, but those are no longer offering relief. You're also looking at do their symptoms seem out of proportion to their injury? Or maybe the timeline is weird. Like you would have expected for that condition, the symptoms to have been gone a long time ago. Or maybe there's no pattern of the symptoms. Do they have a growing mass? Postmenopausal vaginal bleeding or bilateral symptoms. So you're thinking of things like do they have bilateral edema, numbness or tingling, skin pigmentation changes, clubbing, nail bed changes, or skin rash? If this is a patient with neurological symptoms, is there a change in muscle tone or range of motion? And what's their pain pattern like? So back and shoulder pain is actually the most common location of referred pain. So if that patient's coming in with that on their script, maybe have this in the back of your mind, right? You're also looking at, okay, maybe they have pain, but is their range of motion full and painless? You're also taking into account do they have night pain? Are their symptoms constant and intense? Or are their symptoms worse with activity and relieved with rest? Do they describe their pain as throbbing, knife-like, boring, or deep aching, like maybe they have some vascular issues as well? Is the pain poorly localized? Does the pain go in a pattern of coming and going like in spasms? And then of course, you're also looking for do their signs and symptoms kind of match up with certain viscera or like a body system? And then of course, do their symptoms change with food intake or medicine use? So that is all clinical presentation. Now we're moving on to associated signs and symptoms. So for example, you're looking at is there a recent report of confusion? Like did their family member pull you off to the side and, and say things seem a little bit off? There might be a neurologic sign or it might be drug-induced or it could be a sign of infection. You also want to take into account their constitutional symptoms or if they have any unusual vita-vital signs like is their body temperature a hundred degrees or something like that. Do they have proximal muscle weakness, especially if there's a change in DTRs associated with that? Is there joint pain with any skin rashes or nodules? With their review of systems, is there like a sign and symptom characteristic of a certain organ system or do they have any unusual menstrual cycle or symptoms? Okay, so going back to the question I asked in the beginning about what are constitutional signs, these are just signs referring to a conglomeration of signs and symptoms when a patient is experiencing a systemic illness. So we're looking at things like fever, dia-diaphoresis, so that's like when you're sweating and you, you don't really know why, night sweats which can occur during the day, nausea, vomiting, diarrhea, pallor, dizziness or syncope which is like fainting, fatigue, and weight loss Okay, so that was a lot of information. Go back and review it if you need to. But a lot of this comes from the book Differential Diagnoses for Physical Therapists: Screening for Referral by Goodman Snyder. It's really good resource. It's a really thick book, so good to have on hand. Um, this is just kind of the abbreviated version, so highly recommend the book. It's really good. Um, now, if you were paying attention, these are the questions you should be able to answer. One, what is a red flag? Two, can you name five to 10 red flags right off the bat? And three, what is a constitutional symptom? So if you have a story about a patient who had red flags, share it with us. You can email me at ptsnackspodcast@gmail.com, and then I can share with the group. It'll be a good learning opportunity and just a, an example, real-life example of things to look for. Um, but otherwise, just thank you so much for joining me. This is super important stuff that you don't wanna miss in a patient, so definitely good information to master. And if you haven't already, go ahead and hit subscribe so you don't miss any new content. It's one less thing to fit into your busy life, and that automation's gonna help set you up in a good habit to study. So if you like this podcast, please leave a review, share it with your friends. I'm always open to feedback as well. And for more information, you can always check out ptsnackspodcast.com. Otherwise, thanks again, and I'm looking forward to next time.