1.2 Recognise deterioration and act urgently

01

Emergency sign: obtain emergency help now

02

Other worsening change: contact the clinical team promptly

03

Cannot reach help or worsening: seek urgent in-person care

Use your individual plan too; never delay emergency care for this course.

Prepare before a problem happens

This free lesson helps adults and caregivers recognise changes that need prompt professional assessment after hospital discharge. It cannot identify the cause of symptoms. Use your discharge team's condition-specific warning signs as well. Do not wait for a course lesson, scheduled visit, or online answer when an emergency sign appears. Keep a verified local emergency contact and the route to the nearest suitable emergency department accessible. This course does not supply an emergency telephone number; confirm the correct local service with your hospital.

Emergency signs: get help now

Seek emergency help immediately for new severe or persistent chest pressure or pain, especially with sweating, nausea, breathlessness, or pain spreading to an arm, jaw, neck, or back. Severe difficulty breathing, gasping, inability to speak normally because of breathlessness, or blue or grey lips are emergencies. On darker skin, colour changes may be easier to notice on palms or soles. Do not assume symptoms are only acidity, anxiety, or normal postoperative discomfort.

Sudden facial droop, weakness or numbness of one arm or side, or new difficulty speaking can indicate stroke. Sudden major vision change, loss of balance, or a severe unusual headache also need emergency assessment. Note when the person was last known well. Act even if the symptoms improve. Do not drive yourself with these symptoms.

Uncontrolled heavy bleeding, vomiting blood, black tar-like stool with feeling unwell or faint, or collapse require emergency assessment. Get emergency help if a person is difficult to wake, has not fully recovered after fainting, is not breathing normally, has a seizure, or has fainting with chest pain, serious injury, or speech or movement difficulty. A new faint even after recovery needs medical review; after discharge contact your clinical team promptly about it.

Infection can become serious

A person with infection who becomes confused, very breathless, unusually drowsy, very cold or shivery, or has pale, blue, grey or blotchy skin may have a serious condition such as sepsis. Very little urine and feeling dramatically worse are further concerns. Fever may be absent, especially in older adults. You do not need every sign, or a confirmed diagnosis, to seek emergency help when someone appears seriously unwell. Tell the service about recent hospital treatment, wounds, devices, and medicines that weaken immunity. If your oncology or other specialist team gave specific fever instructions, follow those immediately.

Pregnancy and the year after delivery

Tell the clinician if you are pregnant or were pregnant within the last year. Seek immediate medical assessment for severe or worsening headache, vision changes, chest pain, breathing difficulty, fainting, severe persistent abdominal pain, heavy vaginal bleeding, fever, or a painful swollen limb. Foul-smelling vaginal discharge and severe vomiting also need immediate assessment. Thoughts of harming yourself or your baby require immediate help; have a trusted person stay with you and obtain urgent professional care. Do not dismiss serious symptoms as an unavoidable part of motherhood.

Get same-day advice for other worsening changes

Call the discharge service or responsible clinician promptly for increasing wound redness, swelling or discharge, new fever, worsening pain, repeated vomiting, inability to keep prescribed medicines or fluids down, reduced urine, or a marked decline in usual function. Your own plan may require emergency action for these. If you cannot reach the team, symptoms worsen, or you feel seriously unwell, seek urgent in-person care; use emergency services for emergency signs. This list is not complete. A caregiver's observation that someone is very different from usual matters.

Worksheet: a short action plan

Fill in: my usual symptoms; my specific warning signs; daytime clinical contact; after-hours contact; verified emergency service; nearest emergency department; transport or ambulance arrangements; where medicines and discharge papers are kept. Describe a change with its start time, severity, and progression. Bring the current medicine list and papers, but do not delay help to collect them. Stay with the person if safe and follow the emergency dispatcher's instructions. Do not force food, drink, or tablets into an unconscious or poorly responsive person.

Case and teach-back

After discharge, Arun's speech suddenly becomes slurred and one arm weak. His daughter notes the time and obtains emergency help, although his speech starts improving. She does not wait for tomorrow's appointment. Practise saying: “These signs mean emergency help now. These other changes mean I contact the clinical team today. If I cannot reach them and the person worsens, this is my next step.” Ask a clinician to check your plan.

Sources and further reading

• https://www.nhs.uk/conditions/sepsis/
• https://www.nhs.uk/conditions/stroke/symptoms/
• https://www.nhs.uk/conditions/heart-attack/
• https://www.nhs.uk/symptoms/vomiting-blood/
• https://www.nhs.uk/symptoms/fainting/
• https://www.cdc.gov/hearher/maternal-warning-signs/index.html

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