Symptom-to-Action Medical Index

Cardiac chest pain typically presents as central chest pressure radiating to the left arm, jaw, or back; associated with nausea, sweating, shortness of breath, or a sense of impending doom. Risk factors include age >40, smoking, hypertension, diabetes, or family history. Immediate action: Call for emergency help. Give aspirin (300–500 mg) if available and the person is conscious. Keep the person calm and seated or lying down.

Musculoskeletal chest pain is reproducible by pressing on the chest wall, worse with movement or deep breathing, and usually localized to one area. Risk factors include recent trauma, heavy lifting, or muscle strain. Immediate action: Reassure the person, apply ice, rest the area.

Pulmonary chest pain (pneumothorax, pulmonary embolism, pneumonia) is often one-sided, worse with breathing, and may include cough or hemoptysis. Immediate action: Call for emergency help if acute onset or severe. Position the person upright for comfort.

If the person is unconscious or unresponsive, start CPR and call for emergency help immediately.

Fast and shallow breathing (tachypnea >20 breaths/min at rest) often indicates shock, significant pain, anxiety, or metabolic acidosis. Look for pale/clammy skin, weak pulse, confusion, or recent blood loss. Immediate action: Lie the person flat with legs elevated (unless chest trauma suspected), keep them warm, provide oxygen if available, call for emergency help.

One-sided breathing difficulty or chest pain on one side suggests pneumothorax (collapsed lung), especially in tall young people or those with recent trauma. The person may have reduced breath sounds on one side. Immediate action: Keep upright or semi-upright, do not apply pressure to the chest, call for emergency help immediately.

Wheezing or stridor indicates airway narrowing from asthma, anaphylaxis, or upper airway obstruction. Look for hives, throat swelling, or recent allergen exposure. Immediate action: If anaphylaxis, use an epinephrine auto-injector if available. If asthma and rescue inhaler available, use it. Sit upright.

Stridor with drooling or difficulty swallowing may indicate epiglottitis or severe airway swelling—call for emergency help immediately.

Use the AVPU scale to assess responsiveness: Alert (responds to normal voice, aware of surroundings), Verbal (responds only to verbal commands), Pain (responds only to painful stimuli), Unresponsive (no response to any stimulus). Any shift from Alert to lower levels is a medical emergency.

Causes include head injury, stroke, hypoglycemia, intoxication, shock, seizure, or poisoning.

Immediate assessment steps: Check for responsiveness by speaking and gentle shoulder shake. Check airway—is it clear? Look for breath sounds. Check for external bleeding or head trauma. If diabetic, check blood glucose if testing is available.

Immediate action: Place the person in the recovery position (on their side, head tilted back to keep airway open) if unresponsive but breathing normally. Do not move if neck/spine injury is suspected. Call for emergency help. Monitor breathing and pulse every minute.

Do not give food, drinks, or medications by mouth to an unconscious or unresponsive person—risk of aspiration.

Abdominal pain location provides clues to the underlying problem.

Right upper quadrant (RUQ): Gallstones, liver disease, pneumonia (diaphragm irritation). Pain may radiate to the right shoulder.

Right lower quadrant (RLQ): Appendicitis, ectopic pregnancy (if female of childbearing age), kidney stone. Tenderness over McBurney's point (1/3 distance between navel and right hip bone).

Left upper quadrant (LUQ): Spleen injury, stomach ulcer, pneumonia.

Left lower quadrant (LLQ): Diverticulitis, ectopic pregnancy, kidney stone, inflammatory bowel disease.

Central/periumbilical pain: Early appendicitis, gastroenteritis, small bowel obstruction, aortic aneurysm.

Immediate action: Assess pain severity (1–10 scale). Ask about recent trauma, nausea, vomiting, fever, diarrhea, or blood in stool. If mild and no red flags, rest and hydrate. If severe, sudden onset, or accompanied by fever, vomiting, shock signs, or vaginal bleeding, call for emergency help immediately.

Severe, sudden-onset abdominal pain with shock signs (rapid heart rate, pale skin, confusion) may indicate internal bleeding or ruptured organ—call for emergency help immediately.

A fever is a body temperature >37.5°C (99.5°F) at rest. Fever is a sign of infection or inflammatory illness, not a disease itself.

Fever 37.5–39°C (99.5–102.2°F): Likely infection (cold, flu, urinary tract infection, minor bacterial infection). Give antipyretics (acetaminophen or ibuprofen per package directions) to reduce discomfort. Ensure hydration with water, electrolyte solutions, or clear broths. Rest in a cool environment. Monitor temperature every 2–4 hours.

Fever 39–40°C (102.2–104°F): More serious infection (pneumonia, meningitis, severe bacterial infection). Give antipyretics. Cool the person with cool (not cold) water sponging or cool baths. Ensure aggressive hydration. If fever does not come down or worsens, or if confusion, severe headache, neck stiffness, rash, or difficulty breathing develops, call for medical help.

Fever >40°C (>104°F): Heat stroke or severe infection—medical emergency. Cool the person immediately with cold water, ice packs to groin/armpits/neck, or ice baths if available. Remove excess clothing. Call for emergency help immediately.

Fever accompanied by altered consciousness, severe headache, neck stiffness, purple rash, or difficulty breathing is a medical emergency—call for help immediately.

Bright red blood or pink frothy material indicates active bleeding, usually from the esophagus or stomach. Causes include esophageal varices (from liver disease), peptic ulcer, Mallory-Weiss tear (from severe vomiting), or esophagitis. Dark red or "coffee ground" material indicates older blood that has been partially digested, suggesting slower bleeding from the stomach or upper small intestine.

Both are serious and require medical evaluation to identify the source and stop bleeding.

Immediate action: Keep the person upright or semi-upright to prevent aspiration. Do not give food, drink, or medications. Have the person spit out blood rather than swallow it. Note the volume and color of blood for medical personnel. Call for emergency help immediately.

Do NOT induce vomiting: Never make the person vomit—this worsens bleeding, increases aspiration risk, and causes further esophageal damage.

Monitor for shock: Watch for pale/clammy skin, rapid heart rate, weakness, confusion, or dizziness. If shock signs develop, lie the person flat with legs elevated and keep them warm.

Large-volume hemoptysis (>200 mL bright red blood) or signs of shock require immediate emergency help and possible airway management.

A seizure is an episode of abnormal brain electrical activity causing involuntary muscle contractions, loss of consciousness, and possible loss of bodily control.

During a seizure: Stay calm. Do NOT restrain the person or try to stop the convulsions. Remove nearby objects that could cause injury. Gently turn the person onto their side to keep the airway open and allow secretions to drain. Do NOT place anything in the mouth—the myth of "swallowing the tongue" is false, and a bite stick causes more harm (broken teeth, airway obstruction, aspiration).

Time the seizure duration. Most seizures last 30 seconds to 2 minutes. If the seizure lasts >5 minutes, call for emergency help immediately (status epilepticus).

After the seizure (post-ictal period): The person will be confused, disoriented, and exhausted. They may have bitten their tongue, lost bladder control, or have sore muscles. Keep them lying on their side in the recovery position. Do not restrain them. Let them rest. Reassure and reorient them as they regain consciousness.

When to call for emergency help: First seizure, seizure >5 minutes, another seizure within 24 hours, head injury, injury or unresponsiveness after the seizure.

Do not place anything in the mouth during a seizure. Do not attempt CPR unless the person is not breathing after the seizure ends.

Skin color changes reflect blood oxygenation, perfusion, and organ function.

Pale and clammy skin indicates poor perfusion and shock (from blood loss, severe dehydration, severe infection, or cardiac causes). Associated signs include rapid weak pulse, rapid breathing, confusion, or restlessness. Immediate action: Lie the person flat with legs elevated (unless head or chest trauma suspected), keep them warm with blankets, ensure hydration if conscious and able to swallow, and call for emergency help immediately.

Blue lips, fingertips, or nail beds (cyanosis) indicate hypoxia (low blood oxygen) from respiratory failure, cardiac failure, severe anemia, or extreme cold. Associated signs include difficulty breathing, confusion, or loss of consciousness. Immediate action: Ensure airway is open. If not breathing, start rescue breathing or CPR. Position upright for breathing comfort. Call for emergency help immediately.

Yellow skin or sclera (jaundice) indicates liver dysfunction, bile duct obstruction, or hemolysis (red blood cell destruction). This is not an immediate emergency but requires medical evaluation.

Flushed, hot, red skin with fever suggests infection or heat stroke. Immediate action: Cool the person, ensure hydration, call for medical help if accompanied by high fever or altered consciousness.

Pallor with rapid weak pulse and confusion is a sign of shock—call for emergency help immediately and elevate the legs.