• Oropharyngeal edema

• Tense abdomen
• Limb edema with impaired distal neurovascular status
• Facial, neck edema with exposure to suspected allergen
• Edema with anuria

• Pitting edema
• Localized edema

• History of edema, resolved

• CO exposure with cardiopulmonary compromise or mental status change

• Heat exposure with:
  • Dizziness
  • Vomiting
  • Temperature > 39.0°C

• Frostbite
• Rectal temperature
  < 36.0°C (96.8°F)
• Radiation exposure
• Hx: struck by lightning
• CO exposure without symptoms
• Near-drowning with respiratory distress or Hx of resuscitative efforts

• Heat exposure with:
  • Headache
  • Hyperventilation
  • Muscle cramps
  • Sweating
  • Nausea
• Hx: near-drowning without respiratory distress or Hx of resuscitative efforts

• Hemodynamic instability

• Active epistaxis with known coagulopathy
• Tachycardia
• Hypertension

• Resolved epistaxis with known coagulopathy

• Active epistaxis

• Resolved epistaxis

• Blunt trauma to eye with:
  • Diplopia
  • Hyphema
  • Limited EOM
  • Point tenderness
  • Step-off orbital rim
  • Inability to assess eyeball
    secondary to edema
  • Refusal to open eye
  • Penetrating injury
• < 1 mo age with purulent exudate
• Hx: chemical in eyes with:
  • Pain
  • Tearing
  • Refusal to open eye
• Irregular or nonreactive pupil
• 360° subconjunctival edema
• 360° conjunctival edema
• Appearance blue, black, brown material on surface of sclera
• Concerns for orbital cellulitis
• Sudden onset loss of vision

• Unilateral erythema, edema with fever, Hx: fever
• Eyelid laceration
• Hx: FB in eyes with:
  • Pain
  • Tearing
  • Refusal to open eye

• Chemical in eyes with first aid at home, now asymptomatic

• Subconjunctival hemorrhage
• Exudate
• Itching
• Mild unilateral erythema, edema without fever
• Scleral edema

• Hypertension
  Hx: IDDM
• Cardiac disease

• Alert, awake without clear precipitating event

• Hx consistent with vasovagal event

• Near syncopal episode

• Fever, hx: fever ≥ 38°C (100.4°F) with:
  • Age ≤ 8 wks
  • Oncologic disorder
  • Central line in place
  • Special immunology
  • Organ transplantation
  • Neutropenia
• Fever, hx: fever ≥ 38.4°C (101.1°F) with sickle cell disease

• ≥ 38°C with age 9-12 wks

• Females ≥ 39°C and
  < 12 mos
• Uncircumcised males
  ≥ 39°C and < 12 mos
• Fever > 3 days

• Do not do rectal temperature in oncology patients
• Protective isolation needed for the following populations
  • BMT/stem cell transplant within 90 days
  • Aplastic anemia
  • SCID

• Drooling and/or Stridor
• Hemodynamic Instability
• Suspected disc (button) battery in any orifice including ear or nose
• Significant respiratory distress

• Dysphagia
• Wheezing
• Tachypnea
• Retractions
• Nasal flaring
• Unequal breath sounds
• Decreased breath sounds
• Tachycardia
• Chest pain
• Suspected magnet ingestion
• Any inserted foreign body with severe pain or obvious blood/drainage

• Hx: significant choking with cyanosis
• Possible swallowed foreign body
• Vomiting
• Rectal or vaginal foreign bodies without suspicion of abuse
• Ear or nose foreign body with:
  • Pain
  • Expandable Object
  • Hx of unsuccessful attempts

• Ear, nose foreign body without symptoms
• Hx: significant choking episode with symptoms now at baseline

Always evaluate for button battery ingestion in patient with history of unknown or possible foreign body ingestion or insertion or coin ingestion.

• Have an increased suspicion in patients who are non-speaking or with limited verbal ability due to age or baseline condition, patients with history of frequent ingestions or insertion of FBs, and patients where ingestion or insertion was unwitnessed. High suspicion in any patient with FB ingestion where Blue Dye is present on or in the mouth including the roof of the mouth.

If suspicion for presence of Button Battery Ingestion (nasal or ingestion):