If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
Wounds of traumatic aetiology
- Systemic inflammatory response symptoms (SIRS) or clinically unwell
- Wounds with complex foreign body involvement and significant damage to associated surrounding structures including blood vessels, nerves, muscles, joints and tendons.
- Wounds with associated compound fractures
- Persistent significant bleeding not controlled with usual measures
- Worsening pain and/or pain not in keeping with mechanism of injury
- Initial acute burns should be managed as per ANZBA guidelines
- Refer to Vascular High Risk Foot CPC or Diabetic High Risk Foot CPC
Arterial/ischaemic ulcer
- Systemic inflammatory response symptoms (SIRS) or clinically unwell
- Worsening pain and/or pain not in keeping with progression of the wound/ulcer
- Sepsis or acutely unwell due to infection3
- Acute or critical limb ischaemia with necrosis
- Rapidly deteriorating ulceration or necrosis.3
- Ulcers or wounds in a limb with markedly compromised circulation
Wounds on the High-Risk Foot
- Systemic inflammatory response symptoms (SIRS) or clinically unwell
- Worsening pain and/or pain not in keeping with progression of the wound/ulcer
- Progressive cellulitis despite initial treatment
- Acute or critical limb ischaemia with necrosis
- Acute Charcot arthropathy if access to podiatry is not accessible within 48 hours
Stoma related wounds
- Systemic inflammatory response symptoms (SIRS) or clinically unwell
- Worsening pain and/or pain not in keeping with progression of the wound
- Progressive cellulitis despite initial treatment
- Suspected incarcerated hernia or underlying abscess
- Suspected bowel obstruction resulting in non-functioning stoma
- Persistent significant bleeding not controlled with usual measures
- Stomal change in colour from red / pink to blue or black
- Stomal prolapse causing circulatory compromise
- Bleeding peristomal varices
- Ongoing high output stoma and signs of dehydration
NB: If the problem is with the stomal appliance the patient can self-refer to stomal therapy nurse. Patients not in contact with regular stomal therapy nurse/service can be referred by GP.
Pressure injury
- Systemic inflammatory response symptoms (SIRS) or clinically unwell
- Worsening pain and/or pain not in keeping with progression of the wound/ulcer
- Pressure injury if causing systemic infection
- Patients with spinal injuries should be referred to Spinal Outreach Team (SPOT)
Post-operative wound/dehiscence
- Systemic inflammatory response symptoms (SIRS) or clinically unwell
- Worsening pain and/or pain not in keeping with progression of the wound/ulcer
- Prosthesis / metal work is on view
- Purulent discharge with associated fevers
