Pathophysiologic consideration of an intuitive “sense of alarm” / 日本プライマリ・ケア連合学会誌

<b><i>Abstract</i></b><br> Sometimes experienced doctors and nurses have an intuitive sense of alarm about an apparently stable patient, a sense which may be expressed as, for instance, ‘He/she seems seriously ill.’ However, this intuitive sense of alarm remains a rule of thumb, even though it is recognized as an important “diagnostic” indicator in clinical decision-making. In this review, we have attempted to clarify the meaning of the phrase by proposing a pathophysiologic/symptomatologic model that suggests that the sense of alarm is a premonitory sign of a homeostatic crisis characterized by acute systemic autonomic symptoms and acute sickness behavior. The model proposed here may help novices to avoid missing potentially critical diseases.