ESI LEVEL
An 11 year old presents to triage with his mom, who reports that her son has had a cough and runny nose for a week. The child is running around the waiting room and asking his mom for a snack. Vital signs are WNL.
What is an ESI 5
Vital sign re-assessment for an ESI 3
What is every 2 hours
What is 7.5 ml (65/2.2=29.54 kg). Per standardized procedures Weight 26kg-35kg=7.5 ml Lortab solution (hydrocodone+acetaminophen)
Appropriate medication/treatment to anesthetize skin prior to IV start for the pediatric patient. Give 2 examples.
What is the J-tip used with buffered lidocaine. What is LMX (requires 30 min sit time)
What is defeat the purpose of ESI. ESI assesses acuity on presentation, not workload issues. If crutch walking instructions counted as a resource, all patients with sprains would now be triaged as ESI 3; xray and crutch walking.
“The smoke was so bad; I just couldn’t breathe”. Reports a 26 year old female who entered her burning apartment building to try to rescue her cat. She is hoarse and complaining of a sore throat and a cough. You notice that she is working hard at breathing. History of asthma; uses inhalers when needed. No known drug allergies. Vital signs: T 98F, RR 40, HR 114, BP 108/74
What is ESI level 1.
What is the correct way to create an open airway? (Suspected Trauma)
What is... Jaw Thrust
How many X-rays can you order on 1 patient before you must consult the ED MD?
What is 2 X-rays.
State a situation where a minor can consent for treatment.
What is:
A 14 year old having an asthma attack without a parent present.
A 12 year old or older seeking treatment for sexual assault, drug and alcohol related problems, mental health, or reportable diseases.
A minor who pays ALL their own bills.
A 17 year-old active duty Marine.
An attribute of ESI.
What is:
Right resource, right place, right time.
Anticipates expected resource needs.
Used as a communication tool.
A 26 year old female walks into triage and tells you she needs to go into detox again. She has been clean for 18 months but started using heroin again 2 weeks ago when her boyfriend broke up with her. She had called several detox centers but was having no luck finding a bed. She denies SI or HI ideation. She is calm and cooperative.
What is ESI Level 3.
This patient will likely get a tox screen & psych consult (at least 2 resources).
The re-evaluation of a stable patient designated as ESI 2 in the waiting room.
What is every 15 minutes.
Which medication cannot be given per the standardized procedure policy for ED - Propraricaine, Zofran, Benadryl or Bacitracin?
What is Bacitracin.
Number of ESI resources needed for a 10-year old boy who was riding his bike when he lost his balance and everted his left ankle resulting in moderate pain and swelling over the lateral malleolus?
What is 1 resource.
An ankle x-ray (one resource) and an ace wrap for support (not a resource) even if he gets crutches (not a resource).
Eye irrigation, Nebulized Medication Administration and Blood Transfusion.
What are resources.
A 40 year old roofer presents with foot and back pain brought in via private vehicle by his partner. He is unable to ambulate due to the pain. He states that he fell off a ladder about 10 feet landing on his feet while at work a few minutes ago. The pain was immediate when he fully stood after the fall. The triage nurse notes he is diaphoretic and in mild distress. His stated pain is 6/10 and he is sitting upright in a wheelchair.
What is ESI Level 2.
High risk for both lumbar & calcaneus fractures.
"Hello, so what's your emergency today?"
What is something not to say to a patient in triage.
When are the standardized procedures no longer used by the ED RN?
What is at the time of the MSE.
ESI level for a 7 month-old presenting to the ED with mom for evaluation of a fever, cough, and vomiting. The baby has had no diarrhea but vomited twice this morning. Mom did not have a thermometer but tells you the baby felt “very hot” today. The baby is wrapped in a blanket with her eyes open, appears listless, with hot moist skin and sunken fontanels. Respiratory effort is regular and unlabored.
What is ESI 2. This baby is at high risk for sepsis or severe dehydration. This baby is at high risk due to the information regarding the sunken fontanels and lethargy. A temperature reading is not needed to determine that the baby is at high risk.
Appropriate pain scale needed for Mrs. Win who is being triaged for complaint of left leg pain and whose English is very broken.
What is Wong-Baker.
The Wong-Baker Pain Scale is for those who experience a language barrier between the nurse and patient
A 16 year old male is brought to the ED by his mom for a laceration repair. He was playing baseball with the kids when he was struck by the bat by accident. The friends state that he “passed out.” He now complains of not feeling very well, being “sick to my stomach” and a throbbing headache. The triage nurse notes that he is pale, but alert to time, person, and place. The laceration near his left ear has controlled bleeding.
What is ESI level 2.
Patient is at high risk for subdural hematoma.
A 21 year old college student comes to triage with chief complaint of a horrible sore throat, body aches, feeling ill. She can barely speak. Speech is garbled and is drooling a little. Skin is hot to touch. You evaluate her as an ESI 4 and place her back in the waiting room.
What is under-triaging.
This patient is at high risk for airway compromise and should be evaluated for epiglottitis. ESI of 2. Risk for airway obstruction and this should be considered a life-threatening emergency.
Name a medication with associated pain score that can be used to treat the patient with a long bone fracture in triage.
What is:
Acetaminophen & Ibuprofen for a pain score of >4 OR Norco for a pain score of >6 OR Lortab elixir for pain score of >6
ESI level of a healthy 10 year old male brought to the ED by his mom, who reports that her son has not moved his bowels for a week. He is complaining of 7/10 generalized abdominal pain, nausea, and lack of appetite. Vitals: BP 107/66, HR 75, RR 20, T 98.6F, SpO2 99%. What ESI level would you give?
What is ESI level 3.
Two or more resources. Abdominal pain, loss of appetite, and nausea in a 10 year old who has not had a bowel movement in several days is probably due to constipation. He will need two or more resources – labs, maybe an xray, maybe surgery consult, maybe an enema, but at least 2 resources.
“We want to give every one of our patients all the help and information they came for, without rushing. Sometimes that causes others to wait”
What is an example of a "Wait-Lifting" phrase.