Cardiac/Neuro
37-year-old female presents with c/c of a rapid heartrate. SOB. Chest pressure. HR 178. RR 32. BP 82/60. Skin cool and diaphoretic.
What is ESI 1?
Hypotensive, tachycardia. Signs of being unstable. Requires immediate lifesaving interventions which may include meds and cardioversion.
32-year-old female complaining of shortness of breath for several hours. No PMHX. Is a smoker. RR 32, HR 96, BP 126/80, SPO2 93% on room air. T 37C. No allergies. Meds: multivitamin and BCP.
What is ESI 2?
High risk situation: smoker on birth control pills, SOB. Needs a PE rule out.
41-year-old male who fell off his bicycle this morning, landing on his right arm. Pain 6/10 in right wrist with a 2cm laceration on the left elbow. Was wearing a helmet.
What is ESI 3?
Two resources: Xray, sutures
6-year-old male who fell while running on the playground. 3 cm laceration over his right knee. No PMHX, no meds, no allergies. Vaccines up to date.
What is ESI 4?
One resource: sutures
27 yo female who thinks she scratched her cornea last night when removing her contacts. Photophobic. Right eye red, tearing. Pain 6/10. Vitals WNL.
What is ESI 5?
No resources.
88-year-old female whose daughter reports an episode of slurred speech and weakness in her left arm that lasted about 45 minutes. Hx of previous stroke. Takes a daily aspirin. Alert and oriented with clear speech and equal hand grips.
What is ESI 2?
High risk situation: With her history, she may have had a TIA. At high risk and it would not be safe for her to sit in the waiting room for an extended period of time.
Tall, thin 19-year-old male presents with feeling SOB after smoking a cigarette and having a "coughing fit". No PMHX, meds or allergies. Vitals T 36.6C, HR 102, RR 36, BP 128/76, SPO2 92%, Pain 0/10
What is ESI 2?
Young healthy male with elevated respiratory rate and low oxygen saturation. Hx, signs and symptoms consistent with a spontaneous pneumothorax.
58-year-old female who slipped on the ice. No obvious deformity. Vitals WNL. Pain 5/10.
What is ESI 4?
One resource: X-Ray
Mother presents with otherwise healthy 2-year-old who she reports is pulling on his right ear. Tympanic temp of 37.8C. Hx of frequent ear infections. Not on any meds. Urine output normal, eating and drinking normally. Pt is alert and trying to grab your stethoscope.
What is ESI 5?
No resources
53-year-old female thinks she has a UTI. Complaining of dysuria and frequency. Denies abd pain or vaginal discharge. No significant PMHX, no allergies. Vitals T 36.5C, HR 78, RR14, BP 142/70.
What is ESI 4?
One resource: urinalysis and culture
74-year-old male presents after his implanted defibrillator gave him a shock this morning during breakfast. Pt has a significant cardiac history, takes multiple medications including amiodarone. Vitals T 36.9C, RR 20, HR 90, BP 120/80.
What is ESI 2?
High risk situation. Not a patient who should sit in the waiting room. Defibrillator fired for some reason and should be evaluated.
23-year-old female who is 5 weeks post-partum presents with fatigue and shortness of breath with activity. Feels like her ankles are swollen.
What is ESI 2?
This is a high-risk situation. Signs and symptoms concerning for peripartum cardiomyopathy.
68-year-old female presents with pain in her right arm after slipping and falling on ice. Obvious deformity with good circulation, sensation, and movement. No allergies. Vitals WNL. Pain 6/10.
What is ESI 3?
Two or more resources: Suspected displaced fracture which will require closed reduction, X ray, ortho consult.
4-year-old female who fell off the jungle gym at school. Fell 4 feet. Witnessed fall, patient was unconscious for a few minutes. Deformity in left arm. Vital signs HR 162. RR 38.
What is ESI 2?
High risk situation: witnessed fall with LOC.
33-year-old-male presents with toothache. Hasn't seen a dentist in several years. No obvious swelling. Vital signs WNL. Pain 9.10.
What is ESI 5?
No resources
42-year-old male who presents with dizziness and nausea every time he tries to move. No PMHX. Vitals T 36.2C, RR 16, HR 90, BP 130/82, SPO2 99%, Pain 0/10.
What is ESI 3?
Based on the history, pt may have acute labyrinthitis and will require two or more resources, IV fluids and antiemetic.
45-year-old female presents with history of asthma presents with one week of a cold. Started wheezing a few days ago and then developed a cough and fever of 103F. T 38.6C, HR 92, RR 24, BP 148/86, SPO2 97%.
Two or more resources: labs, chest xray, IV
62-year-old man presents with left hand wrapped in a bloody towel. Pt states he was working with a table saw and his hand slipped. Thinks he lost a couple of fingertips. No PMHX, allergies or meds. Vitals WNL. Pain 6/10.
What is ESI Level 3?
Three or more resources: X-ray, IV pain meds, laceration repair, possibly IV antibiotics.
15-year-old female presents with fever and sore throat. Drinking from a water bottle. No past medical history. Is on BCP. No allergies. Vitals 38.1C, HR 88, RR 18, BP 112/76.
Patient will need a rapid strep and culture.
37-year-old female with migraine and vomiting. No allergies. PMHX of migraines. Pain 6/10. T 36.6C RR 20 HR 102 BP 118/62
What is ESI 3?
Resources: IV, IV meds, IV fluids
28-year-old female with a history of tick bites presents with a feeling of paralysis on the left side of her face. Speech is normal, vision is normal, pt denies dizziness.
What is ESI 4?
One resource: patient likely has Bell's Palsy and will need a tick panel drawn to identify any tick borne illnesses.
39-year-old female with a history of asthma presents with several days of a cold. Wheezing started today. No meds, no allergies. T 36.6C, RR 22, HR 88, CP 130/80, SPO2 99%.
What is ESI 4?
One resource: Pt will need a neb treatment. No labs or X-ray should be necessary without fever.
87-year-old male on warfarin presents after falling and hitting his head. He is awake, alert and oriented and remembers the fall. PMHX of Afib. Multiple medications. Vitals WNL.
What is ESI Level 2?
High risk situation. Patient is on warfarin so at high risk of internal bleeding. Needs CT of head.
7-year-old male presents with his father who reports that the patient woke up complaining of a stomachache. Father reports that patient refused to walk down the stairs and is not interested in eating. Pt vomits at triage. Pain 6/10. T 38C, RR 22, HR 88, BP 84/60, SPO2 100%.
What is ESI 3?
More than two resources: labs, CT or ultrasound, IV.
24-year-old male presents with pain and swelling in his left ankle. Patient reports that he was hiking this morning and rolled his ankle. There is bruising across the top of the foot. Vitals WNL. Pain 8/10.
What is ESI 4?
One resource: X-ray