Monday
4-year-old unresponsive
Pulled out of the family pool, mouth-to-mouth resuscitation administered.
Breathing spontaneously, continues to be unresponsive.
Vital signs: HR 126, RR 28, BP 80/64, SpO2 96% on NRB
ESI 1: Unresponsive.
Requires immediate lifesaving interventions for airway, breathing, and circulation
32 y/o F presents to the ED c/o SOB for several hours. No past medical history, +smoker.
VS. HR 96, RR 32, BP 126/80, SpO2 93% Room air, T 98.6. No allergies, current medications include vitamins and birth control pills
ESI 2: High risk situation.
new-onset SOB on birht control pills. she is a smoker and exhibiting S/S of respiratory distress. Pulmonary embolus needs to be ruled out as potential cause for respiratory distress.
28-year-old male cut finger.
2-centimeter laceration on the left first finger.
Bleeding is controlled.
His last tetanus immunization was 10 years ago.
Vital signs are within normal limits.
ESI 4: One resource.
This patient will require a laceration repair.
A tetanus booster is not a resource.
An ambulance arrives with an 87 y/o male who fell and hit his head. he is awake, alert and oriented and remembers the fall. He has a past medical history of atrial fibrillation and is on multiple medication including warfarin. His vital signs are WNL.
ESI 2: High risk situation.
Patients taking warfarin who fall are at high risk of internal bleeding. Although the patients' vital signs are WNL & he shows no signs of a head injury, he needs a prompt eval and CT of the head.
20-year-old male rash in groin area.
Using over the counter spray, no known drug allergies.
Vital signs: RR 16, HR 58, BP 112/70, T 36.6°C (98˚F)
ESI level 5: No resources.
Patient will be sent home with prescriptions and appropriate discharge instructions
41-year-old male bicycle crash
He fell off his bike and landed on his right arm.
Complaining of pain in the wrist area and has a 2-cm laceration.
"My helmet saved me"
ESI 3: Two or more resources.
At a minimum, this patient will require an x-ray of his right arm and suturing of his left elbow laceration.
"The smoke was so bad; I just couldn't breath," reports a 26 y/o 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 to breath. history of asthma; uses inhalers when needed. NKDA. VS T98, RR 40, HR 147, BP 108/74 O2 sat-94%
ESI 1: Requires immediate lifesaving intervention
From the history and presentation, this patient appears to have a significant airway injury and will require immediate intubation. her RR is 40 and she is in respiratory distress.
58-year-old female slipped on the ice and c/o wrist pain.
No obvious deformity.
Vital signs are within normal limits, Pain 5/10.
ESI 4: One resource.
Patient needs an X-ray to rule out a fracture.
A Velcro splint is not a resource.
18-year-old female suspected medication overdose.
Dropped at front door and is unresponsive.
History of depression.
Respiratory rate is 10, SpO2 86%
ESI 1: Requires immediate lifesaving intervention.
Respiratory rate, oxygen saturation, and inability to protect her own airway indicate endotracheal intubation.
4-year-old female fell 4 feet off a jungle gym
Child hit head and unconscious for a couple of mins. Is crying and asking for her mother, left arm is splinted.
Vital signs: HR 162, RR 38.
ESI 2: High-risk situation.
Witnessed fall with loss of consciousness and presents with a change in level of consciousness. She needs to be rapidly evaluated and closely monitored.
47-year-old female right leg is swollen with calf pain
Denies chest pain or shortness of breath
Admits to a history of type 2 diabetes and hypertension.
Vital signs: RR 24, HR 78, BP 158/82, SpO2 98%, T 36.6°C (98˚F), Pain 6/10.
ESI 3: Two or more resources.
Two resources: labs and an ultrasound.
High risk for a deep vein thrombosis. If this patient were short of breath or had chest pain, they would meet ESI -2 criteria.
27-year- old-female eye pain.
"I was taking my contacts out last night, and I think I scratched my cornea".
Right eye is red and tearing, light sensitivity.
Vital signs are within normal limits, pain 6/10.
ESI 5: No resources.
Eye exam and discharged home with prescriptions and follow up with an ophthalmologist.
19-year-old man reports "I was smoking a cigarette and had this coughing fit, and now I feel short of breath,"
Vital signs: RR 36, HR 102, BP 128/76, SpO2 92%, T 36.6°C (98˚F), Pain 0/10.
ESI 2: High-risk situation.
Elevated respiratory rate and a low oxygen saturation.
History and signs and symptoms are suggestive of a spontaneous pneumothorax. He needs to be rapidly evaluated and closely monitored.
34-year-old female sore breast, cracked nipples, and a fever.
Three months postpartum and has recently returned to work.
No past medical history, taking vitamins, and is allergic to penicillin.
Vital signs: RR 18 , HR 90, BP 108/60, T 39.3°C (102.8˚F), Pain 5/10.
ESI 3: Two or more resources.
At a minimum, she will require labs and intravenous antibiotics.
27-year-old female low abdominal pain (6/10) for about 4 days.
This morning, she began spotting. Denies nausea, vomiting, diarrhea, or urinary symptoms, last menstrual period 7 weeks ago.
Past medical history includes previous ectopic pregnancy.
Vital signs: RR 14, HR 66, BP 106/68 mm T 36.6°C (98˚F)
ESI 3: Two or more resources.
Require two or more resources - labs and an ultrasound.
May be pregnant, ectopic pregnancy is a possibility, but this patient is currently hemodynamically stable, and her pain is generalized across her lower abdomen.
60-year-old man right foot hurts.
Great toe and foot skin is red, warm, swollen, tender to touch and denies injury
Vital signs: RR 18, HR 82, BP 146/70, SpO2 99%, T 37.4°C (99.4˚F)
ESI 3: Two or more resources.
Labs and intravenous antibiotics.
27-year-old female 7 weeks pregnant and vomiting.
Lips are dry and cracked.
Vital Signs: RR 18, HR 124, BP 104/68, SpO2 99%, T 36.1°C (97˚F), Pain 0/10.
ESI 2: abnormal vitals and Two or more resources.
Showing signs of dehydration.
Lab studies, intravenous fluid, and an intravenous antiemetic
7-year-old woke up complaining of a stomachache.
"He refused to walk downstairs and is not interested in eating or playing." Vomits in triage.
Vital signs: RR 22, HR 88, BP 94/69, SpO2 100%, T 38°C (100.4˚F), Pain 6/10.
ESI 3: Two or more resources.
Abdominal pain workup includes labs and CT or ultrasound
56-year-old male with a history of high blood pressure.
"I ran out of my blood pressure medicine, and my doctor is on vacation. Can someone here write me a prescription?"
Vital signs: BP 128/84, HR 76, RR 16, T 36.1°C (97˚F).
ESI 5: No resources.
Prescription refill and no other medical complaints.
His blood pressure is controlled with his current medication.
"How long am I going to have to wait before I see a doctor?" asks a 27 y/o female with a migraine. the patient is well known to you and your department. she rates her pain as 20/10 and tells you she has been like this for two days while playing a game on her phone.
She vomited twice this morning. PMH of migraines, NKA, medications include Fioricet.
ESI 3: 2 or more resources.
Will require IV access with fluids and IV pain medications and a antiemetic. despite her high pain level the triage nurse cannot justify giving the last open bed to this patient. The triage nurse will need to address this patient's concerns about wait time.
21-year-old female doesn't feel right with rapid heart rate.
"I can barely catch my breath, and I have this pressure in my chest."
Vital Signs: RR 32, HR is 178, BP 82/68, skin is cool and diaphoretic.
ESI 1: Requires immediate lifesaving interventions.
Shortness of breath, chest pressure, and hypotensive and tachycardia. This patient requires immediate lifesaving interventions, which may include medications and cardioversion.
An ambulance presents to the ED with a 54 y/o female with chronic renal failure who did not go to dialysis yesterday because she was feeling too weak. She tells you to look in her medical record for a list of her current medications and past history. Her vital signs a WNL.
ESI 2: high risk situation
A complaint of weakness can be due to a variety of conditions, such as anemia or infections. A dialysis patient who misses a treatment is a high risk for hyperkalemia or other fluid and electrolyte problems. this is a patient who cannot wait to be seen and should be given your last open bed.
2-week-old male fever
Uncomplicated, vaginal delivery, acting appropriately.
Vital signs: RR 42, HR 154, SpO2 100%, T 38.3°C (101˚F)
ESI level 2: High-risk situation.
A temp higher than 38˚C (100.4˚F ) in an infant less than 28 days old is a high-risk situation no matter how good the infant looks.
Infants in this age range are at a high risk for bacteremia(sepsis).
37-year-old female migraine starting this morning.
Can't get it under control, keeps vomiting.
Past medical history migraines, no allergies.
Vital Signs: RR 20, HR 102, BP 118/62, SpO2 98%,T 36.6°C (98˚F), Pain 6/10.
ESI 3: Two or more resources.
Pain medication, an antiemetic, and fluid replacement.
The pain is not severe at 6/10 not high risk situation.
34-year-old female 10 days postpartum. "I suddenly started bleeding and passing clots the size of oranges, I never did this with my other two pregnancies."
"Can I lie down before I pass out?"
Vital signs: RR 22, HR 132, BP 86/40, SpO2 98%.
ESI 1: Requires immediate lifesaving intervention.
Signs and symptoms of a post-partum hemorrhage.
Vital signs reflect fluid volume deficit. The patient needs immediate intravenous access and fluid resuscitation.