Assign an ESI Level
A 62-year-old with CPR in progress.
What is ESI Level 1
What are some of the immediate roles that will be assigned and priority interventions to this patient? (think C-ABC)
Crowd control considerations
A CT scan is considered a resource in the ESI triage system. True or False
What is True
22-month-old, fever, pulling ears, immunizations up to date, history of frequent ear infections. Awoke screaming, pulling at ears, runny nose this week, alert, tired, flushed, falling asleep now, calm in moms arms, cries with exam. Vitals: Temp 102 F HR 128 RR 28 O2 Sat 97% Assign an ESI level
What is ESI Level 4 or 5?
Can we give tylenol in triage with an order?
What Resources would be used? Are oral meds a resource?
What would make this patient have an increased ESI Level?
Has 24-hour availability of emergency medicine and surgical services which allow the patient to be taken directly to the operating room, if needed.
What is a trauma center.
Healthy 10-year-old child with poison ivy exposure and rash on left arm
What is none. This patient needs an exam and possible prescription and/or oral decadron
A 53-year-old with 30% body surface area burn.
What is ESI Level 2
What are red flag signs that the airway might be compromised? What are you assessing for?
A psychiatry consult is considered a resource in the ESI traige system. True or False
What is True.
What ESI Level is a patient that presents with suicidal ideation with a plan?
6-year-old with cough and fever x 2 days, chills, short of breath with exertion, green sputum, sleeping a lot. Vitals: Temp 104.4 F HR 140 RR 30 O2 Sat 91% Assign an ESI triage level
What is ESI Level 2 The clinical picture indicates high probability of tests that equal two or more resources (ESI level 3). Danger zone vital signs exceeded (SpO2 of 91%, RR 30,) making the patient an ESI level 2.
Bruising or abrasions on the chest and/or abdomen resulting from the use of a seat belt during a motor vehicle crash
Why is this sign concerning?
What is seat belt sign
This is a strong indicator of possible severe, hidden internal injuries, often associated with a four- to eightfold increase in risk for significant intra-abdominal or thoracic damage. While the skin mark may appear minor, it often signifies high-impact forces that can cause fatal vascular damage, bowel ruptures, solid organ lacerations, or spinal fractures (Chance fractures)
Healthy 52-year-old man ran out of blood pressure medication yesterday; BP 150/92 HR 82; denies any shortness of breath or chest pain. Was unable to see PCP and needs refill
What is none. This patient needs an exam and prescription.
A 22-year-old who needs a work note for viral illness. Denies any acute or concerning symptoms
What is ESI Level 5
Are there situations where a patient may need to come to the ED for work notes? Yes! Be kind
Cardiac monitoring is considered a resource in the ESI triage system. True or False
What is False. Monitoring is part of the routine care provided by ED staff.
A 12-year-old with an earache.
What is ESI Level 5.
"those who have sustained a traumatic injury."
What is a trauma patient.
Healthy 29-year-old female with dysuria, denies vaginal discharge, fever, nausea/vomiting
What is one. This patient needs an exam, urine, and urine culture, maybe a urine hCG, and prescription. All of these urine tests count as ONE resource.
"I have been wheezing for a few days, and today I woke up with a fever. My rescue inhaler doesn't seem to be helping," reports a 43-year-old female with a past history of asthma. Vitals: Temp 100.2 F RR 20 HR 90 BP 138/70 SpO2 95% Assign an ESI level.
What is ESI Level 3. This patient has a history of asthma that is not responding to her rescue inhaler. In addition, she has a fever. At a minimun, she will need two resources: hand-held nebulizer treatments and a chest xray.
What would have caused this patient to be a level 2? What about a level 1?
It is considered an ESI resource if a patient requires a constant observer to prevent a fall. True or False
What is true. A constant observer at the bedside us considered a resource. However, if a patient is ESI level 2 or high risk because they are a danger to themselves or others, it is not necessary to predict the number of resources they will reuire in the ED.
An unresponsive 14-year-old. EMS tells you he and his friends had been "doing shots."
What is ESI Level 1.
Mechanism of injury alone is an appropriate reason to divert to a trauma center. True or False
What is False. Mechaniam of injury should be considered but not the only reason to divert.
A 22-year-old male with right lower quadrant abdominal pain since early this morning. +nausea, no appetite
What is at least 2. This patient needs an exam, lab studies, IV fluid, abdominal CT, and perhaps surgical consult.
A 51-year-old presents to triage with redness and swelling of his right hand. He reports being scratched by his cat yesterday. Past medical history of GERD. Vitals: BP 121/71 HR 118 RR 18 Temp 101.8 F SpO2 98% Pain 5/10 Assign an ESI level.
What is Level 3. This patient probably has a cellulitis of the hand and will require labs and IV antibiotics. Starting a saline lock is not a resources, but IV antibiotics are a resource.
A physical exam is considered a resources. True or False
False.
9-year-old male, head trauma. Collided with another player at lacrosse game. Loss of consciousness for "about 5 minutes" witnessed by coach. Now awake with headache and nausea.
What is ESI Level 2. This patient is assigned an ESI level 2 due to the high-risk information provided in the scenario. Vital signs are not necessary, and patient should be immediately taken to treatment area for rapid assessment.
Before transport begins, the patient (or parent/guardian) can request transportation to a hospital that is not a trauma center even though EMS discourages it. True or False
What is True. There are 5 exceptions to mandatory transport to a trauma facility. Request to a hopsital that is not a trauma center is one of those exceptions (assuming the patient is of sound mind and able to make decisions for themselves).
A 45-year-old obese female with left lower leg pain and swelling, started two days ago after driving in a car for 12 hours.
What is at least 2. This patient will need an exam, lab, lower extremity non-invasive vascular studies.