ESI - General
An 80 yo F with CPR in progress
ESI 1 - immediate life saving intervention needed
15 yo F that was bucked off her horse at a riding competition. Bystanders say she was wearing a helmet but lost consciousness for approximately 30s. She complains of a headache, neck pain, and right leg pain. No deformity noted, A/Ox4. HR 90, RR 17, SPO2 98% RA, BP 120/80
ESI 3 - she will need imaging, labs, IV medications, and a trauma team consult.
10 yo M fell off his bike and has an obvious deformity to his right arm. Vital signs are within normal limits for his age. He was wearing a helmet and denies hitting his head or LOC.
ESI 3 - this patient will likely utilize many resources for pain control and moderate sedation to reduce the fracture
Labs (blood or urine)
Resource
This role is responsible for assigning an ESI level as part of the triage process.
What is a nurse (RN)
A regular, homeless patient that is familiar to ED staff arrives with a chief complaint of needing a "turkey samie" and a warm place to sleep. He state he has had CP for a few days and it is getting worse. He is confident that if he gets some rest, he will feel better in the morning. Staff knows him well and comments that he gets "a little worse each time" and must stop drinking".
ESI 3 - don't let your biases cloud your judgement. the patient states he is having chest pain and must be assessed accordingly. He will need a cardiac work-up with requires multiple resources.
25 yo F arrives via the flight team after being rescued from the mountain. She states that she fell approximately 30 feet while hiking and is unable to bear weight on her left leg. The flights team notes an open fracture to her left tib/fib. They gave her Fentanyl on the flight over to control her pain. HR 67, BP 110/70, RR17, SPO2 93% 2L.
ESI 3 multiple resources are anticipated in the care of this trauma patient.
A 5 yo F was swimming with her family when she jumped in to pool and hit her chin on the side of pool, causing a 1 in laceration. Bleeding is controlled and she is clinging to her mother.
ESI 4 - simple lac repair (resource), basic wound care (not a resource), oral pain control (not a resource)
Saline locked IV start
Not a Resource
Administering fluid bolus or medications through the IV is a resource but a saline locked IV is not a resource
False - ESI assignments are for triaging and predicting resources. Decompensating patients should be re-evaluated but the ESI level remains the same.
A 45 yo M with sudden onset of angioedema after starting lisinopril prescribed by his PCP. HR 96, RR 19, SPO2 92% on RA, BP 150/90
ESI 2 - this patient is at risk for losing their airway. Vitals are stable at the moment but this could change rapidly if the swelling continues.
16 yo M with a GSW to his right upper abd. He is screaming profanities at the officers and the medical staff and refusing vital signs.
ESI 2 - even without vital signs, this patient is at high risk for complications and immediate intervention
A 16yo M comes to the ED for a sore throat x4 days. HR 99, Temp 102.5*F, RR 20, BP 130/80. He states that his younger brother was recently diagnosed with strep.
ESI 4 - Exam (not a resource), Swab (Resource), Oral Abx (not a resource)
Consultation with the patient's PCP
Not a resource - consulting a patient's PCP is not a resource, but consultation with a specialty provider is a resource
True or False, ESI is used to determine patient billing
False - ESI is used to triage patient acuity and not for billing purposes
ESI 2 - this patient is at high risk for losing their feet and needs aggressive treatment
78 yo M involved in a MVC. Pt reports 6/10 right hip pain. No loss of consciousness reported. A small lac is noted just above his right eye. He is unable to tell the officer about the collision. HR 65, RR 17, 95% RA,
ESI 3 - this patient is going to require multiple resources: labs, imaging, lac repair, trauma consult, IV fluids, and IV pain medications.
A mother carries her child into the ED. From across the room, you see that the child is cyanotic and limp. What is your first step?
ESI 1 - The child needs immediate life saving intervention
A splint placed on a patient's right wrist for a non-displaced facture
These two things are used to determine a patients acuity (ESI level).
Vital signs and resource anticipated
A 19 yo Male walks into triage alone. While completing the primary triage and assessment, he states that he is actively having thoughts of self harm. He is A/Ox4 but withdrawn. All vitals are within normal limits.
ESI 2 - this patient is at high risk and need to be evaluated by a provider as soon as possible
A patient arrives after a fall on the ice. They take blood thinners for a CVA history. There is a slight hematoma beginning to form on the patient's forehead. All vitals are within normal limits but the patient is angry about being in the ED and would like to leave. Family is attempting to calm them down and states that this is not normal for them
ESI 2 - this patient is at high risk for a head bleed and needs a Stat Head CT. Vital are stable but the patient is altered and showing signs of a possible bleed.
When a child less than 28 days old has this, there is cause for concern. A sepsis work up and elevating the infant to an ESI 2 should be considered.
What is a Fever
These ESI levels are based off vitals signs, not resources
ESI 1 and 2
When determining a patient's ESI level, a nurse begins at what point in the ESI algorithm?
Start with ESI 1
First, determine if life saving intervention is needed. Next determine if is this a high risk situation warranting ESI 2? Lastly, look at vital signs and resources anticipated to care for the patient to decided between ESI 3/4/5.