Cardiac/Resp Related
30-year-old female complaining of chest discomfort. No reported medical history. No home medications.
Vitals: BP 130/83, HR 90, RR 18, SpO2 94%, T 97.8
ESI 3
Resources 2 or more
My baby had a fever of 102 rectally about an hour ago in my pediatrician’s office- he told me to come here,” reports the mother of a 3 week old. The baby is wrapped up in blankets and is hot to touch. Full body non blanchable rash noted on inital assessment.
ESI 2
Needs exam, labs, possible IVF, specialty consult, complex procedure
Resources: danger zone r/t age and vitals
A 48-year-old male tells you that he has a history of kidney stones and thinks he has another one. He has right costovertebral angle pain that radiates around to the front and into his groin. He is nauseous but tells you he took a pain pill, and right now he has minimal pain. He denies vomiting.
T 98°F, RR 16, HR 80, BP 136/74, SpO2 100%. Pain 3/10.
ESI 3
At a minimum, he will need a urinalysis and CT scan. If his pain increases, he may need IV pain medication. At a minimum, two resources are required.
EMS presents to the ED with an 18-year-old female with a suspected medication overdose. Her college roommates found her lethargic and "not acting right," so they called 911. The patient has a history of depression. On exam, you notice multiple superficial lacerations to both wrists. Her respiratory rate is 10, and her SpO2 on room air is 86 percent.
ESI 1
RR and O2 saturation indicate possible inability to protect airway.
**Narcan is considered lifesaving intervention**
29 y/o female presents to the ED with a history of sore throat +fever for the last 6 days. Complains of pain with swallowing. Unable to swallow tylenol. “I just feel wiped out” : voice muffled voice at triage: Drooling.
VS: T-102.8 R-18 PR 120 BP 106/64
ESI 2
possible airway issue.
Healthy 52-year-old male ran out of blood pressure medication yesterday; BP 150/92
ESI 5
Needs an exam and prescription
Resources : None
1-year-old female brought in by mother who states the patient has not had a wet diaper in 14 hours. Patient stares at nurse blankly and does not respond to the nurse blowing bubbles.
Vitals: HR 165, RR 25, SpO2 96%, T 102.5
ESI 2
High Risk vital signs
Needs exam, lab (UA) possible IVF or IV ABX
Healthy 29-year-old female with a urinary tract infection, denies vaginal discharge
ESI 4
Needs an exam, urine, and urine culture, maybe urine hCG, and prescriptions
Resources: Lab (urine, urine C&S, urine hCG)*
20-year-old male is brought to ED by a friend after he took 8 sleeping pills. Patient states that his girlfriend recently broke up with him. No medical history.
Vitals: BP 119/70, HR 101, RR 16, SpO2 94%, T 98.6
ESI 2
Behavioral Health patient
A 45-year-old obese female with left lower leg pain and swelling, started 2 days ago after driving in a car for 12 hours
ESI 3
Needs exam, lab, lower extremity non invasive vascular studies
Resources: 2 or more
A 46-year-old asthmatic in significant respiratory distress presents via ambulance. The paramedics report that the patient began wheezing earlier in the day and had been using her inhaler with no relief.
Vital signs: RR 44, SpO2 93% on room air, HR 98, BP 154/60. The patient is able to answer your questions about allergies and medications.
On her last admission for asthma, she was intubated.
ESI 2
High-risk. An asthmatic with a prior history of intubation is a high-risk situation. This patient is in respiratory distress as evidenced, by her respiratory rate, oxygen saturation, and work of breathing.
Healthy 10-year old child with poison ivy
ESI 5
Need and exam and prescription.
Resources: None
"I think I have food poisoning," reports an otherwise healthy 33-year-old female. "I have been vomiting all night, and now I have diarrhea." The patient admits to abdominal cramping that she rates as 5/10. She denies fever or chills.
Vital signs: T 96.8°F, HR 96, RR 16, BP 116/74.
ESI 3
Resources: 2 or more
48 y/o construction worker who presents to the ED ambulatory with chief complaint, ‘I was at the job and was dumping concrete powder in a bucket and the powder flew up and got in to both of my eyes: patient reports he was NOT wearing goggles/glasses: Complains of much burning/pain to both eyes : +blurred vision
ESI 2
trauma, alkali burns, burns to face and eyes, alkali burns cause necrosis
A 16 year old male wearing a swimsuit walks into the ED. He explains that he dove into a pool and his face struck the bottom. You notice as abrasion on his forehead and nose as he tells you that he needs to see a doctor because of the tingling in both hands
ESI 2
Needs exam, imaging, specialty consultation
A 76 year old male is brought to the ED because of severe abdominal pain. He tells you “it feels like someone is ripping me apart”. The pain began about 30 minutes prior to admission and he rates the intensity as 20/10. He has hypertension for which he takes a diuretic. No allergies. The patient is sitting in a wheelchair moaning in pain. His skin is cool and diaphoretic.
VS: HR 122, BP 88/68, RR 24, SpO2 94%
ESI 1
VS, what do you think this could be?
A mother brings in her 4-year-old daughter after a bee sting; she’s concerned because her grandmother was allergic to bees. Patient with no visible localized swelling/irritation. The patient hides behind her mother and requires coaxing to obtain vitals.
Vitals: HR 119, RR 26, SpO2 99%, T 98.9
ESI 5
Needs exam
A 22-year-old male with right lower quadrant abdominal pain since early this morning + nausea, no appetite
ESI 3
Needs an exam, lab studies, IV fluid, abdominal CT, and perhaps surgical consult
Resources: 2 or more
EMS arrives with a 32-year-old female who fell
off a stepladder while cleaning her first-floor
gutters. She has an obvious open fracture of her
right lower leg. She has +2 pedal pulse. Her toes
are warm, and she is able to wiggle them.
Denies past medical history medications, or
allergies.
Vital signs are within normal limits for
her age
ESI 3
An obvious open fracture will necessitate this
patient going to the operating room. At a
minimum, she will need the following
resources: x ray, lab, IV antibiotics, and IV pain
medication.
Resources: more than 2
"I think I picked up a bug overseas," reports a 34-year-old male who presented in the emergency department complaining of frequent watery stools and abdominal cramping. "I think I am getting dehydrated." T 98F, RR 22, HR 112, BP 120/80, SpO2 100%. His lips are dry and cracked. (1)
ESI 3
exam, lab, IVF, possible imaging
"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 98°F, RR 40, HR 114, BP 108/74.
ESI 1
From the history and presentation, this patient appears to have a significant airway injury and will require immediate intubation. Her respiratory rate is 40, and she is in respiratory distress.
Healthy 15-year-old with sore throat and fever
ESI 4
Needs an exam, throat culture, prescriptions
Resources: Lab (throat cultures)
I have this rash in my groin area," reports a 20-year-old healthy male. "I think it's jock rot, but I can't get rid of it." Using over the counter spray. No known drug allergies.
Vital Signs: T 98°F, HR 58, RR 16, BP 112/70.
ESI 5
needs exam and prescriptions
"My pain medications are not working anymore. Last night I couldn't sleep because the pain was so bad," reports a 47-year-old female with metastatic ovarian cancer. "My husband called my oncologist, and he told me to come to the emergency department." The patient rates her pain as 9/10. Vital signs are within normal limits.
ESI 2
Severe pain or distress.
This patient needs pain management with IV medications.
A 68 year old male brought in by his wife for sudden onset of left arm weakness, slurred speech, and difficulty walking. Symptoms began 2 hours prior to arrival. Past medical history: Atrial fibrillation. Meds: Lanoxin. The patient is awake, oriented, mildly short of breath. Speech is slurred, right-sided facial droop is present. Left upper-extremity weakness noted with 2/5 muscle strength.
ESI 2
s/s of stroke