Traum-o-rama
"I slipped on the ice, and I hurt my wrist," reports a 58-year-old female with a history of migraines. There is no obvious deformity. VS WNL, and she rates her pain as 5/10.
ESI Level 4: One resource
This patient needs an x-ray to rule out a fracture. A splint is not a resource.
Narcan or Naloxone is considered a life-saving intervention True or False
True
Sicker
The "A" in BEFAST stands for what?
Arms. Arm or leg weakness.
Oral meds are considered a resource True or False
False
A 4-year-old female is transported to the ED following a fall off the jungle gym at preschool. A fall of 4 feet. A witness reports that the child her head and was unconscious for a couple of minutes. On arrival you notice that the child is crying and asking for her mother. Her left arm is splinted; HR 162, RR 38
ESI Level 2: High-risk situation
This 4-year-old had a witnessed fall with loss of consciousness and presents to the ED with a change in level of consciousness. She needs to be rapidly evaluated and closely monitored.
8 or less
"I'm 7 weeks pregnant, and every time I try to eat something, I throw up," reports a 27-year-old female. "My doctor sent me to the ER because he thinks I am getting dehydrated." Temp: 97 F, RR 18, HR 104, BP 104/68, SpO2 99%. Pain 0/10. Lips are dry and cracked.
ESI Level 3: Two or more resources
Lab studies, IV fluid, and an IV antiemetic. She is showing signs of dehydration.
A sign or symptom of respiratory distress upon initial assessment
Low SpO2, retractions, tachypnea, tripoding, audible wheezing, etc.
A chest x-ray and an abdominal x-ray are considered 2 separate resources True or False
False.
A 41-year-old male involved in a bicycle accident walks into the emergency department with his right arm in a sling. He tells you he fell off his bike and landed on his right arm. He is complaining of pain in the wrist area and has a 2-centimeter laceration on his left elbow. "My helmet saved me," he tells you.
ESI Level 3: Two or more resources
At minimum, this patient will require an x-ray of his right arm and suturing of his left elbow laceration.
Provide a life-saving intervention in the Hemodynamics category
Significant IV fluid resuscitation
Blood admin
Control of external hemorrhage
EMS arrives with an 87-year-old 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 medications, including warfarin. His vital signs are WNL.
ESI Level 2: High Risk
Patients taking Warfarin who fall are at high risk of internal bleeding. Although the patients' vital signs are WNL and he shows no signs of a head injury, he needs a prompt evaluation and a head CT.
A chief complaint that should be considered high-risk
Chest pain with suspicious on ACS, stroke like symptoms, DKA, Sepsis, Transplant patients, etc.
UA, ultrasound, CT, IV antibiotics, IV fluids
EMS arrives with a 17-year-old restrained driver involved in a high-speed MVA. The patient is immobilized on a backboard and is complaining of abdominal pain. He has multiple lacerations on his left arm. BP 102/60, HR 86, RR 28, SpO2 96%.
ESI Level 2: High-risk situation
The mechanism of injury is significant, and this patient has potential for serious injuries. He needs to be evaluated by the trauma team and should be considered high-risk. If his BP was 70/palp and his HR was 128, he would be an ESI level 1-requiring immediate life-saving intervention.
"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 to breathe. History of asthma; uses inhalers when needed. No known drug allergies. Temp: 98F, RR 40, HR 114, BP 108/74
ESI Level 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 respiratory rate is 40 and she is in respiratory distress.
"I called my pediatrician, and she told me to bring him in because of his fever," reports the mother of a 2-week-old child; Temp 101F, HR 154, RR 42, SpO2 100%. The baby is acting appropriately.
ESI Level 2: High Risk
A temp of higher than 100.4F in an infant less than 28 days old is considered high risk no matter how good the infant looks. Infants in this age range are at a high risk for bacteremia. What is additional information you would ask the parent about in the triage process?
An intoxicated patient with a fresh abrasion and bruise to his forehead who is a poor historian and cannot provide any information on how it was caused would be considered high-risk True or False?
True
A splint application and crutches is a resource True or False
False
Paramedics arrive with a 38-year-old unrestrained driver who hit a tree while traveling at approximately 45 miles per hour. The passenger side of the car had significant damage. The driver was moaning but moving all extremities when help arrived. Initial vitals were BO 74/50, HR 132, RR 36, SpO2 99%, Temp 98.6F
ESI Level 1: Requires immediate lifesaving interventions
The patient is presenting with signs of shock-hypotension, tachycardia, tachypnea. Based on the mechanism of injury and presenting vital signs, this patient requires immediate lifesaving interventions, including aggressive fluid resuscitation.
A neurological presentation that requires a life-saving intervention
Unresponsive- nonverbal and not following commands or requires noxious stimulus (P or U on AVPU scale)
"I was taking my contacts out last night and I think I scratched my cornea," reports a 27-year-old female. "I'm wearing these sunglasses because the light really bothers my eyes." Her right eye is red and tearing. She rates her pain as 6/10. Vital signs are within normal limits.
ESI Level 5: No resources
This patient will need an eye exam and will be discharged to home with prescriptions and an appointment to follow up with an ophthalmologist.
Immediate intervention for a patient c/o neck pain or nuchal rigidity, has a fever and a petechial rash.
Isolation
What decision point in the ESI algorithm contains the evaluation of the need for resources?
Decision point C