Infection
"My baby is having a hard time drinking his bottle," reports the young mother of a 3-month-old. The baby is alert and looking around. You notice a large amount of dried mucus around both nares. T 98°F, RR 40, HR 132, SpO2 99%.
What is ESI Triage level 5
No resource needed. Following a physical exam, this baby will be discharged to home. Prior to leaving, the mother needs to be taught techniques to keep the baby's nares clear of mucus.
A 6-year-old male tells you that he was running across the playground and fell. He presents with a 3-centimeter laceration over his right knee. Healthy, no medications and no allergies, immunizations are up to date.
What is ESI Triage Level 4, one resource
The laceration will need to be sutured—one resource.
A 17-year-old handcuffed male walks into the ED accompanied by the police. The parents called 911 because their son was out of control: verbally and physically acting out and threatening to kill the family. He is cooperative at triage and answers your questions appropriately. He has no past medical history or allergies and is currently taking no medications. Vital signs are within normal limits.
What is ESI Triage level 2, High risk situation
Homicidal ideation is a clear high-risk situation. This patient needs to be placed in a safe, secure environment, even though he is calm and cooperative at triage.
A 16-year-old female is brought to the emergency department by her mother, who reports that her daughter took more than 30 acetaminophen tablets about 30 minutes before admission. The tearful girl tells you that her boyfriend broke up with her this morning. No previous medical history, and no allergies or medications. Vital signs within normal limits.
What is the ESI Triage level 2, High Risk situation
An overdose is a clear high-risk situation. This patient needs to be seen immediately, and interventions to prevent liver damage must be initiated. At the same time she needs to be placed in a safe, secure environment and monitored closely to prevent harm to herself.
Her grandfather pulled her by the wrist up and over a big puddle. Next thing you know, she is crying and refusing to move her left arm," the mother of a healthy 3-year-old tells you. Vital signs are within normal limits.
What is ESI Triage level 4
The child may need an X-ray counting as 1 resource
An 11-year-old presents to triage with his mother, who reports that her son has had a cough and runny nose for a week. The child is running around the waiting room and asking his mother for a snack. Vital signs are within normal limits.
What is ESI Triage Level 5
No resources needed
"He was running after his brother, fell, and cut his lip on the corner of the coffee table. There was blood everywhere," recalls the mother of a healthy 19-month-old. "He'll never stay still for the doctor." You notice that the baby has a 2- centimeter lip laceration that extends through the vermilion border. Vital signs are within normal limits for age.
What is ESI Triage level 3, 2 or more resources
A laceration through the vermilion border requires the physician to line up the edges exactly. Misalignment can be noticeable. A healthy 19-month-old will probably not cooperate. In most settings, he will require conscious sedation, which counts as two resources. The toddler's vital signs are within normal limits for his age, so there is no reason to up-triage to ESI level 2
"I was seen in the ED last night for my fractured wrist. The bone doctor put this cast on and told me to come back if I had any problems. As you can see, my hand is really swollen and the cast is cutting into my fingers. The pain is just unbearable." Circulation, sensation, and movement are decreased.
What is ESI Triage Level 2, High Risk situation
The recent application of a cast along with swelling of the hand and unbearable pain justifies an ESI level-2 acuity level. He may have compartment syndrome
A 16-year-old high school hockey player collapsed on the ice after being hit in the anterior chest by the puck. The coaching staff began CPR almost immediately, and he was defibrillated three times with a return of spontaneous circulation. He arrives in the emergency department intubated.
What is ESI triage level 1, immediate resuscitation
From the history, it sounds like the hockey player experienced a disruption in the electrical activity in his heart due to the blow to the chest from the hockey puck. He will require immediate lifesaving interventions to address airway, breathing, and circulation. This patient is intubated, which meets criteria for lifesaving interventions.
Concerned parents arrive in the ED with their 4-day-old baby girl who is sleeping peacefully in the mother's arms. "I went to change her diaper," reports the father, "and I noticed a little blood on it. Is something wrong with our daughter?" The mother tells you that the baby is nursing well and weighed 7 lbs., 2 oz. at birth.
What is ESI Triage Level 5, no resources
.The parents of this 4-day-old need to be reassured that a spot of blood on their baby girl's diaper is not uncommon. The baby is nursing and looks healthy.
"He has had diarrhea for 2 days, and he just started throwing up this morning. This has been going around the family, and he seems to have it the worst. He has been drinking before today, but now he doesn't want anything to drink," reports the mother of a 19-month-old. The toddler is awake and alert but quiet in the mother's arms, and you notice his lips are dry and cracked. Vital signs: T 99°F, RR 30, HR 130, SpO2 100%.
What is ESI Triage Level 3
This 19-month-old is dehydrated and will require a minimum of two resources: labs and IV fluids. In addition the physician may order an IV antiemetic.
"I was so disappointed about not making the varsity soccer team that I punched a wall," reports a 15-year-old healthy male. His hand is swollen and tender to touch. Vital signs: T 97°F, RR 16, HR 58, BP 106/80, SpO2 100%. Pain 5/10.
What is ESI Triage level 4, one resource
This young man presents with a mechanism of injury suggestive of a boxer's fracture. An x-ray is indicated to rule out a fracture,—one resource.
Melissa, a 4-year-old with a ventriculoperitoneal shunt (drains excess cerebrospinal fluid), is brought to the ED by her parents. The mother tells you that she is concerned that the shunt may be blocked because Melissa is not acting right. The child is sleepy but responds to verbal stimuli. When asked what was wrong, she tells you that her head hurts and she is going to throw up. T 98.6°F, RR 22, HR 120, SpO2 99% on room air, BP 94/76.
What is ESI Triage Level 2
New onset of confusion, lethargy or disorientation
The mother of this 4-year-old knows her child and has probably been through this situation before. A child with a ventriculo-peritoneal shunt with a change in level of consciousness and a headache is thought to have a blocked shunt until proven otherwise and may be experiencing increased intracranial pressure.
Paramedics arrive with a 16-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. His initial vital signs were BP 74/50, HR 132, RR 36, SPO2 99%, T 98.6°F.
What is ESI triage level 1 Requires immediate life saving intervention
The patient is presenting with signs of shock—hypotension, tachycardia, and tachypnea. Based on the mechanism of injury and presenting vital signs, this patient requires immediate lifesaving interventions, including aggressive fluid resuscitation
Our pediatrician told us to bring the baby to the emergency department to see a surgeon and have some tests. Every time I feed him, he vomits and it just comes flying out," reports the mother of a healthy appearing 3�week-old. "None of my other kids did this." Normal vaginal delivery. Vital signs are within normal limits.
What is ESI Triage level 3, 2 or more resources
A 3-week-old with projectile vomiting is highly suspicious for pyloric stenosis. The infant will need, at minimum, labs to rule out electrolyte abnormalities, an ultrasound, and a surgery consult.
"I called my pediatrician, and she told me to bring him in because of his fever," reports the mother of a 2-week-old. Vital signs: T 101°F, HR 154, RR 42, SpO2 100%. Uncomplicated, vaginal delivery. The baby is acting appropriately.
What is ESI Triage level 2, High Risk
A temperature higher than 100.4°F (38.0°C) 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.
A healthy 10-year-old male is brought to the emergency department by his mother, who reports that her son has not moved his bowels for a week. He is complaining of 7/10 generalized abdominal pain, nausea, and lack of appetite. Vital signs: BP 107/66, HR 75, RR 20, T 98.6°F, SpO2 99%.
What is ESI triage level 3, 2 or more resources
Abdominal pain, loss of appetite, and nausea in a 10-year-old who has not had a bowel movement in several days is probably due to constipation. He will need two or more resources—labs, maybe an x-ray, maybe a surgery consult, maybe an enema—but at least two resources.
A 4-year-old female is transported to the ED following a fall off the jungle gym at a preschool. A fall of 4 feet. A witness reports that the child hit 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. Vital signs: HR 162, RR 38.
What is ESI Triage Level 2, High Risk
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.
I just turned my back for a minute," cried the mother of a 4-year-old. The child was pulled out of the family pool by a neighbor who immediately administered mouth-to-mouth resuscitation. The child is now breathing spontaneously but continues to be unresponsive. On arrival in the ED, vital signs were: HR 126, RR 28, BP 80/64, SpO2 96% on a non-rebreather.
What is ESI Triage level 1 Unresponsive
This 4-year-old continues to be unresponsive. The patient will require immediate lifesaving interventions to address airway, breathing, and circulation.
"I don't know what is wrong with my son," reports the worried mother of a normally healthy eight-year-old male. "He's losing weight and acting so cranky. Last night he was up to the bathroom every hour, and he can't seem to get enough to drink." The child is alert and appropriately. Vital signs: T 98.6°F, RR 30, HR 98, BP 92/78, SpO2 98%.
What is ESI Triage level 2
This patient has an elevated respiratory rate and heart rate. The symptoms of polydipsia and polyuria are two classic signs of diabetic ketoacidosis
A normal healthy 7-year-old walks into the emergency department accompanied by his father, who reports that his son woke up complaining of a stomach ache. "He refused to walk downstairs and is not interested in eating or playing." The child vomits at triage. Vital signs: T 100.4°F, RR 22, HR 88, BP 84/60, SpO2100%. Pain 6/10.
What is ESI triage level 3- 2 or more resources
At a minimum, this child will need a workup for his abdominal pain, which will include labs and a CT or ultrasound—two resources.
After my pediatrician saw my son's rash, he said I had to bring him to the emergency department immediately. He has this rash on his face and chest that started today. He has little pinpoint purplish spots he called petechiae. My son is a healthy kid who has had a cold for a couple of days and a cough. My pediatrician said he had to be sure nothing bad is going on. What do you think?"
What is ESI Triage acuity level 2
Rashes are difficult to triage, but the presence of petechiae is always a high-risk situation. Even if the patient looks good, it is important to recognize that petechia can be a symptom of a life-threatening infection, meningococcemia.
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 an abrasion on his forehead and nose as he tells you that he needs to see a doctor because of tingling in both hands.
What is ESI Triage level 2, high risk situation
Because of the mechanism of injury and his complaints of tingling in both hands, this patient should be assigned ESI level 2. He has a cervical spine injury until proven otherwise. He is not an ESI level 1 in that he does not require immediate lifesaving interventions to prevent death. At triage, he needs to be appropriately immobilized.
EMS arrives with a 17-year-old restrained driver involved in a high-speed motor vehicle crash. The patient is immobilized on a backboard and is complaining of abdominal pain. He has multiple lacerations on his left arm. Vital signs prior to arrival: BP 102/60; HR 86, RR 28, SpO2 96%.
What is ESI Triage level 2, High Risk
The mechanism of injury is significant, and this patient has the 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; requires immediate life-saving intervention.
"I don't know what's wrong with my baby girl," cries a young mother. She reports that her 2-week-old baby is not acting right and is not interested in eating. As you begin to undress the baby, you notice that she is listless and her skin is mottled.
What is ESI Triage acuity 1
Requires immediate lifesaving intervention, possible aggressive fluid resuscitation