ESI Levels Competency Set
"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 98°F, RR 22, HR 112, BP 120/80, SpO2 100%. Pain 6/10. - ✔ ✔ ESI level 3: Two or
more resources. From the patient's history, he will require labs and IV fluid replacement —two
resources.
When asked why she came to the emergency department, the 18 -year -old college student begins to cry.
She tells the triage nurse that she was sexually assaulted last night at an off -campus party. - ✔ ✔ ESI
level 3: Two or more re sources. It looks as though this patient has a displaced fracture and will need a
closed reduction prior to casting or splinting. At a minimum, he needs x -rays and an orthopedic consult.
This patient may also require procedural sedation. However, there are already two or more resources,
so it is not necessary to be overly concerned about counting resources beyond two.
"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 int erested in eating. As you begin to undress the baby, you notice that
she is listless and her skin is mottled. - ✔ ✔ ESI level 1: Requires immediate lifesaving intervention;
possible aggressive fluid resuscitation.
"My pain medications are not working anym ore. 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 sig ns
are within normal limits. - ✔ ✔ ESI level 2: Severe pain or distress. This patient needs aggressive pain
management with IV medications. There is nothing the triage nurse can do to decrease the patient's
pain level. The answer to "Would you give your la st open bed to this patient?" should be yes.
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 level 3: Two or more resources. The patient is
presenting with signs and symptoms of another kidney ston e. 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. If the pain level was 7/10 or greater and the triage nurse could not manage the pain at triage,
the pat ient could meet level -2 criteria.
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"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 pete chiae. 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?" - ✔ ✔ ESI level
2: High risk. Rashes are difficult to triage, but the presence of petech iae 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.
"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. - ✔ ✔ ESI level 4 or 5: This case is an example of variations in practice around the
country. Many emergency departments would examine the child and then attempt to reduce the
dislocation of the radial head without an x -ray. Others may x -ray the child's arm, which is considered
one ESI res ource. Relocation is not considered a resource.
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.
On her last admission for asthma, she was intubated. 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. - ✔ ✔ ESI
level 2: High -risk. An asthmatic with a prior history of i ntubation is a high -risk situation. This patient is in
respiratory distress as evidenced, by her respiratory rate, oxygen saturation, and work of breathing. She
does not meet the criteria for ESI level 1, requires immediate lifesaving intervention.
A 56 -year-old male with a recent diagnosis of late -stage non -Hodgkin's lymphoma was brought to the
ED from the oncology clinic. He told his oncologist that he had facial and bilateral arm swelling and
increasing shortness of breath. The patient also reports that his symptoms are worse if he lies down.
Vital signs: BP 146/92, HR 122, RR 38, SpO2 98% on room air, temperature normal. - ✔ ✔ ESI level 2:
High risk. This patient is demonstrating respiratory distress with his increased respiratory rate and
decreased oxy gen saturation. Symptoms are caused by compression of the superior vena cava from the
tumor. It is difficult for blood to return to the heart, causing edema of the face and arms.
EMS arrives with a 28 -year -old male who was stabbed in the left side of his neck during an altercation.
You notice a large hematoma around the wound, and the patient is moaning he can't breathe. HR 110,
RR 36, SpO2 89%. - ✔ ✔ ESI level 1: Requires immediate lifesaving intervention. Depending on the Powered by TCPDF (www.tcpdf.org)
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