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He has no past medical history (PMH), allergies, and is currently taking no medications. His blood pressure is currently in the 80s and his skin is cool and moist. This 4-year-old had a witnessed loss of consciousness and presents to the ED with a change in level of consciousness. She will need one resource-lab, which will include a urinalysis and urine culture. Lab studies, IV fluid, and an IV antiemetic are three of the resources that this patient will require. An obvious open fracture will necessitate this patient going to the operating room. Based on her history, this patient will require two or more resources—lab and an ultrasound. Ectopic pregnancy is on the differential diagnosis list, but this patient is currently hemodynamically stable and her pain is generalized across her lower abdomen.

She has been experiencing low abdominal pain (6/10) for about 4 days. She denies nausea, vomiting, diarrhea, or urinary symptoms. At triage he needs to be appropriately immobilized. She is able to drink fluids and will be able to swallow pills if indicated. He is not ill appearing and his vital signs are within normal limits. This elderly gentleman has such brittle toenails that he is no longer able to clip them himself. This patient will need a bedside pregnancy test prior to receiving medication. 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. This patient is presenting with signs and symptoms of a postpartum hemorrhage.The cases in this chapter are provided to give a nurse the opportunity to practice categorizing patients using ESI. He explains that he dove into a pool and his face struck the bottom. I have finals this week and I am scared this is strep," reports a 19-year-old college student. No PMH, medications: birth control pills, no allergies to medications. "He's pulling on his right ear." The child has a tympanic temperature of 100.2° F and is trying to grab your stethoscope. "I think I have food poisoning," reports an otherwise healthy 33-year-old female. She has an obvious open fracture of her right lower leg. From the history it sounds like this patient has suffered some type of head bleed.Please read each case and based on the information provided assign a triage acuity rating using ESI. "I just turned my back for a minute," cried the mother of a 4-year-old. He thinks my hand is infected," a 76-year-old female with arthritis, chronic renal failure, and diabetes tells you. A 76-year-old male is brought to the ED because of severe abdominal pain. The patient is sitting in a wheelchair moaning in pain. 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. He has a history of frequent ear infections and is currently taking no medications. A 26-year-old female is transported by EMS to the ED because she experienced the sudden onset of a severe headache that began after moving her bowels. Her husband tells you that she is healthy, takes only prenatal vitamins, and has no allergies. "I have this rash in my groin area," reports a 20-year-old healthy male. EMS arrives with a 17-year-old restrained driver involved in a high-speed motor vehicle crash. A 4-year-old female is transported to the ED following a fall off the jungle gym at a preschool. No allergies, takes vitamins, and has no significant PMH. "I have been vomiting all night and now I have diarrhea." The patient admits to abdominal cramping that she rates as 5/10. She is currently unresponsive to voice and could be showing signs of increased intracranial pressure. It looks like this patient has a displaced fracture and will need to have a closed reduction prior to casting or splinting.The child was pulled out of the family pool by a neighbor who immediately administered mouth-to-mouth resuscitation. She has an open area on the palm of her left hand that is red, tender, and swollen. 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 a normal appetite and urine output according to the mother. A 76-year-old male requests to see a doctor because his toenails are hard. On arrival in the ED the patient is moaning and does not respond to voice. "I think its jock rot but I can't get rid of it." Using OTC spray, NKDA. The patient is immobilized on a backboard and is complaining of abdominal pain. Vital signs prior to arrival: BP 102/60, HR 86, RR 28, Sp O 96%. "The smoke was so bad; I just couldn't breathe," reports a 26-year-old female who entered her burning apartment building to try and rescue her cat. Paramedics arrive with a 78-year-old male whose wife heard him fall in the bathroom. A witness reports that the child hit her head and was unconscious for a couple of minutes. A 52-year-old female requests to see a doctor for a possible urinary tract infection. She may not be able to protect her own airway and may need to be emergently intubated. At a minimum, she needs x-rays and an orthopedic consult. The mechanism of injury is significant and this patient has the potential for serious injuries.The child is now breathing spontaneously but continues to be unresponsive. She hands you a list of medications and reports she has no allergies. Upon further questioning the triage nurse ascertains that the patient is unable to cut his own toenails. " An 18-year-old tells you that she had unprotected sex last night. Concerned parents arrive in the ED with their 4-day-old baby girl who is sleeping peacefully in the mother's arms. EMT's tell you that she vomited about 5 minutes ago. A 68-year-old female presents to the ED with her right arm in a sling. She is hoarse and complaining of a sore throat and a cough. History of asthma, uses inhalers when needed, NKDA. He tells you he got a little dizzy when he got up to go to the bathroom. On arrival you notice that the child's left arm is splinted and that she is very sleepy. Her vital signs are stable, so there is no need to up-triage her to an ESI level 2. If she rated her pain as 9/10 and she is tearful, would you up-triage her to an ESI level 2? Following a physical exam, this patient will be sent home with prescriptions and appropriate discharge instructions. He needs to be evaluated by the trauma team and should be considered high risk. A 27-year-old female wants to be checked by a doctor. He is not an ESI level 1 in that he does not require immediate aggressive intervention to prevent death. In most EDs, this patient will have a rapid strep screen sent to the lab; one resource. This child has had previous ear infections and is presenting today with the same type of symptoms. ESI level 1: requires immediate lifesaving intervention.

He needs immediate IV access, aggressive fluid resuscitation, and perhaps blood prior to surgery. He has a cervical spine injury until proven otherwise.

It is not safe for this patient to wait for an extended period of time in the waiting room. He has a history of hypertension and is presenting with signs and symptoms that could be attributed to a dissecting aortic abdominal aneurysm. Because of the mechanism on injury and his complaints of tingling in both hands, this patient should be assigned ESI level 2.

On arrival in the emergency department (ED) vital signs (VS) were: heart rate (HR) 126, respiratory rate (RR), 28, blood pressure (BP) 80/64, Sp O 96% on a non-rebreather. A 28-year-old male presents to the ED requesting to be checked. "My mother is just not acting herself," reports the daughter of a 72-year-old female. "My dentist can't see me until Monday and my tooth is killing me. " a 38-year-old healthy male asks the triage nurse. He denies any breaks in the skin or signs of infection. "My girlfriend told me to come to the hospital because there is a pill I can take to prevent pregnancy." The patient is healthy, takes no medications, and has no allergies. "I went to change her diaper," reports the father, "and I noticed a little blood on it. " The mother tells you that the baby is nursing well and weighed 7 lbs 2 oz at birth. "I suddenly started bleeding and passing clots the size of oranges," reports a pale 34-year-old who is 10 days post partum. She was walking out to the mailbox and slipped on the ice. I was lucky I didn't hit my head." Right arm with good circulation, sensation, and movement, obvious deformity noted. He has a history of prostate cancer and hypertension that is controlled by a diuretic. Probably not, given the many nursing interventions you could initiate to decrease her pain, such as ice, elevation, and appropriate immobilization. If his BP was 70/palp and his HR was 128 he would be an ESI level 1; requires immediate life-saving intervention. ESI level 1: requires immediate lifesaving intervention.

He has a severe shellfish allergy and mistakenly ate a dip that contained shrimp. VS: BP 136/84, HR 108, RR 20, Sp O 97%, temperature (T) 97° F. "He was running after his brother, fell and cut his lip on the corner of the coffee table. "I have this infection in my cuticle," reports a 26-year-old healthy female. A 17-year-old handcuffed male walks into the ED accompanied by the police. "She is sleeping more than usual and complains that it hurts to pee." VS: T 100.8° F, HR 98, RR 22, BP 122/80. He tells you the pain started yesterday and he rates his pain as 10/10. He has a history of chronic obstructive pulmonary disease (COPD) and uses several metered dose inhalers. From the history and presentation, this patient appears to have a significant airway injury and will require immediate intubation.

He immediately felt his throat start to close so he used his Epi Pen®. There was blood everywhere," recalls the mother of a healthy 19-month-old. A 44-year-old female is retching continuously into a large basin as her son wheels her into the triage area. "It started hurting 2 days ago and today I noticed the pus." The patient has a small paronychia on her right 2nd finger. The parents called 911 because their son was out of control: verbally and physically acting out and threatening to kill the family. The patient responds to verbal stimuli but is disoriented to time and place. EMS arrives with a 75-year-old male with a self-inflicted 6-cm laceration to his neck. With tears in his eyes, the patient tells you that his wife of 56 years died last week. Her respiratory rate is 40 and she is in respiratory distress. ESI level 1: requires immediate lifesaving intervention.

"He'll never stay still for the doctor." You notice that the baby has a 2-cm lip laceration that extends through the vermilion border. Her son tells you that his diabetic mother has been vomiting for the past 5 hours and now it is "just this yellow stuff." "She hasn't eaten or taken her insulin," he tells you. He is cooperative at triage and answers your questions appropriately. "I should have paid more attention to what I was doing," states a 37-year-old carpenter who presents to the ED with a 3-cm laceration to his right thumb. This elderly gentleman is not tolerating a heart rate of 178.

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