This patient will need an eye exam and will be discharged to home with prescriptions and an appointment to follow up with an ophthalmologist.
The patient’s respiratory rate, oxygen saturation, and inability to protect her own airway indicate the need for immediate endotracheal intubation.
The patient is unresponsive and will require immediate lifesaving interventions to maintain airway, breathing, circulation, and neuro status; specifically, the patient will require immediate confirmation of endotracheal tube placement.
The patient needs a prescription refill and has no other medical complaints. His blood pressure is controlled with his current medication. If at triage his blood pressure was 188/124 and he complained of a headache, then he would meet the criteria for a high-risk situation and be assigned to ESI level 2. If this patient’s BP was elevated and the patient had no complaints, he or she would remain an ESI level 5. The blood pressure would be repeated and would most likely not be treated in the ED or treated with PO medications.
At a minimum, this patient will require an x-ray of his right arm and suturing of his left elbow laceration.
This 32-year-old female with new-onset shortness of breath is on birth control pills. She is a smoker and is exhibiting signs and symptoms of respiratory distress (SpO2 and respiratory rate.) Based on history and signs and symptoms, a pulmonary embolus, as well as other potential causes for her respiratory distress, must be ruled out.
This 4-year-old continues to be unresponsive. The patient will require immediate lifesaving interventions to address airway, breathing, and circulation.
At a minimum, this child will need a workup for his abdominal pain, which will include labs and a CT or ultrasound—two resources.
The laceration will need to be sutured—one resource.
This patient needs an x-ray to rule out a fracture. A splint is not a resource.
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.
This patient has a significant medical history, and based on his presentation, he will require two or more resources, which could include labs and IV antibiotics.
She will need one resource—lab, which will include a urinalysis and urine culture. She most likely has a UTI that will be treated with oral medications.
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.
At a minimum, she will require labs and IV antibiotics.
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.
This history sounds more like pneumonia. Because the patient is not in acute respiratory distress, he or she doesn’t meet ESI level-2 criteria. This patient will require labs, a chest x-ray, and perhaps IV antibiotics.
This patient will require a physical exam. He has no signs and symptoms of an abscess or cellulitis, so he will be referred to a dentist for treatment. In the emergency department, he may be given medications by mouth. On arrival he rates his pain as 9/10, but because he does not meet the criteria for ESI level 2, he would not be given the last open bed.
Lab studies, IV fluid, and an IV antiemetic are three of the resources this patient will require. The patient is not high risk or in severe pain or distress.
A patient with a known history of migraines with vomiting will require pain medication, an antiemetic, and fluid replacement. The pain is not severe, 6/10. This patient is not high risk.
This patient will require a laceration repair. A tetanus booster is not a resource.
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.
Lab studies, IV fluid, and an IV antiemetic are three of the resources this patient will require. She is showing signs of dehydration.
At a minimum, she will require labs and noninvasive vascular studies of her lower leg. She should be placed in a wheelchair with her leg elevated and instructed not to walk until the doctor has seen her.
Patients taking warfarin who fall are at high risk of internal bleeding. Although the patients’ vital signs are within normal limits and he shows no signs of a head injury, he needs a prompt evaluation and a head CT.
Following a physical exam, this patient will be sent home with prescriptions and appropriate discharge instructions.
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.
No resources are required. Following a physical exam, this patient will be sent home with appropriate discharge instructions and a prescription if indicated.
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.
Prehospital intubation is one of the criteria for ESI level 1. This patient has sustained a major head injury and will require an immediate trauma team evaluation.
Based on the patient’s presentation, he will require a minimum IV pain medication and laceration repairs. In addition he may need an x-ray and IV antibiotics.
Based on her history, this patient will require two or more resources—lab and an ultrasound. She may in fact be pregnant. Ectopic pregnancy is on the differential diagnosis list, but this patient is currently hemodynamically stable, and her pain is generalized across her lower abdomen.
This patient is at high risk for a deep vein thrombosis. For diagnostic purposes, she will require two resources: labs and a Doppler ultrasound. If a deep vein thrombosis is confirmed, she will require additional resources—remember, ESI level 3 is two or more resources. If this patient were short of breath or had chest pain, they would meet ESI level-2 criteria.
This child needs a physical exam. Even if eardrops are administered in the emergency department, this does not count as a resource. The family will be sent home with instructions and a prescription.
A complaint of weakness can be due to a variety of conditions, such as anemia or infection. A dialysis patient who misses a treatment is at high risk for hyperkalemia or other fluid and electrolyte problems. This is a patient who cannot wait to be seen and should be given your last open bed.
It looks like this patient has a displaced fracture and will need to have a closed reduction prior to casting or splinting. At a minimum, she needs x-rays and an orthopedic consult. Her vital signs are stable, so there is no need to uptriage her to an ESI level 2. Her pain is currently 6/10. If she rated her pain as 9/10 and she is tearful, would you up-triage her to an lESI level 2? Probably not, given the many nursing interventions you could initiate to decrease her pain, such as ice, elevation, and appropriate immobilization.
The patient is hypotensive with a heart rate of 178. She is showing signs of being unstable—shortness of breath and chest pressure. This patient requires immediate lifesaving interventions, which may include medications and cardioversion.
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.
This patient will require eye irrigation. Eye drops are not a resource. A slit lamp exam is part of the physical exam of this patient.
This patient will require one resource—lab. A urinalysis and urine culture will be sent, and depending on your institution, a urine pregnancy test. One or all of these tests count as one resource.
This young, healthy male has an elevated respiratory rate and a low oxygen saturation. The patient’s history and signs and symptoms are suggestive of a spontaneous pneumothorax. He needs to be rapidly evaluated and closely monitored.
From the history, it sounds like this patient has suffered some type of head bleed. She is currently unresponsive to voice and could be showing signs of increased intracranial pressure. She may not be able to protect her own airway and may need to be emergently intubated.
Facial droop is one of the classic signs of a stroke. This patient needs to be evaluated by the stroke team and have a head CT within minutes of arrival in the ED. Many nurses want to make all stroke alerts an ESI level 1. This patient does not meet level 1 criteria as she does not require immediate lifesaving interventions. The triage nurse needs to facilitate moving this patient into the treatment area and initiate the stroke alert process.
The patient’s history indicates that she may have had a transient ischemic attack this morning. The patient is high risk, and it would not be safe for her to sit in the waiting room for an extended period of time.
Based on her history, this patient will require two or more resources—labs, an ultrasound. On the differential diagnosis list is a spontaneous abortion. Currently, she is hemodynamically stable and has minimal cramping or pain.
The only resource this patient will require is irrigation of his eyes. A slit lamp exam is not considered a resource but is part of the physical exam.
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.
. This patient is presenting with signs and symptoms of a post partum hemorrhage. She tells you she is going to pass out, and her vital signs reflect her fluid volume deficit. The patient needs immediate IV access and aggressive fluid resuscitation.
This patient will need a hand-held nebulizer treatment for her wheezing. No labs or x-ray should be necessary because the patient does not have a fever.
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.
Studies have shown that lowering brain temperature post cardiac arrest decreases ischemic damage. This patient requires immediate lifesaving interventions to airway, breathing, circulation, and neurologic outcome. Even though the patient converted to a stable rhythm, the nurse should anticipate that additional lifesaving interventions might be necessary.
She will need two or more resources—laboratory tests, IV fluid, medication for her nausea, and probably a CT of her abdomen. This patient will be in your emergency department an extended period of time being evaluated. If her pain was 10/10 and she was tachycardic, the patient would meet the ESI level-2 criteria.
This patient is describing more than just the fatigue or anemia. This patient could be describing the classic symptoms of a low-volume but high-risk situation—peripartum cardiomyopathy, a form of cardiomyopathy that occurs in the last month of pregnancy and up to 5 months postpartum. There is a decrease in the left ventricular ejection fraction which causes congestive heart failure.
This patient will need a bedside pregnancy test before receiving medication. She may be an ESI level 4, if your institution routinely sends pregnancy tests to the lab.
This elderly gentleman has such brittle toenails that he is no longer able to clip them himself. He requires a brief exam and an outpatient referral to a podiatrist.
Based on the history, this patient may have acute labyrinthitis and will require two or more resources—IV fluids and an IV antiemetic.
Based on mechanism of injury, this patient will need rapid evaluation by the trauma team.
This patient is not someone who should sit in your waiting room. He does not meet the criteria for ESI level 1, but he meets the criteria for ESI level 2. The patient’s internal defibrillator fired for some reason and needs to be evaluated.
The history combined with the signs and symptoms indicate that this patient is probably having an MI. The “pressure” started after shoveling wet snow, and now he is nauseous and short of breath, and his skin is cool and clammy. He needs immediate IV access, the administration of medications, and external pacing pads in place.
Breast cancer can metastasize to the lungs and can cause a pleural effusion. The collection of fluid in the pleural space leads to increasing respiratory distress as evidenced by the increased respiratory rate and work of breathing.
Abdominal pain in a 58-year-old male will require two or more resources. At a minimum, he will need labs and an abdominal CT.
This child has had previous ear infections and is presenting today with the same type of symptoms. He is not ill appearing, and his vital signs are within normal limits. The child requires a physical exam and should be discharged with a prescription.
Because the mother could not get an appointment with a primary care physician, she brought her son to the emergency department for a routine physical exam. He will be examined and discharged.
This patient will need a bedside pregnancy test prior to receiving medication. She may be an ESI level 4 if your institution routinely sends pregnancy tests to the lab.
In most EDs, this patient will have a rapid strep screen sent to the lab; one resource. She is able to drink fluids and will be able to swallow pills if indicated.
The patient is in third-degree heart block and requires external pacing to preserve airway, breathing, and circulation.
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.
Based on the history, this patient will require at a minimum labs and IV antibiotics. In addition she may need a gyn consult and IV pain medication.
The trauma team needs to be in the trauma room and ready to aggressively manage this 17-year-old with a single gunshot wound to the left chest. He will require airway management, fluid resuscitation and, depending on the injury, a chest tube or rapid transport to the operating room.
The history is suggestive of an orbital fracture. The patient will require one resource—an x-ray. She will need a visual acuity check and eye evaluation, but these are not ESI resources.
The patient is presenting with signs of shock—hypotensive, tachycardic, with decreased peripheral perfusion. He has a history of HTN and is presenting with signs and symptoms that could be attributed to a dissecting aortic abdominal aneurysm. He needs immediate IV access, aggressive fluid resuscitation, and perhaps blood prior to surgery.
. Abdominal pain and vomiting post gastric bypass needs to be evaluated. This patient needs labs, IV, antiemetics, and a CT.
This patient is seeking help finding a detoxification program that will help her. She is not a danger to herself or others. The social worker or psychiatric counselor should be consulted to assist her. Once a placement has been found, she can be discharged from the emergency department and can get herself to the outpatient program. If your social worker or psychiatric counselor requires a urine toxicology or other lab work, the patient will require two or more resources and then meet ESI level-3 criteria.
Voice changes, fever, difficulty swallowing, and swelling on one side of the throat can be signs of a peritonsilar abscess. The patient needs to be monitored closely for increasing airway compromise and respiratory distress.
This patient has a complex medical history and presented with an infected hand. At a minimum she will need labs, an IV, and IV antibiotics to address her presenting complaint. Her vital signs are normal, so there is no reason to up-triage her to ESI level 2.
This patient is experiencing delusions and may have a past medical history of schizophrenia or other mental illness, or he may be under the influence of drugs. Regardless, the major concern is patient and staff safety. He needs to be taken to a safe, secure area and monitored closely
No resources should be necessary. He will require a physical exam, but without signs of an abscess or cellulitis, this patient will be referred to a dentist. In the ED, he may be given oral medications and prescriptions for antibiotics and/or pain medication. He is not an ESI level 2, even though he rates his pain as 10/10. Based on the triage assessment, he would not be given the last open bed.
This patient probably has been on antibiotics for 5 days for mastitis and now presents to the ED due to fever, chills, and feeling rundown. She will require labs, IV antibiotics, a lactation consult if available, and perhaps admission.
This patient has two obvious wounds, but until he is thoroughly examined in the trauma room, you can’t rule out the possibility that he has another gunshot wound. The wounds on his thigh look non-life-threatening, but a bullet could have nicked a blood vessel or other structure; therefore, he meets ESI level-2 criteria. His vital signs are within normal limits, so he does not meet ESI level-1 criteria.
Abdominal pain in the elderly can be indicative of a serious medical condition, and a pain score of 10/10 is significant. The triage nurse needs to keep in mind that due to the normal changes of aging, the elderly patient may present very differently than a younger patient and is more likely to present with vague symptoms.
This patient will require a laceration repair. A tetanus booster is not a resource.
Following a physical exam, this 4-year-old will be sent home with appropriate discharge instructions and perhaps a prescription.
At a minimum, this patient will require an IV with fluid, IV pain medication, and an antiemetic. Although she rates her pain as 20/10, she should not be assigned to ESI level 2. She has had the pain for 2 days, and the triage nurse can’t justify giving the last open bed to this patient. The triage nurse will need to address this patient’s concerns about wait time.
This 75-year-old male tried to kill himself by cutting his throat. Because of the anatomy of the neck, this type of laceration has the potential to cause airway, breathing, and/or circulation problems. At the same time, he is suicidal, and the ED needs to ensure that he does not leave or attempt to harm himself further.
The daughter reports that her mother has a change in level of consciousness. The reason for her change in mental status may be a UTI that has advanced to bacteremia. She has an acute change in mental status and is therefore high risk.
The patient was brought to the emergency department for a new Foley catheter—one resource. There are no other changes in her condition, and she is already on antibiotics for a UTI, so no further evaluation is needed.
Based on the history, this patient may have a cellulitis from the navel piercing. At a minimum she will require labs and IV antibiotics.
The history of events is unclear. How did the 73-year-old gentleman get the laceration on his forehead? Did he fall? Get hit? Because of his age, presentation, and presence of alcohol, he is at risk for a number of complications.
This patient may be describing a penile fracture, a medical emergency. It is most often caused by blunt trauma to an erect penis. This patient needs to be evaluated promptly.
This young woman needs an incision and drainage of her paronychia. She will require no other resources.
The triage nurse is unable to manage his pain at triage other than applying a sling and ice. He will require IV opioids to reduce his pain and relocate his shoulder.
Immediate aggressive airway management is what this patient requires. Her saturation is very low, and she appears to be tiring. The triage nurse does not need the other vital signs in order to decide that this patient needs immediate care.
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 tetanus immunization does not count as a resource. The patient will be seen by a physician or midlevel provider and receive a tetanus immunization and discharge instructions. This patient will require no resources.
This patient will be sent back to the nursing home after the feeding tube is reinserted. There is no acute change in his medical condition that warrants any further evaluation. He is unresponsive, but that is the patient’s baseline mental status so he is not an ESI level 1.
The patient has used his EpiPen but still requires additional medications and close monitoring.
A physical exam and providing the mother with reassurance and education is what this 18-month-old will require. His activity level is appropriate, and he is taking fluids by mouth.
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.
A 44-year-old diabetic with continuous vomiting is at risk for diabetic ketoacidosis. The patient’s vital signs are a concern, as her heart rate and respiratory rate are both elevated. It is not safe for this patient to wait for an extended period of time in the waiting room.
This 76-year-old patient is in hemorrhagic shock from his GI bleed. His blood pressure is 70, his heart rate is 128, and his respiratory rate is 40, all indicating an attempt to compensate for his blood loss. This patient needs immediate IV access and the administration of fluid, blood, and medications.