ESI practice thread

30-something ambulatory female also with non-traumatic unilateral pleuritic chest pain. Looks okay in triage but concerned about herself. I can't remember her meds but, if any, they were irrelevant to the presentation. No pregnancy concerns (current menses). Has had this complaint before. And.......GO!

Agree with you.

However, this took an interesting twist that I didn't want to give away (so totally not a 'fair' question!!). I thought I'd mentioned it here because I'd never heard of this before that day...and we were talking about a textbook spontaneous pneumo earlier in the thread....

As I'm doing my quick triage, pt reports a number of pneumothoraces in the past, always during menstruation. I would've made her a 3, but bumped her to 2.

She did have yet another pneumo.

Catamenial pneumothorax

Catamenial Pneumothorax - NORD (National Organization for Rare Disorders)

Thanks for sharing! I love it when the opportunity arises to learn about the rare stuff.

How SOB is she? Is she able to speak clear sentences or is she having difficulties. This will help determine if she is an ESI 2 or 3. Also what is her oxygen saturation?[/quote']

She was pretty short of breath, had a hard time speaking in full sentences when she came up to the window. I gave her an ESI 2. I did not have vital signs. I brought her back to the secondary triage nurse immediately who finished the triage and/or immediately bedded her and up-triaged her to an ESI 1. I think she was given an emergent respiratory treatment along with mag and solumedrol, and possibly CPAP or BIPAP and admitted for observation.

I felt like I should have given her an ESI 1, but didn't have time to fully assess her. It didn't really matter because she was treated very rapidly.

She was pretty short of breath, had a hard time speaking in full sentences when she came up to the window. I gave her an ESI 2. I did not have vital signs. I brought her back to the secondary triage nurse immediately who finished the triage and/or immediately bedded her and up-triaged her to an ESI 1. I think she was given an emergent respiratory treatment along with mag and solumedrol, and possibly CPAP or BIPAP and admitted for observation.

I felt like I should have given her an ESI 1, but didn't have time to fully assess her. It didn't really matter because she was treated very rapidly.

In your case, because of your two-stage process, I might have done just as you did but it's a little hard to say without seeing her (e.g. was she tripodding, accessory muscle use, color of nail beds and lips, duration of symptoms, and general appearance).

Shortness of breath can range from ESI 3 (e.g. uncomplicated asthma) to ESI 1 (severe distress, concerning hx, lousy VS, etc).

She was pretty short of breath, had a hard time speaking in full sentences when she came up to the window. I gave her an ESI 2. I did not have vital signs. I brought her back to the secondary triage nurse immediately who finished the triage and/or immediately bedded her and up-triaged her to an ESI 1. I think she was given an emergent respiratory treatment along with mag and solumedrol, and possibly CPAP or BIPAP and admitted for observation.

I felt like I should have given her an ESI 1, but didn't have time to fully assess her. It didn't really matter because she was treated very rapidly.

I likely would've made her a 2 also. It is what it is. I would hate having to assign an ESI without more info. It seems like the initial triage person should only have to say dying/sick/not sick or dying/high risk/not high risk. For that initial sorting process that's all that is really needed, so long as you pull out those who are definitely an ESI 1.

?

Has anyone heard of tagging an ESI 1 on a patient solely for SpO2

I've seen it argued based on

Level-1 patients are critically ill and require immediate physician evaluation and interventions. When considering the need for immediate lifesaving interventions, the triage nurse carefully evaluates the patient's respiratory status and oxygen saturation (SpO2). A patient in severe respiratory distress or with an SpO2

or

Examples of ESI level 1:

• Cardiac arrest

• Respiratory arrest

• Severe respiratory distress

• SpO2

My issue is that page 9 specifically states that supplemental Os, whether NC or NR, is *not* lifesaving so I consider these inconsistent and I still maintain that SpO2

It strikes me that if the patient presents for a ESI 3 or 4 complaint but happens to have a low RA sat, you don't make 'em a 1... you put 'em on supplemental and see if they respond and then ESI 'em as appropriate.

Has anyone heard of tagging an ESI 1 on a patient solely for SpO2

***

My issue is that page 9 specifically states that supplemental Os, whether NC or NR, is *not* lifesaving so I consider these inconsistent and I still maintain that SpO2

I think that, by itself, the

There might be a rare situation...but as a rule, no, I have never made anyone a 1 just based on the statements you quoted from the manual. I haven't seen anyone else really argue for it, either, thankfully.

Side note - I'm also not a fan of places that want to make too many categorical rules, such as "all ____'s are a 1" - - there are obviously some situations where most_____'s will be a 1, but for example all chest pains are not ESI 1, despite the fact that some of them definitely are, and despite the fact that they need a 12-lead in 'X' minutes. I think they try to do this so people without much triage training can be put in triage...I just see it as a quick way to inadvertently defeat the purpose and benefit of wise use of ESI.

Location plays a factor as well. In CO and WY we wouldn't panic about 02 90 or just under.