ESI practice thread

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I am starting this tread for people to post scenarios (easy or hard) and for others to say how they would triage this patient according to ESI and their rationale for doing so. I think we can learn a lot from each other. Especially newer ER nurses learning from those more experienced.

Does anyone want to start?

It can be based off real patient scenarios.

Specializes in Family Nurse Practitioner.
Definitely a 2. Septic workup!

Yup, any fever >38c in an infant 30 days and younger is an automatic high risk situation. For infants and young children older than 30 days inquire about vaccination status to determine ESI.

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Specializes in Family Nurse Practitioner.
The thing with ESI is that vital signs are part of the algorithm too. With the way your triage is set up, you aren't getting the whole picture. I would have a hard time making this a 1 without knowing more, as the secondary nurse did; my first thought was a 2. A breathing treatment is not a lifesaving medication; the airway lifesaving measures are BVM, intubation, surgical airways, or emergent CPAP or BiPAP. If she did need CPAP or BiPAP emergently, then a 1 is accurate. Or if her sats were in the toilet and she was in severe respiratory distress, then I could see it as well. I ask myself, "Self, is this patient fixin' to die?" If I think so, then it's a 1.

I agree. Also if she has copd let's say (she was older) and has been intubated 3 times already if she had the presentation of your patient, then she would be an ESI. It's always good to find out if the respiratory patients have been intubated for breathing difficulties.

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Specializes in Family Nurse Practitioner.
Has anyone heard of tagging an ESI 1 on a patient solely for SpO2

I've seen it argued based on

or

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.

I think a more accurate way to judge a patient's spo2 is are they maxed out on nasal cannula (6L) and has an spo2 less than 90%. They will need at least a venti mask which depending on other factors (how SOB they are) can put them in ESI 1 territory.

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Here's one.

Two weak old infant. Fever of 102. VS otherwise stable.

Can anybody identify the most likely bacterial agent that would cause a fever in such a young neonate? What kind of work up would you expect to do/assist with?

Hope ya'll don't mind me throwing out these kind of questions. I love these kind of discussions.

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Specializes in Family Nurse Practitioner.
Can anybody identify the most likely bacterial agent that would cause a fever in such a young neonate? What kind of work up would you expect to do/assist with?

Hope ya'll don't mind me throwing out these kind of questions. I love these kind of discussions.

Meningitis I guess is always possible. I guess the kid could catch pneumonia. Or some sort of untreated lady partsl infection in the mother that passed on to child.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Or some sort of untreated lady partsl infection in the mother that passed on to child.

Yep, I believe Group B Strep (GBS) is high on the list!

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You guys rock! Late-onset Group B Strep occurs in infants greater than one week and up to 3 months of age. Late-onset GBS is more likely to cause meningitis than early onset. These kids can get very sick very fast. What kind of interventions would you expect?

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Specializes in ED, Cardiac-step down, tele, med surg.
You guys rock! Late-onset Group B Strep occurs in infants greater than one week and up to 3 months of age. Late-onset GBS is more likely to cause meningitis than early onset. These kids can get very sick very fast. What kind of interventions would you expect?

Wouldn't there be a sepsis work up done, blood cultures, lactate, CBC, CMP, coags? Then the usual fluids and antibiotics modified for a new born I would suspect. I have not had a patient like this before, so perhaps there is something else to do that I am not familiar with. I know a meningitis work up on an adult would be an LP. Do they do this on someone this small or just treat just in case with meds?

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Specializes in ED, Cardiac-step down, tele, med surg.

How about ESI for the following patient: 28-year-old female presents with severe abdominal pain is screaming at the top of her lungs "help me help me" She is brought in by EMS. She has a history of diabetes and is often non compliant with medication. She also has a history of gastroperesis and is a frequent patient at EDs in the area. Her vitals are stable, with a BP of 160s/100s, HR 110s, SpO2 98% on room air, afibrile. She screams that her pain is 10/10.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Wouldn't there be a sepsis work up done, blood cultures, lactate, CBC, CMP, coags? Then the usual fluids and antibiotics modified for a new born I would suspect. I have not had a patient like this before, so perhaps there is something else to do that I am not familiar with. I know a meningitis work up on an adult would be an LP. Do they do this on someone this small or just treat just in case with meds?

Very likely an LP, regardless of age. The youngest neonate I have held in position for an LP was 6 days old, poor little thing!

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How about ESI for the following patient: 28-year-old female presents with severe abdominal pain is screaming at the top of her lungs "help me help me" She is brought in by EMS. She has a history of diabetes and is often non compliant with medication. She also has a history of gastroperesis and is a frequent patient at EDs in the area. Her vitals are stable, with a BP of 160s/100s, HR 110s, SpO2 98% on room air, afibrile. She screams that her pain is 10/10.

ESI 3 unless some other part of the story or my initial once-over is very compelling for ESI 2.

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Specializes in ED, Cardiac-step down, tele, med surg.
ESI 3 unless some other part of the story or my initial once-over is very compelling for ESI 2.

I gave her an ESI 3 but another nurse changed it to ESI 2 for sever pain or distress.

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