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.

Here's one.

57 year old female, getting chemo for breast CA. Comes in with fever of 101.5. C/o cough. Vital signs stable otherwise.

ESI 2 and we would place her in a room with kind of altered neutropenic precautions until blood works comes back. To confirm if they need to be fully in place.

Here's one.

57 year old female, getting chemo for breast CA. Comes in with fever of 101.5. C/o cough. Vital signs stable otherwise.

ESI 2

Here's one.

57 year old female, getting chemo for breast CA. Comes in with fever of 101.5. C/o cough. Vital signs stable otherwise.

ESI 2, high risk situation

55 year old male comes in pale, cool, diaphoretic. Complaints of palpitations and chest pain, heart rate 150s and irregular. Pt is hypotensive 80s/60s.

55 year old male comes in pale, cool, diaphoretic. Complaints of palpitations and chest pain, heart rate 150s and irregular. Pt is hypotensive 80s/60s.

ESI 1

78 year old comes in c/o palpitations.Hx afib. HR 176. BP 126/72. Feels "lightheaded and dizzy" No CP

55 year old male comes in pale, cool, diaphoretic. Complaints of palpitations and chest pain, heart rate 150s and irregular. Pt is hypotensive 80s/60s.

Agree with Lev, ESI 1— this one is about to crump/fixin' to die.

78 year old comes in c/o palpitations.Hx afib. HR 176. BP 126/72. Feels "lightheaded and dizzy" No CP

Sounds like a-fib with RVR, symptomatic with the dizziness. My knee-jerk is to make it a 2 because pressure is stable, but he needs immediate intervention in the form of cardioversion — stable people get drugs, unstable people get electricity. If he looked like crud and his pulse felt irregular, I might lean toward a 1 in that case. I have a hard time with walking/talking ESI 1s because they used to just be the ones with CPR in progress! ESI would probably make this a 1 for that immediate life-saving intervention piece.

Mid-twenties, tall gangly male with right-sided chest pain that worsens with inspiration and mild SOB. Go!

Sounds like a-fib with RVR, symptomatic with the dizziness. My knee-jerk is to make it a 2 because pressure is stable, but he needs immediate intervention in the form of cardioversion — stable people get drugs, unstable people get electricity. If he looked like crud and his pulse felt irregular, I might lean toward a 1 in that case. I have a hard time with walking/talking ESI 1s because they used to just be the ones with CPR in progress! ESI would probably make this a 1 for that immediate life-saving intervention piece.

Exactly my thoughts.

Honestly, answering these on paper is not what I do best after years of this. My algorithm tends to be more: High risk AND looks like crap = 1. High risk and doesn't look like complete crap = 2. I think there is something to that - - eventually creeping more and more towards up-triage takes away the benefit of ESI to the point where in a busy ED we're back to really not knowing who needs help the most, and needing for 1s to be prioritized amongst each other and 2s to be prioritized amongst each other. In this case I'd be inclined to say ESI 1 is the pt that needs electricity (i.e. tx right NOW), and ESI 2 is the one who can get meds. But then comes the "creep" of saying that we should make this a 1 now because it could get worse and require electricity, when in reality ESI 2 already acknowledges that the situation could get worse, that's what makes it "high risk", and it already acknowledges that we are indeed putting this patient our last bed because we recognize the risk of deterioration. If the up-triage "creep" continues you eventually have people who make all dizziness a 2 in case someone might later find out it's a cardiac problem...etc., etc.

Not criticizing any answer(s) here, this is just my own stream of consciousness...

Mid-twenties, tall gangly male with right-sided chest pain that worsens with inspiration and mild SOB. Go!

Well, spontaneous pneumo. If he's stable I say 2.

Well, spontaneous pneumo. If he's stable I say 2.

Yay! For the new kids on the block tell us why you suspect a pneumo and why you made him an ESI 2.