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.

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

That would be an ESI 2 - concern for spontaneous pneumo.

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

esi 1, needs a physician at the bedside now and emergent treatment for likely symptomatic SVT or afib or vtach.

I think according to ESI if they are symptomatic like that - brady or tachy they should be an ESI 1. However, an ESI 2 could also be argued. You bring up a good point. Just because this patient has a history of afib does not mean he isn't having vtach with a pulse right now - in that case he would be an ESI 1.

How about this:

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!

ESI 3 unless she is having other symptoms that can indicate ACS.

Also diabetes history makes a difference.

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

if he was a smoker and around 20-40 then that would make me suspect it even more.

53 y/o male comes in by EMS for AMS, lethargy, and hypoglycemia. Finger stick in the field was 27 and he was given D10 in the field with a recheck of 70 in route. On arrival pt is still lethargic and confused. Pt is mildly hypotensive 90s/60s. Pt is NSR with a rate of 66 on the monitor. Pt's O2 sat is 89% on room air. Past medical history of diabetes, COPD, and GI bleed. What is the ESI?

I would say an ESI 1 but this may be triaged by many people as an ESI 2.

Why do I say ESI 1?

- Altered mental status (AVPU) Don't know how altered he is but if he does not open his eyes when you talk to him and only responds to pain or is completely unresponsive (and this is not baseline - that puts you in ESI 1 territory)

- Dextrose is considered a life saving measure by ESI

- He is also not oxygenating well

Ok here's one

38 year old male smoker, c/o of cough up yellow phlegm. not short of breath. Mild chest pain when he takes a deep breath. Temp 102, HR 127. No medical history. no ETOH.

Ok here's one

38 year old male smoker, c/o of cough up yellow phlegm. not short of breath. Mild chest pain when he takes a deep breath. Temp 102, HR 127. No medical history. no ETOH.

ESI 2, possible sepsis, meets SIRS criteria with the fever and tachycardia

"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!"

ESI 3 or 4. She might just need an EKG and an MSE. I've seen this presentation, without risk factors go through our fast track. I would be concerned if she took birth control pills and was a smoker for PE and if she had a history of DM for possible ACS.

I have another one. A 37-year-old female comes to the widow at triage huffing and puffing, can't catch her breath, is able to say she has asthma and her inhalers aren't working. Her respiratory rate is about 35.

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!

ESI 3 unless she is having other symptoms that can indicate ACS.

Also diabetes history makes a difference.

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)

I have another one. A 37-year-old female comes to the widow at triage huffing and puffing, can't catch her breath, is able to say she has asthma and her inhalers aren't working. Her respiratory rate is about 35.

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?

Here's one.

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