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.

35 y.o. female comes in with c/o of chills, malaise, sore throat, right neck/ear tenderness x4 days. "It hurts to swallow and I can't open my mouth all the way." VS as follows T: 38.5, HR: 97, BP: 107/64, RR: 18, SpO2: 98% on room air. Denies breathing difficulties.

35 y.o. female comes in with c/o of chills malaise, sore throat, right neck/ear tenderness x4 days. "It hurts to swallow and I can't open my mouth all the way." VS as follows T: 38.5, HR: 97, BP: 107/64, RR: 18, SpO2: 98% on room air. Denies breathing difficulties.[/quote']

She could be an esi 2 depending on what her throat look like. I'd look in her mouth really quick to make a final determination. In an uncomplicated sore throat, it would be an ESI 4 for a throat swab.

35 y.o. female comes in with c/o of chills malaise, sore throat, right neck/ear tenderness x4 days. "It hurts to swallow and I can't open my mouth all the way." VS as follows T: 38.5, HR: 97, BP: 107/64, RR: 18, SpO2: 98% on room air. Denies breathing difficulties.[/quote']

Peritonsilar abscess? Ludwig's angina?

35 y.o. female comes in with c/o of chills malaise, sore throat, right neck/ear tenderness x4 days. "It hurts to swallow and I can't open my mouth all the way." VS as follows T: 38.5, HR: 97, BP: 107/64, RR: 18, SpO2: 98% on room air. Denies breathing difficulties.[/quote']

She could be an esi 2 depending on what her throat look like. I'd look in her mouth really quick to make a final determination. In an uncomplicated sore throat, it would be an ESI 4 for a throat swab.

Agree. I'd be most concerned about peritonsillar abscess, and would assign ESI the same as ^

Ludwig's I think is usually bilateral/floor of mouth...I remember trying to figure out why it was called 'angina' when I was really new and trying to understand how it compared to chest pain/angina.

Agree. I'd be most concerned about peritonsillar abscess, and would assign ESI the same as ^

Ludwig's I think is usually bilateral/floor of mouth...I remember trying to figure out why it was called 'angina' when I was really new and trying to understand how it compared to chest pain/angina.

I think people with Ludwig's angina have a hard time opening their mouth, that's why I threw that in there. :)

Peritonsillar abscess, ESI 2, high risk situation. Incubation period is 3-5 days. Usually one sided pain. If severe, may have respiratory distress or trouble controlling oral secretions. Can be ESI 1 if airway loss is impending.

I think people with Ludwig's angina have a hard time opening their mouth, that's why I threw that in there. :)

Of course! I'm all for the idea of having a good list of ddx to mentally work through when assessing patients! :) It sure beats the alternative...

35 y.o. female comes in with c/o of chills malaise, sore throat, right neck/ear tenderness x4 days. "It hurts to swallow and I can't open my mouth all the way." VS as follows T: 38.5, HR: 97, BP: 107/64, RR: 18, SpO2: 98% on room air. Denies breathing difficulties.[/quote']Elevated T and HR, w/ suspected source of infection meets SIRS criteria and I'd probably make her an ESI 2 and, at one facility, order a stat CBC, C7, and lactate to be drawn within 10 minutes.

If she looked good and had an unremarkable exam, I might make her a 3 but not a 4... at a minimum she'll get labs, possibly XR/CT neck, likely fluids.

Also may have muffled voice with the peritonsillar abscess.

-----

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

I would go with 3.

Mild SOB, and stable vitals. I would not use my last bed for him, he could stay that way for days. Our protocol allows us to order a chest film though, and he could be bumped up quickly if need be. Maybe I'm ruined by Canadian healthcare, we can have 3s waiting 3-4 hours, and I would probably have a sicker person waiting awhile.

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.

Sit her down, take vitals, verbal reassurance, lung sounds, talk about her history. She may be a 2 and need nebs, she may be just SOB with exertion, and a 3, or she might be hyperventilating with anxiety.