ESI Triage Question

amarilla, RN · Apr 24, 2015

Hmm. While I may not be one of the more eloquent posters here, I'll try to be succinct: I triage people in danger of dying or nearly dead as '1', indicating immediate lifesaving intervention needed, i.e., arrests brought in in progress. Emergent treatment - like reviving an altered hypoglycemic patient with D50 - I would still triage a 2. Urgent with many resources a 3 and so on.

In your example, I would triage the hypoglycemic patient who has already received interventions based on my assessment when I receive them. If that second finger stick on arrival is now 180 (from the D50) and they are awake/alert, they are a 3 and will be roomed accordingly unless there was a fall, LOC or some other issue at play dictating more immediate care (found down? poor vital signs?). I don't usually care how they looked an hour ago unless it's something like head injury or trauma which could have other implications, (internal injuries, shock etc) that may impact patient's status and resulting treatment going forward.

Just my opinion and will look forward to reading others'.

Anna Flaxis, BSN, RN · Apr 24, 2015

I would triage the patient in question based on what I first see- with the caveat that I will take into consideration the patient's presentation in the field as well as their risk of deterioration. Undertriage can delay needed medical evaluation and treatment, resulting in a bad outcome, while overtriage never hurt anybody. This person certainly wouldn't be a 1, because the immediate life saving intervention has already been done in the field- but I would make them a 2 due to being a high risk for rapid deterioration.

Sassy5d · Apr 25, 2015

Im sure there's a link on google somewhere for the official triage system of number ranking.

Many times that makes people's triage esi number higher, as in the cheeto eating c/o 10/10 pain would be a 2..

Technically, i would make hypoglycemia that needed d50 a 2.. High risk situation?? How long is d50 going to keep them alert?

Christy1019, ASN, RN · Apr 25, 2015

I agree with all the above posters in that I would triage them based on what I see, not what the situation was pre-hospital, unless they are an unresponsive post code etc. As for this situation, if they had overdosed on insulin and has a high likelihood of consistent, rebound hypogylycemia, I'd make them a 2. If it's a diabetic who just forgot to eat with their meds but is now A&O x 3 and fully capable of eating, I'd probably make them a 3. I hope that helps.

Altra, BSN, RN · Apr 25, 2015

You should be basing your own education and that which you are planning for your staff on the actual ESI handbook - it's dowloadable for free.

Short answer: ESI is based on s/s upon presentation to the ED, though the "backstory" of what went on pre-hospital can contribute to the risk assessment.

widi96 · Apr 25, 2015

I do have the book and have actually already read it from cover to cover. Since the blood sugar was an example our educator had given in class in regards to someone who had walked in the front door - then experiencing the patient via EMS who had already been treated - wasn't something I had previously thought about - EMS treatment changing the triage level.