Question

While working in the Emergency Department, you are assigned as the Triage Nurse, who is to screen "walk-in" patients, assign an ESI priority level to each patient, and prioritize which patient should be assigned to an available treatment area first.  There are currently three open beds in the department.  The following 10 patients are waiting to be seen.  

"This morning, I stepped on a rusty nail, and it went right through my shoe into my foot. I washed it really well. I read on the Internet that I need a tetanus shot." No previous medical history, and vital signs are within normal limits.

"I was walking down the street and twisted my ankle as I stepped off the curb. I don't think it's broken, but it hurts so much," report a 43-yearold female with a history of colitis. Vital signs: T 98°F, HR 72, RR 18, BP 134/80, SpO2 100%. Pain 8/10.

An 87-year-old male who slipped on the ice and injured his right hip arrives by car.  His daughter, who drove him to the hospital, comes in to ask for a wheelchair and help getting him out of the car. His right leg is shortened and externally rotated. The patient's only complaint is hip pain. He rates his pain as 5/10, and his vital signs are within normal limits.

A 46-year-old asthmatic in significant respiratory distress arrives reporting that the she began wheezing earlier in the day and had been using her inhaler with no relief. On her last admission for asthma, she was intubated. Vital signs: RR 44, SpO2 93% on room air, HR 98, BP 154/60. The patient is able to answer your questions about allergies and medications.

"I woke up this morning, and my eyes are all red and crusty," reports a 29-year-old kindergarten teacher. "I think I got it from the kids at school," she tells you. She denies pain or other visual disturbances. Her vital signs are within normal limits.

A 74-year-old male arrives complaining of severe mid-abdominal pain. "My husband is not a complainer," reports his wife. "The only medication he takes is for high blood pressure." On arrival in the ED, the patient's HR is 140, RR 28, SpO2 94%, BP 72/56.

A 26-year-old female presents to the ED because she can't get an appointment with her therapist. She went home for the holidays, and the visit brought back many issues from her childhood. She is unable to sleep and has been drinking more than usual. She admits to thinking about hurting herself but has no plan. History of previous suicide attempts. Vital signs within normal limits.

A 67-year-old female who has been unable to get an appointment to see the doctor arrives. The patient has had a fever and cough for 3 days. She reports coughing up thick green phlegm and is concerned that she has pneumonia. She denies shortness of breath. Past medical history HTN, T 102°F, RR 28, HR 86, BP 140/72, SpO2 94%.

A 22-year-old woman with asthma who began wheezing earlier this morning, who is sitting upright and leaning forward. You notice she is frequently using an albuterol inhaler. The patient is diaphoretic, working hard at breathing and unable to answer your questions. Her respiratory rate is 48, SpO2 is 94%, and she has a prior history of intubations.

A healthy 10-year-old male is brought to the emergency department by his mother, who reports that her son has not moved his bowels for a week. He is complaining of 7/10 generalized abdominal pain, nausea, and lack of appetite. Vital signs: BP 107/66, HR 75, RR 20, T 98.6°F, SpO2 99%.

Please indicate which patients you will place in the three rooms currently available, and assign an ESI priority level to the remaining seven patients.  Explain your choices.

Answer 1

#. The patients whom i will place in the three rooms are :-

1. A 22-year-old woman with asthma who began wheezing earlier this morning, who is sitting upright and leaning forward. You notice she is frequently using an albuterol inhaler. The patient is diaphoretic, working hard at breathing and unable to answer your questions. Her respiratory rate is 48, SpO2 is 94%, and she has a prior history of intubations.

2. A 67-year-old female who has been unable to get an appointment to see the doctor arrives. The patient has had a fever and cough for 3 days. She reports coughing up thick green phlegm and is concerned that she has pneumonia. She denies shortness of breath. Past medical history HTN, T 102°F, RR 28, HR 86, BP 140/72, SpO2 94%.

3. A 74-year-old male arrives complaining of severe mid-abdominal pain. "My husband is not a complainer," reports his wife. "The only medication he takes is for high blood pressure." On arrival in the ED, the patient's HR is 140, RR 28, SpO2 94%, BP 72/56.

#. ESI priority level for other patients :-

- This morning, I stepped on a rusty nail, and it went right through my shoe into my foot. I washed it really well. I read on the Internet that I need a tetanus shot." No previous medical history, and vital signs are within normal limits.

ESI - 3 ( urgent )

"I was walking down the street and twisted my ankle as I stepped off the curb. I don't think it's broken, but it hurts so much," report a 43-year old female with a history of colitis. Vital signs: T 98°F, HR 72, RR 18, BP 134/80, SpO2 100%. Pain 8/10.

ESI - 4 ( non urgent )

An 87-year-old male who slipped on the ice and injured his right hip arrives by car. His daughter, who drove him to the hospital, comes in to ask for a wheelchair and help getting him out of the car. His right leg is shortened and externally rotated. The patient's only complaint is hip pain. He rates his pain as 5/10, and his vital signs are within normal limits.

ESI - 3 ( urgent)

A 46-year-old asthmatic in significant respiratory distress arrives reporting that the she began wheezing earlier in the day and had been using her inhaler with no relief. On her last admission for asthma, she was intubated. Vital signs: RR 44, SpO2 93% on room air, HR 98, BP 154/60. The patient is able to answer your questions about allergies and medications.

ESI - 3 ( urgent )

"I woke up this morning, and my eyes are all red and crusty," reports a 29-year-old kindergarten teacher. "I think I got it from the kids at school," she tells you. She denies pain or other visual disturbances. Her vital signs are within normal limits.

ESI - 3 (urgent )

A 26-year-old female presents to the ED because she can't get an appointment with her therapist. She went home for the holidays, and the visit brought back many issues from her childhood. She is unable to sleep and has been drinking more than usual. She admits to thinking about hurting herself but has no plan. History of previous suicide attempts. Vital signs within normal limits.

ESI - 3 ( urgent )

A healthy 10-year-old male is brought to the emergency department by his mother, who reports that her son has not moved his bowels for a week. He is complaining of 7/10 generalized abdominal pain, nausea, and lack of appetite. Vital signs: BP 107/66, HR 75, RR 20, T 98.6°F, SpO2 99%.

ESI - 3 ( urgent )