J Emergency Nursing Feb 2008; 30(1):22-29 1/2/2018 35
There is no time allocation in ESI Dying patient- see immediately Sick appearing patient- “shouldn’t wait” The lower 3 levels are categorized based on resource needs 1/2/2018 36
Level 1-life threatening Patients in this category require immediate attention with maximal utilization of resources to prevent loss of life, limb, or eyesight. Level 2-emergent Patients in this category should be seen by a physician because of high risk for rapid deterioration, loss of life, limb, or eyesight if treatment or interventions are delayed. LEVEL 3-URGENT/ACUTE Patients who develop a sudden illness or injury within 24- 48 hours. Symptoms and risk factors for serious disease do not indicate a likelihood of rapid deterioration in the near future . 1/2/2018 39
Level 4-stable: Patients with chronic complaints, medical maintenance, or medical conditions posing no threat to loss of life, limb, or eyesight. Level 5 walk-in/routine Patients in this category are currently stable and require no resources such as labs or x-ray. 1/2/2018 40
Airway, emergency medications, hemodynamic interventions (IV, O 2 , monitor, ECG or labs DO NOT count); and/or any of the following clinical conditions: intubated, apneic, pulseless, severe respiratory distress, SpO 2 <90, acute mental status changes, or unresponsive. 1/2/2018 41
Put patient in your last open bed. Severe pain/distress is determined by clinical observation and/or patient rating of ≧ 7 on 0-10 pain scale. 1/2/2018 42
Count the number of different types of resources, not the individual tests or X-rays (examples: CBC, electrolytes and coags equals one resource; CBC plus CXR equals 2 resources ). Resources Not Resources • Labs (blood, urine) • ECG, X -rays • CT -MRI-ultrasound-angiography • History & physical (including pelvic) • Point -of-care testing • IV fluids (hydration) • Saline or heplock • IV or IM or nebulized medications • PO medications • Tetanus immunization • Prescription refills • Specialty consultation • Phone call to PCP • Simple procedure =1 (lac repair, foley cath) • Complex procedure =2 (conscious sedation) • Simple wound care (dressings, recheck) • Crutches, splints, slings 1/2/2018 43
Consider up-triage to ESI 2 if any vital sign criterion is exceeded. Pediatric Fever Considerations: 1 to 28 days of age: assign at least ESI 2 if temp >38.0 C 1-3 months of age: consider assigning ESI 2 if temp >38.0 C 3 months to 3 yrs of age: consider assigning ESI 3 if temp >39.0 C, or incomplete immunizations, or no obvious source of fever 1/2/2018 44
Is the patient dying • Needs an immediate airway, medication, or other hemodynamic intervention • Is already intubated, apneic, pulseless, severe respiratory distress, SpO2 < 90 percent, acute mental status changes, or unresponsive 1/2/2018 45
Should the patient wait? • Is this a high-risk situation? • Is the patient confused, lethargic or disoriented? • Is the patient in severe pain or distress?
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