J emergency nursing feb 2008 18 35 there is no time

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

1/2/2018
37

1/2/2018
38


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

1/2/2018
46


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?