ESI LEVEL QUESTIONS AND ANSWERS
1."Ifiwasfitakingfimyficontactsfioutfilastfinight,fiandfiIfithinkfiIfiscratchedfimyficornea,"fireportsfiafi27-
year-
oldfifemale.fi"I'mfiwearingfithesefisunglassesfibecausefithefilightfireallyfibothersfimyfieyes."fiHerfirig
htfieyefiisfiredfiandfitearing.fiShefiratesfiherfipainfiasfi6/10.fiVitalfisignsfiarefiwithinfinormalfilimits.fi-
fianswer--5
2.EMSfipresentsfitofithefiEDfiwithfianfi18-year-
oldfifemalefiwithfiafisuspectedfimedicationfioverdose.fiHerficollegefiroommatesfifoundfiherfilethargi
cfiandfi"notfiactingfiright,"fisofitheyficalledfi911.fiThefipatientfihasfiafihistoryfioffidepression.fiOnfiexa
m,fiyoufinoticefimultiplefisuperficialfilacerationsfitofibothfiwrists.fiHerfirespiratoryfiratefiisfi10,fiandfih
erfiSpO2fionfiroomfiairfiisfi86fipercent.fi-fianswer--1
3.EMSfiarrivedfiwithfianfiunresponsivefi19-year-oldfimalefiwithfiafisinglefiself-
inflictedfigunshotfiwoundfitofithefihead.fiPriorfitofiintubation,fihisfiGlasgowfiComafiScalefiscorefiwasfi
3.fi-fianswer--1
4."Ifiranfioutfioffimyfibloodfipressurefimedicine,fiandfimyfidoctorfiisfionfivacation.fiCanfisomeonefiher
efiwritefimefiafiprescription?"firequestsfiafi56-year-
oldfimalefiwithfiafihistoryfioffiHTN.fiVitalfisigns:fiBPfi128/84,fiHRfi76,fiRRfi16,fiTfi97°F.fi-fianswer--5
5.Afi41-year-
oldfimalefiinvolvedfiinfiafibicyclefiaccidentfiwalksfiintofithefiemergencyfidepartmentfiwithfihisfirightfiar
mfiinfiafisling.fiHefitellsfiyoufithatfihefifellfiofffihisfibikefiandfilandedfionfihisfirightfiarm.fiHisfiisficomplaini
ngfioffipainfiinfithefiwristfiareafiandfihasfiafi2-
centimeterfilacerationfionfihisfileftfielbow.fi"Myfihelmetfisavedfime,"fihefitellsfiyou.fi-fianswer--3
6.Afi32-year-
oldfifemalefipresentsfitofithefiemergencyfidepartmentficomplainingfioffishortnessfioffibreathfiforfise
veralfihours.fiNofipastfimedicalfihistory,fi+smoker.fiVitalfisigns:fiRRfi32,fiHRfi96,fiBPfi126/80,fiSpO2fi
93%fionfiroomfiair,fiTfi98.6°F.fiNofiallergies,ficurrentfimedicationsfiincludefivitaminsfiandfibirthficont
rolfipills.fi-fianswer--2
7."Ifijustfiturnedfimyfibackfiforfiafiminute,"ficriedfithefimotherfioffiafi4-year-
old.fiThefichildfiwasfipulledfioutfioffithefifamilyfipoolfibyfiafineighborfiwhofiimmediatelyfiadministeredfi
mouth-to-
mouthfiresuscitation.fiThefichildfiisfinowfibreathingfispontaneouslyfibutficontinuesfitofibefiunrespon
sive.fiOnfiarrivalfiinfithefiED,fivitalfisignsfiwere:fiHRfi126,fiRRfi28,fiBPfi80/64,fiSpO2fi96%fionfiafinon-
rebreather.fi-fianswer--1
8.Afinormalfihealthyfi7-year-
oldfiwalksfiintofithefiemergencyfidepartmentfiaccompaniedfibyfihisfifather,fiwhofireportsfithatfihisfiso
, nfiwokefiupficomplainingfioffiafistomachfiache.fi"Hefirefusedfitofiwalkfidownstairsfiandfiisfinotfiinteres
tedfiinfieatingfiorfiplaying."fiThefichildfivomitsfiatfitriage.fiVitalfisigns:fiTfi100.4°F,fiRRfi22,fiHRfi88,fiBPf
i84/60,fiSpO2100%.fiPainfi6/10.fi-fianswer--3
9.Afi6-year-
oldfimalefitellsfiyoufithatfihefiwasfirunningfiacrossfithefiplaygroundfiandfifell.fiHefipresentsfiwithfiafi3-
centimeterfilacerationfioverfihisfirightfiknee.fiHealthy,finofimedicationsfiandfinofiallergies,fiimmuniz
ationsfiarefiupfitofidate.fi-fianswer--4
10."Ifislippedfionfithefiice,fiandfiIfihurtfimyfiwrist,"fireportsfiafi58-year-
oldfifemalefiwithfiafihistoryfioffimigraines.fiTherefiisfinofiobviousfideformity.fiVitalfisignsfiarefiwithinfin
ormalfilimits,fiandfishefiratesfiherfipainfiasfi5/10.fi-fianswer--4
11.Afi4-year-
oldfifemalefiisfitransportedfitofithefiEDfifollowingfiafifallfiofffithefijunglefigymfiatfiafipreschool.fiAfifallfioffi
4fifeet.fiAfiwitnessfireportsfithatfithefichildfihitfiherfiheadfiandfiwasfiunconsciousfiforfiaficouplefioffimin
utes.fiOnfiarrivalfiyoufinoticefithatfithefichildfiisficryingfiandfiaskingfiforfiherfimother.fiHerfileftfiarmfiisfis
plinted.fiVitalfisigns:fiHRfi162,fiRRfi38.fi-fianswer--2
12.Afi60-year-
oldfimanfirequestsfitofiseefiafidoctorfibecausefihisfirightfifootfihurts.fiOnfiexamfithefigreatfitoefiandfifoo
tfiskinfiisfired,fiwarm,fiswollen,fiandfitenderfitofitouch.fiHefideniesfiinjury.fipastfimedicalfihistoryfiinclu
desfitypefi2fidiabetes,fiandfipsoriasis.fiVitalfisigns:fiTfi99.4°F,fiRRfi18,fiHRfi82,fiBPfi146/70,fiSpO2fi9
9%.fi-fianswer--3
13.Afi52-year-
oldfifemalefirequestsfitofiseefiafidoctorfiforfiafipossiblefiurinaryfitractfiinfectionfi(UTI).fiShefiisficompla
iningfioffidysuriafiandfifrequency.fiShefideniesfiabdominalfipainfiorfivaginalfidischarge.fiNofiallergie
s,fitakesfivitamins,fiandfihasfinofisignificantfipastfimedicalfihistory.fiVitalfisigns:fiTfi97.4°F,fiHRfi78,fiR
Rfi14,fiBPfi142/70.fi-fianswer--4
14."Ificalledfimyfipediatrician,fiandfishefitoldfimefitofibringfihimfiinfibecausefioffihisfifever,"fireportsfith
efimotherfioffiafi2-week-
old.fiVitalfisigns:fiTfi101°F,fiHRfi154,fiRRfi42,fiSpO2fi100%.fiUncomplicated,fivaginalfidelivery.fiThe
fibabyfiisfiactingfiappropriately.fi-fianswer--2
15."Myfirightfibreastfiisfisofisore,fimyfinipplesfiareficracked,fiandfinowfiIfihavefiafifever.fiDofiyoufithinkfi
Ifiwillfihavefitofistopfinursingfimyfibaby?"fiasksfiafitearfulfi34-year-
oldfifemale.fiShefiisfi3fimonthsfipostfipartumfiandfihasfirecentlyfireturnedfitofiworkfiparttime.fiVitalfisi
gns:fiTfi102.8°F,fiHRfi90,fiRRfi18,fiBPfi108/60,fipainfi5/10.fiNofipastfimedicalfihistory,fitakingfimultivit
amins,fiandfiisfiallergicfitofipenicillin.fi-fianswer--3
16.Paramedicsfiarrivefiwithfiafi16-year-
oldfiunrestrainedfidriverfiwhofihitfiafitreefiwhilefitravelingfiatfiapproximatelyfi45fimilesfiperfihour.fiThef
ipassengerfisidefioffitheficarfihadfisignificantfidamage.fiThefidriverfiwasfimoaningfibutfimovingfiallfie
xtremitiesfiwhenfihelpfiarrived.fiHisfiinitialfivitalfisignsfiwerefiBPfi74/50,fiHRfi132,fiRRfi36,fiSPO2fi99
%,fiTfi98.6°F.fi-fianswer--1
1."Ifiwasfitakingfimyficontactsfioutfilastfinight,fiandfiIfithinkfiIfiscratchedfimyficornea,"fireportsfiafi27-
year-
oldfifemale.fi"I'mfiwearingfithesefisunglassesfibecausefithefilightfireallyfibothersfimyfieyes."fiHerfirig
htfieyefiisfiredfiandfitearing.fiShefiratesfiherfipainfiasfi6/10.fiVitalfisignsfiarefiwithinfinormalfilimits.fi-
fianswer--5
2.EMSfipresentsfitofithefiEDfiwithfianfi18-year-
oldfifemalefiwithfiafisuspectedfimedicationfioverdose.fiHerficollegefiroommatesfifoundfiherfilethargi
cfiandfi"notfiactingfiright,"fisofitheyficalledfi911.fiThefipatientfihasfiafihistoryfioffidepression.fiOnfiexa
m,fiyoufinoticefimultiplefisuperficialfilacerationsfitofibothfiwrists.fiHerfirespiratoryfiratefiisfi10,fiandfih
erfiSpO2fionfiroomfiairfiisfi86fipercent.fi-fianswer--1
3.EMSfiarrivedfiwithfianfiunresponsivefi19-year-oldfimalefiwithfiafisinglefiself-
inflictedfigunshotfiwoundfitofithefihead.fiPriorfitofiintubation,fihisfiGlasgowfiComafiScalefiscorefiwasfi
3.fi-fianswer--1
4."Ifiranfioutfioffimyfibloodfipressurefimedicine,fiandfimyfidoctorfiisfionfivacation.fiCanfisomeonefiher
efiwritefimefiafiprescription?"firequestsfiafi56-year-
oldfimalefiwithfiafihistoryfioffiHTN.fiVitalfisigns:fiBPfi128/84,fiHRfi76,fiRRfi16,fiTfi97°F.fi-fianswer--5
5.Afi41-year-
oldfimalefiinvolvedfiinfiafibicyclefiaccidentfiwalksfiintofithefiemergencyfidepartmentfiwithfihisfirightfiar
mfiinfiafisling.fiHefitellsfiyoufithatfihefifellfiofffihisfibikefiandfilandedfionfihisfirightfiarm.fiHisfiisficomplaini
ngfioffipainfiinfithefiwristfiareafiandfihasfiafi2-
centimeterfilacerationfionfihisfileftfielbow.fi"Myfihelmetfisavedfime,"fihefitellsfiyou.fi-fianswer--3
6.Afi32-year-
oldfifemalefipresentsfitofithefiemergencyfidepartmentficomplainingfioffishortnessfioffibreathfiforfise
veralfihours.fiNofipastfimedicalfihistory,fi+smoker.fiVitalfisigns:fiRRfi32,fiHRfi96,fiBPfi126/80,fiSpO2fi
93%fionfiroomfiair,fiTfi98.6°F.fiNofiallergies,ficurrentfimedicationsfiincludefivitaminsfiandfibirthficont
rolfipills.fi-fianswer--2
7."Ifijustfiturnedfimyfibackfiforfiafiminute,"ficriedfithefimotherfioffiafi4-year-
old.fiThefichildfiwasfipulledfioutfioffithefifamilyfipoolfibyfiafineighborfiwhofiimmediatelyfiadministeredfi
mouth-to-
mouthfiresuscitation.fiThefichildfiisfinowfibreathingfispontaneouslyfibutficontinuesfitofibefiunrespon
sive.fiOnfiarrivalfiinfithefiED,fivitalfisignsfiwere:fiHRfi126,fiRRfi28,fiBPfi80/64,fiSpO2fi96%fionfiafinon-
rebreather.fi-fianswer--1
8.Afinormalfihealthyfi7-year-
oldfiwalksfiintofithefiemergencyfidepartmentfiaccompaniedfibyfihisfifather,fiwhofireportsfithatfihisfiso
, nfiwokefiupficomplainingfioffiafistomachfiache.fi"Hefirefusedfitofiwalkfidownstairsfiandfiisfinotfiinteres
tedfiinfieatingfiorfiplaying."fiThefichildfivomitsfiatfitriage.fiVitalfisigns:fiTfi100.4°F,fiRRfi22,fiHRfi88,fiBPf
i84/60,fiSpO2100%.fiPainfi6/10.fi-fianswer--3
9.Afi6-year-
oldfimalefitellsfiyoufithatfihefiwasfirunningfiacrossfithefiplaygroundfiandfifell.fiHefipresentsfiwithfiafi3-
centimeterfilacerationfioverfihisfirightfiknee.fiHealthy,finofimedicationsfiandfinofiallergies,fiimmuniz
ationsfiarefiupfitofidate.fi-fianswer--4
10."Ifislippedfionfithefiice,fiandfiIfihurtfimyfiwrist,"fireportsfiafi58-year-
oldfifemalefiwithfiafihistoryfioffimigraines.fiTherefiisfinofiobviousfideformity.fiVitalfisignsfiarefiwithinfin
ormalfilimits,fiandfishefiratesfiherfipainfiasfi5/10.fi-fianswer--4
11.Afi4-year-
oldfifemalefiisfitransportedfitofithefiEDfifollowingfiafifallfiofffithefijunglefigymfiatfiafipreschool.fiAfifallfioffi
4fifeet.fiAfiwitnessfireportsfithatfithefichildfihitfiherfiheadfiandfiwasfiunconsciousfiforfiaficouplefioffimin
utes.fiOnfiarrivalfiyoufinoticefithatfithefichildfiisficryingfiandfiaskingfiforfiherfimother.fiHerfileftfiarmfiisfis
plinted.fiVitalfisigns:fiHRfi162,fiRRfi38.fi-fianswer--2
12.Afi60-year-
oldfimanfirequestsfitofiseefiafidoctorfibecausefihisfirightfifootfihurts.fiOnfiexamfithefigreatfitoefiandfifoo
tfiskinfiisfired,fiwarm,fiswollen,fiandfitenderfitofitouch.fiHefideniesfiinjury.fipastfimedicalfihistoryfiinclu
desfitypefi2fidiabetes,fiandfipsoriasis.fiVitalfisigns:fiTfi99.4°F,fiRRfi18,fiHRfi82,fiBPfi146/70,fiSpO2fi9
9%.fi-fianswer--3
13.Afi52-year-
oldfifemalefirequestsfitofiseefiafidoctorfiforfiafipossiblefiurinaryfitractfiinfectionfi(UTI).fiShefiisficompla
iningfioffidysuriafiandfifrequency.fiShefideniesfiabdominalfipainfiorfivaginalfidischarge.fiNofiallergie
s,fitakesfivitamins,fiandfihasfinofisignificantfipastfimedicalfihistory.fiVitalfisigns:fiTfi97.4°F,fiHRfi78,fiR
Rfi14,fiBPfi142/70.fi-fianswer--4
14."Ificalledfimyfipediatrician,fiandfishefitoldfimefitofibringfihimfiinfibecausefioffihisfifever,"fireportsfith
efimotherfioffiafi2-week-
old.fiVitalfisigns:fiTfi101°F,fiHRfi154,fiRRfi42,fiSpO2fi100%.fiUncomplicated,fivaginalfidelivery.fiThe
fibabyfiisfiactingfiappropriately.fi-fianswer--2
15."Myfirightfibreastfiisfisofisore,fimyfinipplesfiareficracked,fiandfinowfiIfihavefiafifever.fiDofiyoufithinkfi
Ifiwillfihavefitofistopfinursingfimyfibaby?"fiasksfiafitearfulfi34-year-
oldfifemale.fiShefiisfi3fimonthsfipostfipartumfiandfihasfirecentlyfireturnedfitofiworkfiparttime.fiVitalfisi
gns:fiTfi102.8°F,fiHRfi90,fiRRfi18,fiBPfi108/60,fipainfi5/10.fiNofipastfimedicalfihistory,fitakingfimultivit
amins,fiandfiisfiallergicfitofipenicillin.fi-fianswer--3
16.Paramedicsfiarrivefiwithfiafi16-year-
oldfiunrestrainedfidriverfiwhofihitfiafitreefiwhilefitravelingfiatfiapproximatelyfi45fimilesfiperfihour.fiThef
ipassengerfisidefioffitheficarfihadfisignificantfidamage.fiThefidriverfiwasfimoaningfibutfimovingfiallfie
xtremitiesfiwhenfihelpfiarrived.fiHisfiinitialfivitalfisignsfiwerefiBPfi74/50,fiHRfi132,fiRRfi36,fiSPO2fi99
%,fiTfi98.6°F.fi-fianswer--1
