ENA Triage ESI 2.0 Exam: 200
Questions & Answers with Expert
Clinical Rationales
ECTION 1: ESI LEVEL 1 - RESUSCITATION (Questions 1-25)
Question 1
A 58-year-old patient presents with weakness and lightheadedness. Vital
signs: BP 102/58 mm Hg, HR 40 beats/min, RR 20 breaths/min, T 36.1°C
(97.1°F), SpO2 94% on room air.
Answer: ESI Level 1
Rationale: Bradycardia at 40 beats/min with hypotension indicates
hemodynamic instability requiring immediate life-saving intervention. The
patient is at risk for cardiovascular collapse and requires emergent pacing
or medication. ESI Level 1 criteria include patients requiring immediate life-
saving intervention (e.g., airway, breathing, circulation support) .
Question 2
A 5-month-old infant was carried down stairs when caregiver tripped and
fell 6 steps. The baby was crying then stopped and now appears limp.
Vitals: BP 89/58 mm Hg, HR 90 beats/min, RR 16 breaths/min, T 36.5°C
(97.7°F), SpO2 91% on room air.
,Answer: ESI Level 1
Rationale: This infant presents with ALTERED MENTAL STATUS (limp,
stopped crying), hypoxemia (SpO2 91%), and a concerning mechanism of
injury in a non-verbal patient. This represents an immediate life threat
requiring emergent evaluation for intracranial injury or spinal cord injury.
Any patient with altered mental status and abnormal vitals meets ESI Level
1 criteria .
Question 3
A patient with severe respiratory distress, stridor, retractions, and SpO2 89%
on room air.
Answer: ESI Level 1
Rationale: Hypoxia (SpO2 < 90%) with signs of moderate to severe
respiratory distress indicates immediate life threat. Stridor suggests upper
airway obstruction requiring emergent intervention. ESI Level 1 is assigned
when a patient requires immediate life-saving intervention, and respiratory
compromise qualifies .
Question 4
An unconscious patient is brought in after a motor vehicle crash with
snoring respirations, HR 122, BP 88/52 mm Hg, and obvious femur
deformity with bleeding.
Answer: ESI Level 1
Rationale: This patient has AIRWAY COMPROMISE (snoring respirations),
HYPOTENSION (shock), and a significant mechanism of injury. The priority
is airway management using jaw-thrust maneuver and evaluation of
, breathing. This represents an immediate life-threatening situation requiring
resuscitation .
Question 5
A patient with chest pain, diaphoresis, and ECG changes consistent with
STEMI.
Answer: ESI Level 1
Rationale: STEMI is a time-sensitive, life-threatening condition requiring
immediate intervention (door-to-balloon within 90 minutes). The threat to
physiologic safety (Maslow's basic physiological needs) necessitates
emergent assessment and treatment .
SECTION 2: ESI LEVEL 2 - HIGH RISK (Questions 6-75)
Question 6
A 28-year-old patient presents with vaginal bleeding that started 2 hours
ago. She had a positive home pregnancy test a week ago but no confirmed
IUP. Vitals: BP 106/62 mm Hg, HR 126 beats/min, RR 16 breaths/min, T
36.6°C (97.8°F), SpO2 99%.
Answer: ESI Level 2
Rationale: This patient has FIRST-TRIMESTER VAGINAL BLEEDING with a
positive pregnancy test and tachycardia (HR 126). She is at HIGH RISK for
ectopic pregnancy or miscarriage with potential for hemorrhagic shock. Her
skin is cool and diaphoretic, and she will continue to bleed unless
Questions & Answers with Expert
Clinical Rationales
ECTION 1: ESI LEVEL 1 - RESUSCITATION (Questions 1-25)
Question 1
A 58-year-old patient presents with weakness and lightheadedness. Vital
signs: BP 102/58 mm Hg, HR 40 beats/min, RR 20 breaths/min, T 36.1°C
(97.1°F), SpO2 94% on room air.
Answer: ESI Level 1
Rationale: Bradycardia at 40 beats/min with hypotension indicates
hemodynamic instability requiring immediate life-saving intervention. The
patient is at risk for cardiovascular collapse and requires emergent pacing
or medication. ESI Level 1 criteria include patients requiring immediate life-
saving intervention (e.g., airway, breathing, circulation support) .
Question 2
A 5-month-old infant was carried down stairs when caregiver tripped and
fell 6 steps. The baby was crying then stopped and now appears limp.
Vitals: BP 89/58 mm Hg, HR 90 beats/min, RR 16 breaths/min, T 36.5°C
(97.7°F), SpO2 91% on room air.
,Answer: ESI Level 1
Rationale: This infant presents with ALTERED MENTAL STATUS (limp,
stopped crying), hypoxemia (SpO2 91%), and a concerning mechanism of
injury in a non-verbal patient. This represents an immediate life threat
requiring emergent evaluation for intracranial injury or spinal cord injury.
Any patient with altered mental status and abnormal vitals meets ESI Level
1 criteria .
Question 3
A patient with severe respiratory distress, stridor, retractions, and SpO2 89%
on room air.
Answer: ESI Level 1
Rationale: Hypoxia (SpO2 < 90%) with signs of moderate to severe
respiratory distress indicates immediate life threat. Stridor suggests upper
airway obstruction requiring emergent intervention. ESI Level 1 is assigned
when a patient requires immediate life-saving intervention, and respiratory
compromise qualifies .
Question 4
An unconscious patient is brought in after a motor vehicle crash with
snoring respirations, HR 122, BP 88/52 mm Hg, and obvious femur
deformity with bleeding.
Answer: ESI Level 1
Rationale: This patient has AIRWAY COMPROMISE (snoring respirations),
HYPOTENSION (shock), and a significant mechanism of injury. The priority
is airway management using jaw-thrust maneuver and evaluation of
, breathing. This represents an immediate life-threatening situation requiring
resuscitation .
Question 5
A patient with chest pain, diaphoresis, and ECG changes consistent with
STEMI.
Answer: ESI Level 1
Rationale: STEMI is a time-sensitive, life-threatening condition requiring
immediate intervention (door-to-balloon within 90 minutes). The threat to
physiologic safety (Maslow's basic physiological needs) necessitates
emergent assessment and treatment .
SECTION 2: ESI LEVEL 2 - HIGH RISK (Questions 6-75)
Question 6
A 28-year-old patient presents with vaginal bleeding that started 2 hours
ago. She had a positive home pregnancy test a week ago but no confirmed
IUP. Vitals: BP 106/62 mm Hg, HR 126 beats/min, RR 16 breaths/min, T
36.6°C (97.8°F), SpO2 99%.
Answer: ESI Level 2
Rationale: This patient has FIRST-TRIMESTER VAGINAL BLEEDING with a
positive pregnancy test and tachycardia (HR 126). She is at HIGH RISK for
ectopic pregnancy or miscarriage with potential for hemorrhagic shock. Her
skin is cool and diaphoretic, and she will continue to bleed unless
