ESI LEVELS COMPETENCY SET WITH COMPLETE SOLUTIONS 100%
VERIFIED!!!! ALREADY GRADED A+
"I think I picked up a bug overseas," reports a 34-year-old male who presented in the emergency
department complaining of frequent watery stools and abdominal cramping. "I think I am getting
dehydrated." T 98°F, RR 22, HR 112, BP 120/80, SpO2 100%. Pain 6/10. - (ANSWER)ESI level 3: Two or
more resources. From the patient's history, he will require labs and IV fluid replacement—two resources.
When asked why she came to the emergency department, the 18-year-old college student begins to cry.
She tells the triage nurse that she was sexually assaulted last night at an off-campus party. -
(ANSWER)ESI level 3: Two or more resources. It looks as though this patient has a displaced fracture and
will need a closed reduction prior to casting or splinting. At a minimum, he needs x-rays and an
orthopedic consult. This patient may also require procedural sedation. However, there are already two or
more resources, so it is not necessary to be overly concerned about counting resources beyond two.
"I don't know what's wrong with my baby girl," cries a young mother. She reports that her 2-week-old
baby is not acting right and is not interested in eating. As you begin to undress the baby, you notice that
she is listless and her skin is mottled. - (ANSWER)ESI level 1: Requires immediate lifesaving intervention;
possible aggressive fluid resuscitation.
"My pain medications are not working anymore. Last night I couldn't sleep because the pain was so
bad," reports a 47-year-old female with metastatic ovarian cancer. "My husband called my oncologist,
and he told me to come to the emergency department." The patient rates her pain as 9/10. Vital signs
are within normal limits. - (ANSWER)ESI level 2: Severe pain or distress. This patient needs aggressive
pain management with IV medications. There is nothing the triage nurse can do to decrease the patient's
pain level. The answer to "Would you give your last open bed to this patient?" should be yes.
A 48-year-old male tells you that he has a history of kidney stones and thinks he has another one. He has
right costovertebral angle pain that radiates around to the front and into his groin. He is nauseous but
tells you he took a pain pill, and right now he has minimal pain. He denies vomiting. T 98°F, RR 16, HR 80,
BP 136/74, SpO2 100%. Pain 3/10. - (ANSWER)ESI level 3: Two or more resources. The patient is
presenting with signs and symptoms of another kidney stone. At a minimum, he will need a urinalysis
and CT scan. If his pain increases, he may need IV pain medication. At a minimum, two resources are
required. If the pain level was 7/10 or greater and the triage nurse could not manage the pain at triage,
the patient could meet level-2 criteria.
"After my pediatrician saw my son's rash, he said I had to bring him to the emergency department
immediately. He has this rash on his face and chest that started today. He has little pinpoint purplish
, ESI LEVELS COMPETENCY SET WITH COMPLETE SOLUTIONS 100%
VERIFIED!!!! ALREADY GRADED A+
spots he called petechiae. My son is a healthy kid who has had a cold for a couple of days and a cough.
My pediatrician said he had to be sure nothing bad is going on. What do you think?" - (ANSWER)ESI level
2: High risk. Rashes are difficult to triage, but the presence of petechiae is always a high-risk situation.
Even if the patient looks good, it is important to recognize that petechia can be a symptom of a life-
threatening infection, meningococcemia.
"Her grandfather pulled her by the wrist up and over a big puddle. Next thing you know, she is crying and
refusing to move her left arm," the mother of a healthy 3-year-old tells you. Vital signs are within normal
limits. - (ANSWER)ESI level 4 or 5: This case is an example of variations in practice around the country.
Many emergency departments would examine the child and then attempt to reduce the dislocation of
the radial head without an x-ray. Others may x-ray the child's arm, which is considered one ESI resource.
Relocation is not considered a resource.
A 46-year-old asthmatic in significant respiratory distress presents via ambulance. The paramedics report
that the patient 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. - (ANSWER)ESI
level 2: High-risk. An asthmatic with a prior history of intubation is a high-risk situation. This patient is in
respiratory distress as evidenced, by her respiratory rate, oxygen saturation, and work of breathing. She
does not meet the criteria for ESI level 1, requires immediate lifesaving intervention.
A 56-year-old male with a recent diagnosis of late-stage non-Hodgkin's lymphoma was brought to the ED
from the oncology clinic. He told his oncologist that he had facial and bilateral arm swelling and
increasing shortness of breath. The patient also reports that his symptoms are worse if he lies down.
Vital signs: BP 146/92, HR 122, RR 38, SpO2 98% on room air, temperature normal. - (ANSWER)ESI level
2: High risk. This patient is demonstrating respiratory distress with his increased respiratory rate and
decreased oxygen saturation. Symptoms are caused by compression of the superior vena cava from the
tumor. It is difficult for blood to return to the heart, causing edema of the face and arms.
EMS arrives with a 28-year-old male who was stabbed in the left side of his neck during an altercation.
You notice a large hematoma around the wound, and the patient is moaning he can't breathe. HR 110,
RR 36, SpO2 89%. - (ANSWER)ESI level 1: Requires immediate lifesaving intervention. Depending on the
exact location penetrating neck trauma can cause significant injury to underlying structures. Based on
the presenting vital signs, immediate actions to address airway, breathing, and circulation are required.
Intubation might be necessary due to the large neck hematoma, which may expand.
VERIFIED!!!! ALREADY GRADED A+
"I think I picked up a bug overseas," reports a 34-year-old male who presented in the emergency
department complaining of frequent watery stools and abdominal cramping. "I think I am getting
dehydrated." T 98°F, RR 22, HR 112, BP 120/80, SpO2 100%. Pain 6/10. - (ANSWER)ESI level 3: Two or
more resources. From the patient's history, he will require labs and IV fluid replacement—two resources.
When asked why she came to the emergency department, the 18-year-old college student begins to cry.
She tells the triage nurse that she was sexually assaulted last night at an off-campus party. -
(ANSWER)ESI level 3: Two or more resources. It looks as though this patient has a displaced fracture and
will need a closed reduction prior to casting or splinting. At a minimum, he needs x-rays and an
orthopedic consult. This patient may also require procedural sedation. However, there are already two or
more resources, so it is not necessary to be overly concerned about counting resources beyond two.
"I don't know what's wrong with my baby girl," cries a young mother. She reports that her 2-week-old
baby is not acting right and is not interested in eating. As you begin to undress the baby, you notice that
she is listless and her skin is mottled. - (ANSWER)ESI level 1: Requires immediate lifesaving intervention;
possible aggressive fluid resuscitation.
"My pain medications are not working anymore. Last night I couldn't sleep because the pain was so
bad," reports a 47-year-old female with metastatic ovarian cancer. "My husband called my oncologist,
and he told me to come to the emergency department." The patient rates her pain as 9/10. Vital signs
are within normal limits. - (ANSWER)ESI level 2: Severe pain or distress. This patient needs aggressive
pain management with IV medications. There is nothing the triage nurse can do to decrease the patient's
pain level. The answer to "Would you give your last open bed to this patient?" should be yes.
A 48-year-old male tells you that he has a history of kidney stones and thinks he has another one. He has
right costovertebral angle pain that radiates around to the front and into his groin. He is nauseous but
tells you he took a pain pill, and right now he has minimal pain. He denies vomiting. T 98°F, RR 16, HR 80,
BP 136/74, SpO2 100%. Pain 3/10. - (ANSWER)ESI level 3: Two or more resources. The patient is
presenting with signs and symptoms of another kidney stone. At a minimum, he will need a urinalysis
and CT scan. If his pain increases, he may need IV pain medication. At a minimum, two resources are
required. If the pain level was 7/10 or greater and the triage nurse could not manage the pain at triage,
the patient could meet level-2 criteria.
"After my pediatrician saw my son's rash, he said I had to bring him to the emergency department
immediately. He has this rash on his face and chest that started today. He has little pinpoint purplish
, ESI LEVELS COMPETENCY SET WITH COMPLETE SOLUTIONS 100%
VERIFIED!!!! ALREADY GRADED A+
spots he called petechiae. My son is a healthy kid who has had a cold for a couple of days and a cough.
My pediatrician said he had to be sure nothing bad is going on. What do you think?" - (ANSWER)ESI level
2: High risk. Rashes are difficult to triage, but the presence of petechiae is always a high-risk situation.
Even if the patient looks good, it is important to recognize that petechia can be a symptom of a life-
threatening infection, meningococcemia.
"Her grandfather pulled her by the wrist up and over a big puddle. Next thing you know, she is crying and
refusing to move her left arm," the mother of a healthy 3-year-old tells you. Vital signs are within normal
limits. - (ANSWER)ESI level 4 or 5: This case is an example of variations in practice around the country.
Many emergency departments would examine the child and then attempt to reduce the dislocation of
the radial head without an x-ray. Others may x-ray the child's arm, which is considered one ESI resource.
Relocation is not considered a resource.
A 46-year-old asthmatic in significant respiratory distress presents via ambulance. The paramedics report
that the patient 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. - (ANSWER)ESI
level 2: High-risk. An asthmatic with a prior history of intubation is a high-risk situation. This patient is in
respiratory distress as evidenced, by her respiratory rate, oxygen saturation, and work of breathing. She
does not meet the criteria for ESI level 1, requires immediate lifesaving intervention.
A 56-year-old male with a recent diagnosis of late-stage non-Hodgkin's lymphoma was brought to the ED
from the oncology clinic. He told his oncologist that he had facial and bilateral arm swelling and
increasing shortness of breath. The patient also reports that his symptoms are worse if he lies down.
Vital signs: BP 146/92, HR 122, RR 38, SpO2 98% on room air, temperature normal. - (ANSWER)ESI level
2: High risk. This patient is demonstrating respiratory distress with his increased respiratory rate and
decreased oxygen saturation. Symptoms are caused by compression of the superior vena cava from the
tumor. It is difficult for blood to return to the heart, causing edema of the face and arms.
EMS arrives with a 28-year-old male who was stabbed in the left side of his neck during an altercation.
You notice a large hematoma around the wound, and the patient is moaning he can't breathe. HR 110,
RR 36, SpO2 89%. - (ANSWER)ESI level 1: Requires immediate lifesaving intervention. Depending on the
exact location penetrating neck trauma can cause significant injury to underlying structures. Based on
the presenting vital signs, immediate actions to address airway, breathing, and circulation are required.
Intubation might be necessary due to the large neck hematoma, which may expand.
