ESI Practice Cases Questions and Answers 2022/2023 with complete solution
Course
ESI
Institution
ESI
ESI Practice Cases Questions and Answers 2022/2023 with complete solution
"I was taking my contacts out last night, and I think I scratched my cornea," reports a 27-year-old female. "I'm wearing these sunglasses because the light really bothers my eyes." Her right eye is red and tearing. She rat...
ESI Practice Cases Questions and Answers 2022/2023 with
complete solution
"I was taking my contacts out last night, and I think I scratched my cornea,"
reports a 27-year-old female. "I'm wearing these sunglasses because the light
really bothers my eyes." Her right eye is red and tearing. She rates her pain as
6/10. Vital signs are within normal limits.
ESI level 5: No resources.
This patient will need an eye exam and will be discharged to home with prescriptions
and an appointment to follow up with an ophthalmologist.
EMS presents to the ED with an 18-year-old female with a suspected medication
overdose. Her college roommates found her lethargic and "not acting right," so
they called 911. The patient has a history of depression. On exam, you notice
multiple superficial lacerations to both wrists. Her respiratory rate is 10, and her
SpO2 on room air is 86 percent.
ESI level 1: Requires immediate lifesaving intervention.
The patient's respiratory rate, oxygen saturation, and inability to protect her own airway
indicate the need for immediate endotracheal intubation.
EMS arrived with an unresponsive 19-year-old male with a single self-inflicted
gunshot wound to the head. Prior to intubation, his Glasgow Coma Scale score
was 3.
ESI level 1: Requires immediate lifesaving intervention.
The patient is unresponsive and will require immediate lifesaving interventions to
maintain airway, breathing, circulation, and neuro status; specifically, the patient will
require immediate confirmation of endotracheal tube placement.
"I ran out of my blood pressure medicine, and my doctor is on vacation. Can
someone here write me a prescription?" requests a 56-year-old male with a
history of HTN. Vital signs: BP 128/84, HR 76, RR 16, T 97°F.
ESI level 5: No resources.
The patient needs a prescription refill and has no other medical complaints. His blood
pressure is controlled with his current medication. If at triage his blood pressure was
188/124 and he complained of a headache, then he would meet the criteria for a high-
risk situation and be assigned to ESI level 2. If this patient's BP was elevated and the
patient had no complaints, he or she would remain an ESI level 5. The blood pressure
would be repeated and would most likely not be treated in the ED or treated with PO
medications.
A 41-year-old male involved in a bicycle accident walks into the emergency
department with his right arm in a sling. He tells you that he fell off his bike and
landed on his right arm. His is complaining of pain in the wrist area and has a 2-
centimeter laceration on his left elbow. "My helmet saved me," he tells you.
,ESI level 3: Two or more resources.
At a minimum, this patient will require an x-ray of his right arm and suturing of his left
elbow laceration.
A 32-year-old female presents to the emergency department complaining of
shortness of breath for several hours. No past medical history, +smoker. Vital
signs: RR 32, HR 96, BP 126/80, SpO2 93% on room air, T 98.6°F. No allergies,
current medications include vitamins and birth control pills.
ESI level 2: High risk.
This 32-year-old female with new-onset shortness of breath is on birth control pills. She
is a smoker and is exhibiting signs and symptoms of respiratory distress (SpO2 and
respiratory rate.) Based on history and signs and symptoms, a pulmonary embolus, as
well as other potential causes for her respiratory distress, must be ruled out.
"I just turned my back for a minute," cried the mother of a 4-year-old. The child
was pulled out of the family pool by a neighbor who immediately administered
mouth-to-mouth resuscitation. The child is now breathing spontaneously but
continues to be unresponsive. On arrival in the ED, vital signs were: HR 126, RR
28, BP 80/64, SpO2 96% on a non-rebreather.
ESI level 1: Unresponsive.
This 4-year-old continues to be unresponsive. The patient will require immediate
lifesaving interventions to address airway, breathing, and circulation.
A normal healthy 7-year-old walks into the emergency department accompanied
by his father, who reports that his son woke up complaining of a stomach ache.
"He refused to walk downstairs and is not interested in eating or playing." The
child vomits at triage. Vital signs: T 100.4°F, RR 22, HR 88, BP 84/60, SpO2100%.
Pain 6/10.
ESI level 3: Two or more resources.
At a minimum, this child will need a workup for his abdominal pain, which will include
labs and a CT or ultrasound—two resources.
A 6-year-old male tells you that he was running across the playground and fell.
He presents with a 3-centimeter laceration over his right knee. Healthy, no
medications and no allergies, immunizations are up to date.
ESI level 4: One resource.
The laceration will need to be sutured—one resource.
"I slipped on the ice, and I hurt my wrist," reports a 58-year-old female with a
history of migraines. There is no obvious deformity. Vital signs are within normal
limits, and she rates her pain as 5/10.
ESI level 4: One resource.
This patient needs an x-ray to rule out a fracture. A splint is not a resource.
A 4-year-old female is transported to the ED following a fall off the jungle gym at a
preschool. A fall of 4 feet. A witness reports that the child hit her head and was
, unconscious for a couple of minutes. On arrival you notice that the child is crying
and asking for her mother. Her left arm is splinted. Vital signs: HR 162, RR 38.
ESI level 2: High-risk situation.
This 4-year-old had a witnessed fall with loss of consciousness and presents to the ED
with a change in level of consciousness. She needs to be rapidly evaluated and closely
monitored.
A 60-year-old man requests to see a doctor because his right foot hurts. On exam
the great toe and foot skin is red, warm, swollen, and tender to touch. He denies
injury. past medical history includes type 2 diabetes, and psoriasis. Vital signs: T
99.4°F, RR 18, HR 82, BP 146/70, SpO2 99%.
ESI level 3: Two or more resources.
This patient has a significant medical history, and based on his presentation, he will
require two or more resources, which could include labs and IV antibiotics.
A 52-year-old female requests to see a doctor for a possible urinary tract infection
(UTI). She is complaining of dysuria and frequency. She denies abdominal pain or
vaginal discharge. No allergies, takes vitamins, and has no significant past
medical history. Vital signs: T 97.4°F, HR 78, RR 14, BP 142/70.
ESI level 4: One resource.
She will need one resource—lab, which will include a urinalysis and urine culture. She
most likely has a UTI that will be treated with oral medications.
"I called my pediatrician, and she told me to bring him in because of his fever,"
reports the mother of a 2-week-old. Vital signs: T 101°F, HR 154, RR 42, SpO2
100%. Uncomplicated, vaginal delivery. The baby is acting appropriately.
ESI level 2: High risk.
A temperature higher than 100.4°F (38.0°C) in an infant less than 28 days old is
considered high risk no matter how good the infant looks. Infants in this age range are
at a high risk for bacteremia.
"My right breast is so sore, my nipples are cracked, and now I have a fever. Do
you think I will have to stop nursing my baby?" asks a tearful 34-year-old female.
She is 3 months post partum and has recently returned to work parttime. Vital
signs: T 102.8°F, HR 90, RR 18, BP 108/60, pain 5/10. No past medical history,
taking multivitamins, and is allergic to penicillin.
ESI level 3: Two or more resources.
At a minimum, she will require labs and IV antibiotics.
Paramedics arrive with a 16-year-old unrestrained driver who hit a tree while
traveling at approximately 45 miles per hour. The passenger side of the car had
significant damage. The driver was moaning but moving all extremities when help
arrived. His initial vital signs were BP 74/50, HR 132, RR 36, SPO2 99%, T 98.6°F.
ESI level 1: Requires immediate lifesaving intervention.
The patient is presenting with signs of shock—hypotension, tachycardia, and
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