Nur 401 - Triage "I cut my finger trying to slice a bagel," reports a 28 -year -old healthy male. A 2 -centimeter laceration is noted on the left first finger. Bleeding is controlled. Vital signs are within normal limits. His last tetanus immunization was 10 years ago. - ESI level 4: One resource. This patient will require a laceration repair. A tetanus booster is not a resource. "I have a fever and a sore throat. I have finals this week, and I am scared this is strep," reports a 19 -year -
old college student. She is sitting at triage drinking bottled water. No past medical history, medications: birth control pills, no allergies to m edications. Vital signs: T 100.6°F, HR 88, RR 18, BP 112/76. - ESI level 4: One resource. In most EDs, this patient will have a rapid strep screen sent to the lab; one resource. She is able to drink fluids and will be able to swallow pills if indicated. "I have had a cold for a few days, and today I started wheezing. When this happens, I just need one of those breathing treatments," reports a 39 -year -old female with a history of asthma. T 98°F, RR 22, HR 88, BP 130/80, SpO2 99%, No meds, no allergies. - ESI level 4: One resource. This patient will need a hand -held nebulizer treatment for her wheezing. No labs or x -ray should be necessary because the patient does not have a fever. "I have this rash in my groin area," reports a 20 -year -old healthy male. "I think it's jock rot, but I can't get rid of it." Using over the counter spray. No known drug allergies. Vital Signs: T 98°F, HR 58, RR 16, BP 112/70. - ESI level 5: No resources. Following a physical exam, this patient will be sent home with prescriptions and appropriate discharge instructions. "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 treat ed in the ED or treated with PO medications. "I think I need a tetanus shot," a 29 -year -old female tells you. "I stepped on a rusty nail this morning, and I know I haven't had one for years." No past medical history, No known drug allergies, no medications. - ESI level 5: No resources. A tetanus immunization does not count as a resource. The patient will be seen by a physician or midlevel provider and receive a tetanus immunization and discharge instructions. This patient will require no resources. "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 a re 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. "My dentist can't see me until Monday, and my tooth is killing me. Can't you give me something for the pain?" a healthy 38 -year -old male asks the triage nurse. He tells you the pain started yesterday, and he rates his pain as 10/10. No obvious facial swell ing is noted. Allergic to penicillin. Vital signs: T 99.8°F, HR 78, RR 16, BP 128/74. - ESI level 5. No resources. No resources should be necessary. He will require a physical exam, but without signs of an abscess or cellulitis, this patient will be referred to a dentist. In the ED, he may be given oral medications and prescriptions for antib iotics and/or pain medication. He is not an ESI level 2, even though he rates his pain as 10/10. Based on the triage assessment, he would not be given the last open bed. "My doctor told me to come to the ED. He thinks my hand is infected," a 76 -year -old female with arthritis, chronic renal failure, and diabetes tells you. She has an open area on the palm of her hand that is red, tender, and swollen. She hands you a list of her medications and reports that she has no allergies. She is afebrile. Vital signs: HR 72, RR 16, BP 102/60. - ESI level 3: Two or more resources. This patient has a complex medical history and presented with an infected hand. At a minimum she will need labs, an IV, and IV antibiotics to address her presenting complaint. Her vital signs are normal, so there is no reason to up -triage her to ESI level 2. "My mother is just not acting herself," reports the daughter of a 72 -year -old female. She is sleeping more than usual and complains that it hurts to pee." Vital signs: T 100.8°F, HR 98, RR 22, BP 122/80. The patient responds to verbal stimuli but is disori ented to time and place. - ESI level 2: New onset confusion, lethargy, or disorientation. The daughter reports that her mother has a change in level of consciousness. The reason for her change in mental status may be a UTI that has advanced to bacteremia. She has an acute change in mental status and is therefore high risk. "My sister has metastatic breast cancer, and her doctor suggested that I bring her in today to have more fluid drained off her lungs." The fluid buildup is making it harder for her to breathe. The patient is a cachectic 42 -year -old female on multiple medic ations. Vital signs: T 98.6°F, RR 34, SpO2 95%, HR 92, BP 114/80. - ESI level 2: High risk. Breast cancer can metastasize to the lungs and can cause a pleural
