ESI Sample Cases 1
Summary
TLDRThis DVD segment offers an in-depth look at the Emergency Severity Index (ESI) triage process through various patient case scenarios. Experts Pat, Linda, and Karen guide viewers in assessing patients' conditions and determining their ESI levels, which range from non-acute to requiring immediate life-saving interventions. The discussion covers the evaluation of symptoms, vital signs, and resource allocation, highlighting the importance of accurate triage in emergency care.
Takeaways
- π The video script discusses the use of the Emergency Severity Index (ESI) for patient triage in a DVD segment, emphasizing the importance of correctly identifying the level of care needed for various cases.
- π¦ An eight-year-old with a sprained ankle is likely an ESI Level 4 patient, potentially requiring an X-ray and not meeting ESI Level 1 or 2 criteria unless additional severe symptoms are present.
- π€ The Ottawa ankle rules are mentioned as a criteria set some institutions use to determine the necessity of X-rays for ankle injuries, which can affect the ESI level assigned to a patient.
- π§ For adults, the ESI level can vary based on the resources required for treatment, such as X-rays and crutch walking instructions, which may consume significant staff time.
- π A 42-year-old morbidly obese female with acute respiratory distress and a respiratory rate of 48 is considered an ESI Level 1 or 2 patient, requiring immediate life-saving interventions.
- π₯ The script highlights the importance of considering both the patient's condition and the resources they will consume when determining their ESI level, such as labs, IV fluids, and imaging.
- π€ A 28-year-old male with a large bump on his back, described as a large pimple, would be categorized as an ESI Level 4 patient, likely needing an incision and drainage procedure along with antibiotics.
- π€° The video includes a case of a 23-year-old female with lower abdominal pain and vaginal bleeding, which is a common complaint requiring careful assessment to rule out serious conditions like ectopic pregnancy.
- π¨ββοΈ The triage process involves assessing the patient's appearance, vital signs, and the number of resources they will need, which together help determine the appropriate ESI level.
- π©Ί A 70-year-old male with a non-productive cough and normal vital signs, despite arriving by ambulance, does not meet ESI Level 1 or 2 criteria and is categorized as ESI Level 3.
- π©Ή A five-year-old with a laceration on her hand from broken glass would be an ESI Level 5 if the wound can be closed with glue, which does not count as a resource; however, if conscious sedation is required, the level would be ESI Level 3 due to additional resources consumed.
Q & A
What is the Emergency Severity Index (ESI) used for in the context of the DVD segment?
-The Emergency Severity Index (ESI) is used for triaging patients in the emergency department based on the severity of their condition and the resources they will likely need.
Why is it important to assess the resources a patient will consume during triage?
-Assessing the resources a patient will consume helps in determining the appropriate ESI level and ensures that patients receive the necessary care efficiently without over or underutilizing emergency department resources.
What criteria would classify a patient as ESI Level 1 or 2?
-Patients classified as ESI Level 1 or 2 are typically in life-threatening situations requiring immediate, life-saving interventions such as intubation or fluid resuscitation.
How does the Ottawa ankle rules come into play in the scenario with the eight-year-old child?
-The Ottawa ankle rules are a set of validated criteria used to determine when X-rays are necessary for ankle injuries. If applied and the patient does not meet the criteria for an X-ray, they would be classified as ESI Level 5.
What is the significance of crutch walking in the context of resource consumption?
-Crutch walking can consume a significant amount of emergency department staff time, especially when instructing patients on how to use them properly. However, it may not always count as a resource in determining ESI levels.
How does the ESI system account for patients with different levels of pain?
-The ESI system takes into account the patient's pain level and overall appearance, with higher pain levels and signs of severe distress potentially leading to a higher ESI level.
What is the role of vital signs in determining a patient's ESI level?
-Vital signs play a crucial role in assessing the patient's stability and urgency of care needed. Abnormal vital signs can indicate a need for immediate interventions, which may result in a higher ESI level.
Why might a patient with a severe headache be classified as ESI Level 2?
-A patient with a severe headache that is new onset, or significantly worse than their usual headaches, may be classified as ESI Level 2 due to the potential risk of a serious condition like a subarachnoid hemorrhage.
What factors contribute to a patient being classified as ESI Level 4?
-Patients classified as ESI Level 4 are typically stable but require multiple resources such as labs, imaging, or procedures, and are less acute than ESI Level 3 patients.
How does the ESI system differentiate between patients who need immediate care and those who can wait?
-The ESI system uses a combination of the patient's condition severity, pain level, vital signs, and the number of resources they will need to differentiate between patients who require immediate care and those who can safely wait.
Outlines
π₯ Emergency Severity Index (ESI) Practice Cases
This segment of the DVD focuses on practicing the Emergency Severity Index (ESI), a triage system used in emergency departments. The video features Pat, Linda, and Karen, who will read cases and determine the appropriate ESI level for each patient. The first case involves an eight-year-old with an injured ankle, discussing whether the child meets ESI levels 1 or 2 criteria and the resources needed for treatment, such as X-rays and crutch walking instructions.
π Assessing Acute Respiratory Distress and Other Critical Conditions
The second paragraph discusses a 42-year-old morbidly obese female experiencing acute respiratory distress. The paramedics found her struggling to breathe with a respiratory rate of 48 and a room air saturation of 84%. The discussion revolves around her ESI level, with a consensus that she is an ESI level 1 due to the need for immediate intubation. Other cases include a 28-year-old male with a back lump, a woman with abdominal pain and vaginal bleeding, and a scenario where the group watches a video of a patient with abdominal pain.
π€° Lower Abdominal Pain in Women of Childbearing Age
This paragraph addresses a common chief complaint in women of childbearing age, lower abdominal pain with vaginal bleeding. The case involves a healthy 23-year-old female who does not require immediate life-saving interventions, thus not meeting ESI level 1 criteria. The discussion explores whether she meets ESI level 2 criteria, considering her vital signs, pain level, and the need for resources such as labs, IV fluids, and an ultrasound.
π¨β𦳠Urinary Retention and Its Impact on ESI Level Determination
The fourth paragraph discusses a case of a patient with urinary retention, who does not meet ESI level 1 criteria but is evaluated for potential distress and the number of resources needed. The patient requires a urethral catheter, urinalysis, and possibly a urine culture, leading to an ESI level 3 classification. The paragraph also touches on the importance of distinguishing between ESI levels based on resource consumption.
π Injuries and Their Resource Requirements in ESI Triage
This paragraph covers various cases, including a 45-year-old male with a dislocated shoulder, a 4-year-old boy bitten by a dog, and a 70-year-old male with a non-productive cough. The discussion focuses on the severity of the conditions, the resources required (e.g., X-rays, IV antibiotics), and the appropriate ESI levels. Emphasis is placed on the need for immediate interventions and the assessment of vital signs.
π©Ί Differentiating ESI Levels Based on Patient Presentation and Resource Needs
The sixth paragraph delves into the nuances of determining ESI levels based on patient presentations and the anticipated resources. Cases include a patient with a severe headache, a post-operative patient with an infected incision, and a patient with a red arm from a dog bite. The discussion highlights the importance of history, patient appearance, and the number of resources needed to inform the ESI level assignment.
π€ Managing Post-Operative Complications and Assessing ESI Levels
The final paragraph discusses a 19-year-old male with a post-operative infection, emphasizing the need for lab work and IV antibiotics. The patient's vital signs are within normal limits, leading to an ESI level 3 classification. The paragraph underscores the importance of vital signs in determining ESI levels and the potential need for resources such as labs and antibiotics.
Mindmap
Keywords
π‘Emergency Severity Index (ESI)
π‘Triage
π‘Ankle Sprain
π‘Ottawa Ankle Rules
π‘Respiratory Distress
π‘Intubation
π‘Morbidity
π‘Vital Signs
π‘Urinary Retention
π‘Neurovascular Deficits
π‘Incision
Highlights
Introduction to practice casings using the Emergency Severity Index (ESI) with Pat, Linda, and Karen.
Case of an eight-year-old with an injured ankle, discussing ESI level determination and resource consumption.
Mention of Ottawa ankle rules and their application in adult patients for X-ray necessity.
Differentiation between ESI level 3 and 4 based on resource use, such as X-rays and crutch walking instructions.
Discussion on the importance of resources in distinguishing ESI levels and the functioning of the ESI system.
Presentation of a 42-year-old morbidly obese female with acute respiratory distress, addressing ESI level 1 criteria.
Criteria for immediate life-saving interventions and the urgency of intubation in severe respiratory distress.
Case of a 28-year-old male with a back lump, exploring the ESI level and the impact of procedure resources like incision and drainage.
Consideration of patient's presentation and vital signs in determining the ESI level for a non-life-threatening condition.
Use of video scenarios to discuss patient cases interactively, enhancing understanding of ESI triage.
Scenario of a 23-year-old female with lower abdominal pain and vaginal bleeding, evaluating ESI level and resource needs.
Differentiation between various causes of abdominal pain in women of childbearing age and their respective ESI levels.
Case of a 49-year-old male with cirrhosis and vomiting blood, highlighting the urgency for ESI level 1 intervention.
Importance of patient history in assessing the risk and determining the appropriate ESI level for a severe headache.
Discussion on the management of post-operative patients with incision issues, identifying ESI level 3 criteria.
Analysis of a patient with a dog bite, emphasizing the need for labs and IV antibiotics in ESI level 3 cases.
Consideration of vital signs in triage assessment and their role in maintaining or upstaging a patient's ESI level.
Final case discussion of a 70-year-old male with a non-productive cough, addressing the triage process and ESI level assignment.
Transcripts
in this segment of the DVD
we're going to be doing some practice casings
using the Emergency Severity Index
and joining us are Pat Linda and Karen
so what I'm gonna do is read the case
and then we'll determine what ESI level
each patient is alright
an eight year old is brought to triage
because of an injured right ankle
the child who tripped over a ball while playing soccer
the ankle hurt with ambulation
and you notice
edema over the medial aspect of the ankle
mom tells you the child is healthy
takes no medications and has no allergies
his vital signs are within normal limits
so do you think he meets any ESI level 1 or 2 criteria
definitely not he has a sprained ankle
most likely he does but let's talk about resources
how many resources is this patient going to consume
um probably one
just an X ray
you might not do an X ray
will you see Ottawa ankle rules at least in adults
that's a really good point
let's talk about resources
how many resources do you think this child's gonna need
he might need an X ray
and then would meet ESI Level 4 criteria
but if this child was actually an adult
and your institution use it Ottawa ankle rules
and the patient did not require an X ray
according to the Ottawa ankle rules
then they would be an ESI
Level 5 how do I
ankle rules
are just a set of validated criteria
that some institutions
use to determine when X rays are necessary
but what about crutch walking
he may go home on crutches
now that takes a lot of my time
so shouldn't that count
as we discussed in the first case
a lot of thought went into
what does and what does not count as a resource
if Crutchwalk encountered
then again we would have at least two resources
crotchwalking and an X ray
and we would not be able to distinguish team ESI
level 3 and level 4 patients
the use and definitions of resources
is what distinguishes ESI
and actually makes it work
so you can really think about it like this
the crotch walking instructions may consume a fair
amount of the emergency department staff members time
it's often provided to patients
who have simple ankle sprains
these patients are typically classified as ESI Level 4
the patients are clearly less acute and less
resource intensive than more complex patients
like those with tibia fibula fractures
who are usually ESI level 3
a better way to reflect the Ed
staff efforts for CRUT talking instruction
is with a nursing resource intensity measure
let's go on to the next case
he and I survives with a 42 year old
morbidly obese female who call for chief complaint
a shortness of wrath
the paramedics found her sitting upright
working hard at breathing
with a respiratory rate of 48
and a room air saturation of 84%
they are unable to obtain any further history
so what do you think of this scenario
I think she's in acute respiratory distress
she's going to need to be tubed
so what level would you make her
well she's in severe respiratory distress
so I'd make her a level 2 patient
anybody think anything differently
she's going to need to be a one
she's going to be intubated
so yes she is an ESI level 1
sounds like she's in a lot of respiratory distress
she's working hard of breathing
her rumere saturation is 84%
I'm not sure how long
she'll be able to breathe on her own
so I would predict
she may need either immediate intubation
or valhalation with a bag valve
mouse device
so her saturation is less than 90%
her respiratory rate is greater than 24
and she's very short of breath
she definitely needs immediate
life saving interventions
you need a physician at the bedside
to determine if intubation is needed immediately
okay let's move on to the next case
I have a lump on my back
reports a 28 year old healthy male
upon further question
he tells you the lump looks like a huge large pimple
he reports no drainage no fever
he's got no past medical history
he takes no medications his vital signs
his temperature is 99 8 heart rate 72
his respiratory rate is 16
and his blood pressure is 1 18 over 74
obviously no life threat or Harris concerns here
so let's jump to to resources
what kind of resources do you think you'll need
nothing it's kind of hard to tell
I can't see it well you're right
but let's say it's the size of a golf ball
it's really big
all they're going to do is Ind it
and then send them home on pill antibiotics
but does an ID count
is that a procedure
well yes it is
it does count as a resource
so what ESI level is this patient
ESI level 4 okay
good let's go on to the next case
okay we're gonna do something a little bit different
we're gonna actually watch a patient scenario here
and then kind of talk about it as a group
sound like a plan
see if I can turn on this video
these are some videos of some patient scenarios
that are actually real scenarios here
Linda Fox
that's me have a seat Linda
my name is Nikki I'm one of the nurses
I need to ask you a few questions about
what brought you here today
you're having some belly pain and bleeding
yeah it's not really pain
it's like cramping up on me like I have my period
I thought maybe I was pregnant
because I skipped a period okay
how long have you had this cramping
it started about two hours ago
I was sitting watching TV and it just came on
kind of sudden okay
on a scale 0 to 10
with 10 being the worst pain you could imagine
how do you write this cramping
about a 5 all right
and you're bleeding
it started spotting in the morning
and now it's like a heavy period
have you passed any clots
no
um when was your last normal menstrual period
it's been a while let me see
maybe seven or weeks ago have you ever been pregnant
no okay
any dizziness no
okay good
how old are you 23
any medical problems you see doctor regularly for
no I'm real healthy
all right you taking medications
nope any allergies to any medications
no all right
I just need to take your blood pressure
and put this thing in your anger
lower abdominal pain with vaginal bleeding is a common
chief complaint in women of childbearing age
the cause can range from an ectopic pregnancy
to a spontaneous abortion
to an irregular menses
in order to decide the acute level
it is important to look at the patient
this healthy 23 year old female
does not require immediate life saving interventions
so she does not meet criteria for ESI level 1
the question becomes
does she meet criteria for ESI level two
and the answer is no she is awake
alert oriented
her pain is five over 10
and her abdominal cramping is generalized
lower abdominal pain her skin is warm and dry
and she has experienced no dizziness
no indication that she has an ectopic pregnancy
the triage nurse feels comfortable that she is stable
to wait in the waiting room
so moving on to resources
this patient will consume a number of resources
she will need labs and IV with fluids and ultrasound
and perhaps IV pain medication
two or more resources
so she will be assigned ESI Level 3
after the nurse looks at the patient's vital signs
and notes they are within normal limits
if the patient's vital signs fell outside
the accepted parameter for this age
in this case a heart rate greater than 100
a respiratory rate greater than 20
she could uptriage her to ESI Level 2
if she was hypotensive or significantly tachycartic
or had impaired mental status or was hemorrhaging
that necessitated the need for immediate
hemodynamic interventions
like food resuscitation or blood
she would make criteria for ESI Level 1
this is a good time to talk about the patient
who presents with abdominal pain
most patients with abdominal pain will be at least
ESI level 3 consume many resources labs
IV with fluids IV medications and a cat scan
the elderly patient in severe pain
or abnormal vital signs
would meet ESI level 2 criteria
the need for hemodynamic interventions
would make an abdominal pain
ESI level 1
requiring immediate life saving interventions
okay so let's stop and talk about that for a little bit
do you guys have any questions about this scenario
Mr Humbles then quite get that off
any questions about that one
what do you think pretty straightforward
yeah I thought it was pretty typical
the patients that present an R E
d and um
the types of things you assess
the types of common interventions
and her color looked good
she was fairly animated
she even smiled in conversation with the nurse
so and she didn't have any unilateral pain
or anything indicative of anectopic
so I'd feel comfortable that even if she's pregnant
she's relatively stable
we got a lot of patients asking about that ectopic
or a lot of nurses asking about that
they wanna make that
that complaint a level 2 because of an ectopic
but she really doesn't I think you said
go ahead right
I was gonna say she looked too good
I mean her pain level was low
she interacted well her color was good
and her file signs were certainly appropriate yep
generalized abdominal pain as you said
not localized abdominal pain
sounds like you guys got it yeah
we agree that it was a level 3
oh good
okay should we do another one
sure okay
so we can turn this on again
Mr Humphrey my name is Nikki
I'm one of the nurses here in the emergency department
I need to ask you a
few questions about what brought you here today okay
I understand you're having trouble passing your water
that's right I try and I try to pee
but I only dribble a little I feel full
like I have to go and can
my doctor told me to come in
when was the last time you were able to pass your water
normally about 10 a m
have you noticed any burning
a little any blood no
all right had a fever chills nope
all right
scale of 0 to 10
with 10 being the worst pain you could imagine
how would you rate this discomfort
maybe 4 okay
do you see a doctor regularly for anything
high blood pressure heart disease
cancer diabetes
no I'm as healthy as a horse
all right do you take any medicines regularly
just an Aspen the day all right
any allergies to anything no
okay good
as you look at this patient
it is clear he does not meet criteria for ESI level 1
he presents to the emergency department
with the inability to urinate
for about 4 and a half hours
probably due to benign prosthetic hypertrophy
he looks comfortable he's able to sit in the chair
and calmly give his history to the triage nurse
and he rates his level of discomfort is four over 10
so he does not meet the criteria for ESI Level two
if while waiting his discomfort increase significantly
he could always be uptriaged
remember
the patient in severe distress due to urinary retention
would be pacing probably tachycartic
unable to sit still
and verbalizing to the triage nurse
that he is miserable
if this patient looked miserable
he would have been assigned ESI Level 2 due to distress
so let's move on to the next step in the algorithm
the triage nurse then answers the question
how many different resources will this patient consume
a patient with urinary retention will need a
urethral catheter
a urinalysis and perhaps a urine culture
two resources a procedure plus a lab
the patient's vital signs are within normal limits
so this patient is an ESI level 3
so what do you think do you agree
yes I
level 3 sure
I thought it was very clear cut
I mean it's a very uncomplicated patient
and pretty straightforward
not in a lot of distress exactly
he was able to sit there
I think that should take a segment
show that very well right
but he'll need procedures and labs
so we'll take some time
so the resource piece was clear that when you say labs
are you saying blood work too
well certainly your analysis
yeah because you could have an infection too
sometimes that's a urinary tract infection
that's a good point but remember
lab doesn't matter whether it's blood
urine or stool it's still one resource
so his resources were a urethral catheter in lab 2
he's an ESI level three
okay let's move on to the next case
okay now
we have a 45 year old male
brought to triage by his friend
who states the patient injured his left shoulder
while playing football patient has a gross deformity
to his shoulder
and his neurovascular deficits to his left arm
he's unable to move his arm
and is complaining of excruciating pain
20 over 10 and he's diaphoratic
so what do you think is going on with this scenario
I think he's a level 2 he's in severe pain or distress
and I can't really do anything with him in triage good
there's probably another reason that
you could make him a level 2
is it because of his neurovascular deficits
absolutely now are all dislocated shoulders level two
probably not it probably depends on how they look
how severe their pain is great
so what if he did look pretty good
wasn't in a lot of pain
and had good neurovascular status
well he'll just need an X ray
so a level 4
probably not he is still gonna require IV
medications to relocate that shoulder
and he's still gonna need X rays
so at a minimum
dislocated shoulders are at least ESI level 3
and remember conscious sedation as a procedure
counts as two resources
okay next case
mom brings in her 4 year old son
with a chief complaint of a red arm
patient
was bitten by the family dog about three days ago
and the child's kind of cranky
his right arm is red with some edema to a large area
surrounding the dog bite his temperature is 99
5 heart rates 1 20 respirations are 24
so any level 1 or 2 criteria being met here
no I think he's an ESI level 3
okay how come
he needs labs and IV antibiotics
and he probably has cellulitis
what about his vital signs
should you upgrade him based on these
probably not
he is within the normal vital sign criteria
great this case demonstrates
how important it is to always check extremities
and visually assess the area of two complaint
whenever possible
if he had a decrease pulse or compartment syndrome
he may even be an ESI level 2 but good
this patient is ESI level three
next case a 70 year old male arrives by ambulance
in the nursing home
the nursing home reports a non productive cough
since he choked on his lunch today
his baseline mano status is unchanged
and he's normally confused
his skin is warm and moist
his vital signs of the following
temperature 100.2 heart rate 94
blood pressure 1
35 over 80 and his ramir saturation is 94%
his respiratory rate is twenty and non labor
so do I hear ESI level 1 for this patient
I don't know
I don't think he needs to be intubated right now
good neither do I
you know he really is not in acute respiratory distress
but what about US natal status
does he need ESI level 1 criteria for this
I don't think so
okay why not
well because he's not unresponsive
he's just confused so maybe he needs a level 2 criteria
so what is the rest of you think yes
I level 2
not really he's always confused
so it's nothing new
what about severe distress or high risk
do you think this is a high risk situation
would you give this patient your last open bed
well he comes in by ambulance
and I really don't want him in the waiting room
nor do I but
all patients that arrive by ambulance
are categorized as ESI
Level 1 or two only if they meet the criteria
so when you think about it
this patient does not meet level 1 or 2 criteria
and his vital signs are within normal limits
he does not violate any vital sign criteria
so he's actually in ESI Level 3
he will definitely require two or more resources
no labs X ray
IV antibiotics he most likely has pneumonia
but you can still facilitate placement in a bed
but this case does illustrate a really important point
placement and triage category
are sometimes two different things
there are some
level 3 patients that can go directly to a room
but others can actually wait for the triage process
okay next case
now we have a five year old
that is carried in by her father
who reports that the daughter was trying to help
set the dinner table on broken glass
so
you notice a 3 centimeter laceration on her left hand
the bleeding is controlled
and the child has no medical history
takes no medications and has no allergies
and our vitals are normal
so what do you think is going on here
this is easy just a laceration
one resource a laceration repair
okay good
what if this was a 3 year old
who was screaming bloody murder
are you thinking conscious sedation
absolutely so if that was the case
how many resources would the patient consume
and how would that change your triage category
well conscious sedation is two resources
plus they would use IV meds
so that makes the patient a level three
absolutely so what if wound glue was sufficient
that would be great does wound glue count as a resource
no it does not
so if wound glue is sufficient
and it doesn't count as a resource
this patient would be ESI level 5
EMS arrives with a 49 year old male
with a history of cirrhosis and Hepatitis C
his wife called 9 1
1 when he started vomiting bright red blood
on arrival he's pale diaphoratic
he has a blood pressure of 92 over 78
his heart rate's 1:30 and his respiratory rate is 28
so what do you think of this case
does he meet ESI level 1 or 2 criteria
maybe he is a little hypotensive
and he's also tachycardic and ticipnik
so you thinking ESI level 1 or 2
well I think he can go either way
okay think about his history
what is he at risk for well
he could bleed out from his varices
okay but what immediate
life saving interventions does he need
he needs a couple of lines for fluid and blood
so I guess he's A1
right he's hypotensive
tachycartic to kypnic he's pale and he's vomiting blood
he needs immediate IV access
and possibly o negative blood
and at least a Floyd bolus
okay let's go back and watch some more video cases here
oh
I have a awful headache
I can't stand the pain I've had headaches before
but not like this one
you look really miserable
you know on a scale of 0 to 10
if 10 was the worst pain you could ever imagine
how would you rate it right now
a 10+ I can't stand it when did this start
today about an hour ago
I went to the bathroom
I move my bowels and it started right after that
okay are you having any nausea vomiting
I feel sick to my stomach
can't you give me something for the pain
no not right now
you're gonna see the doctor in a few minutes
so first I need to ask you a couple more questions
and get your blood pressure okay
how old are you 35
okay and to have any medical problems no
to take any medications every day for any reason no
okay and do you have any allergies to medications no
okay
this is an ESI level 2
this patient has a new onset severe headache
that is a typical presentation
for subarachnoid hemorrhage
this is a high risk situation
headaches are frequent complaints
and are worthy of a little further discussion
patients
that present with their typical migraine headache
are often triaged as ESI Level 3
they usually require an IV with fluid
and IV pain medication however
migraine patients that know they only require an IM
selective serotonin agonist and anti migraine medicine
will require only one resource and IM medication
and therefore will be classified as ESI Level 4
even a patient with a typical migraine
that presents in severe pain vomiting
a triage even though it is a typical headache
could be triaged as ESI Level 2 due to severe pain
to summarize with headaches
history is important to rule out a high risk situation
then you really need to assess how the patient looks
and finally
how many resources you might anticipate will be needed
in this particular scenario
the patient Matt ESI level 2 criteria
okay so headaches are kind of messy and gray sometimes
so what did you guys think about that scenario
well I think that's new
open my eyes to how I treat headaches
and especially people with migraines
cause usually well you know
it's just a headache
so you don't really think much about the bleeding
or like a possible tumor or something
but I do agree with that level
that she should be the 2 because of her
I think the reason why that was a 2 was cause
mainly because of her pain and her instability
that way that correct
I think the connection with the vowel movement
was really important too
and she looked so awful too
yeah although some migraine people do
but the bell movement connection was important
I think definitely that bell sovereign everything right
certainly a tip off that this could be a separate
greater good to put her over the edge
any other headache kind of questions
no just the worst headache I've ever had in my life
do you want the acuity for that statement
horse had a good or life usually
once they say that it's
it's pretty tough to not make them a level 2 patient
even in a migraine person who has frequent migraines
it's their worst migraine
and worse than their normal current migraine
and it's not typical migraine than I probably would
I would too and sometimes say that
because they want pain medication fast
I think
well did you have to take them at their word
when you're triaging them
exactly sure okay
all right next case
patient comes into triage and tells you
I have my appendix out last week
and my incision is all red and it's opened up
and I've got this yellow
gross stuff coming out of my incision
this is a 19 year old male who has no medical history
takes no medications
and he tells you he's allergic to penicillin
his temperature is 101 8
his heart rate is 98 and his respirations are 16 as P O
two is fine so what do you think of this case
does he need any level 1 or 2 criteria
no I think he's level 3
he's going to need lab work
and also to be put on IV antibiotics
so nobody wants to give him your last open bed
he's draining all this yellow stuff
so okay I was just checking
so you're right
he's gonna require at least two resources
patients who are post op
usually end up being at least an ESI
level 3 so let's talk about vital science
does he violate any of those parameters
I don't think so
okay go ahead and check your sheets with the algorithm
it's always good to keep these at triage
after you're really comfortable with ESI
you really won't need to use them anymore
but it's always good to have them out there
there are always people who are new to triage
so in this case his vital signs are within no limits
so we can still keep him as a level 3 patient great
absolutely okay
so let's move on to the next case
sa segment na ito ng DVD
gagawa kami ng ilang practice casing
gamit ang Emergency Severity Index
at kasama namin sina Pat Linda at Karen
Kaya ang gagawin ko ay basahin ang kaso
at pagkatapos ay tutukuyin natin kung anong antas ng ESI
ayos naman ang bawat pasyente
isang walong taong gulang ay dinala sa pagsubok
dahil sa nasugatan na kanang bukung-bukong
ang batang natapilok ng bola habang naglalaro ng soccer
masakit ang bukung-bukong na may ambulasyon
at napapansin mo
edema sa ibabaw ng medial na aspeto ng bukung-bukong
Sinasabi sa iyo ni nanay na malusog ang bata
Hindi umiinom ng gamot at walang allergy
Ang kanyang mga vital sign ay nasa loob ng normal na limitasyon
So sa tingin mo ba natutugunan niya ang anumang ESI level 1 o 2 criteria
Siguradong hindi siya may sprained ankle
Malamang ginagawa niya ngunit pag-usapan natin ang tungkol sa mga mapagkukunan
gaano karaming mga mapagkukunan ang ubusin ng pasyenteng ito
Um malamang isa
X ray lang
Baka hindi ka magpa-X ray
makikita mo ba ang Ottawa ankle rules kahit man lang sa mga matatanda
iyan ay talagang magandang punto
pag-usapan natin ang mga mapagkukunan
ilang mapagkukunan sa tingin mo ang kakailanganin ng batang ito
Baka kailangan niya ng X ray
at pagkatapos ay matutugunan ang pamantayan ng ESI Level 4
ngunit kung talagang matanda na ang batang ito
at ginagamit ito ng iyong institusyon Ottawa ankle rules
at ang pasyente ay hindi nangangailangan ng X ray
ayon sa Ottawa ankle rules
pagkatapos sila ay magiging isang ESI
Level 5 paano ko
Mga panuntunan sa bukung-bukong
ay isang set lamang ng validated criteria
na ilang institusyon
gamitin upang matukoy kung kailan kinakailangan ang X ray
pero paano naman ang crutch walking
Baka umuwi siyang nakasaklay
Ngayon na tumatagal ng maraming oras ko
So hindi ba dapat mabibilang yun
gaya ng napag-usapan natin sa unang kaso
maraming naisip ang pumasok
ano ang ginagawa at hindi binibilang bilang isang mapagkukunan
kung nakatagpo ang Crutchwalk
at muli magkakaroon tayo ng hindi bababa sa dalawang mapagkukunan
crotchwalking at isang X ray
at hindi namin magagawang makilala ang ESI ng koponan
level 3 at level 4 na mga pasyente
ang paggamit at mga kahulugan ng mga mapagkukunan
ay kung ano ang nakikilala sa ESI
at talagang ginagawa itong gumana
So maiisip mo talaga ang ganito
Ang mga tagubilin sa paglalakad ng pundya ay maaaring kumonsumo ng isang patas
dami ng oras ng mga miyembro ng kawani ng emergency department
Madalas itong ibinibigay sa mga pasyente
na may simpleng ankle sprains
Ang mga pasyenteng ito ay karaniwang inuri bilang ESI Level 4
ang mga pasyente ay malinaw na hindi gaanong talamak at mas kaunti
Resource intensive kaysa sa mas kumplikadong mga pasyente
tulad ng mga may tibia fibula fractures
na karaniwang ESI level 3
isang mas mahusay na paraan upang ipakita ang Ed
mga pagsisikap ng kawani para sa pagtuturo sa pagsasalita ng CRUT
ay may sukat ng intensity ng mapagkukunan ng pag-aalaga
pumunta tayo sa susunod na kaso
Siya at ako ay nakaligtas sa isang 42 taong gulang
morbidly obese na babae na tumatawag para sa pangunahing reklamo
isang igsi ng galit
Natagpuan siya ng mga paramedic na nakaupo nang tuwid
nagsusumikap sa paghinga
na may respiratory rate na 48
at isang room air saturation na 84%
hindi na sila makakuha ng anumang karagdagang kasaysayan
So ano sa tingin mo ang scenario na ito
Sa tingin ko siya ay nasa acute respiratory distress
Kakailanganin niyang i-tubed
So anong level ang gagawin mo sa kanya
Well siya ay nasa matinding paghinga
kaya gagawin ko siyang level 2 na pasyente
kahit sino ay nag-iisip ng anumang bagay na naiiba
She 's going to need to be one
Siya ay magiging intubated
So yes isa siyang ESI level 1
Mukhang nahihirapan siya sa paghinga
nahihirapan siyang huminga
Ang kanyang raere saturation ay 84%
Hindi ako sigurado kung gaano katagal
makakahinga siya mag-isa
kaya hulaan ko
Maaaring kailanganin niya ang alinman sa agarang intubation
o valhalation na may balbula ng bag
aparato ng mouse
So less than 90% ang saturation niya
Ang kanyang respiratory rate ay higit sa 24
at kinakapos siya ng hininga
Tiyak na kailangan niya ng agarang
mga interbensyon sa pagliligtas ng buhay
kailangan mo ng manggagamot sa tabi ng kama
upang matukoy kung kailangan kaagad ang intubation
okay lumipat tayo sa susunod na kaso
May bukol ako sa likod
ulat ng isang 28 taong gulang na malusog na lalaki
sa karagdagang tanong
Sinasabi niya sa iyo na ang bukol ay mukhang isang malaking tagihawat
Iniulat niya na walang drainage walang lagnat
wala siyang nakaraang medikal na kasaysayan
hindi siya umiinom ng gamot sa kanyang vital signs
ang kanyang temperatura ay 99 8 heart rate 72
ang kanyang respiratory rate ay 16
at ang kanyang presyon ng dugo ay 1 18 higit sa 74
Malinaw na walang banta sa buhay o alalahanin ni Harris dito
kaya tumalon tayo sa mga mapagkukunan
anong uri ng mga mapagkukunan sa tingin mo ang kakailanganin mo
wala medyo mahirap sabihin
Hindi ko makita ng maayos tama ka
pero sabihin na nating kasing laki ng bola ng golf
malaki talaga
Ang gagawin lang nila ay Ind it
at pagkatapos ay pauwiin sila gamit ang pill antibiotics
ngunit may bilang ng ID
procedure ba yan
Well oo nga
ito ay binibilang bilang isang mapagkukunan
So anong ESI level itong pasyente
mabuti pumunta tayo sa susunod na kaso
okay may gagawin tayong medyo kakaiba
Manonood talaga kami ng senaryo ng pasyente dito
at pagkatapos ay uri ng pag-uusap tungkol dito bilang isang grupo
parang plano
tingnan kung maaari kong i-on ang video na ito
ito ang ilang video ng ilang sitwasyon ng pasyente
mga totoong scenario talaga yan dito
That 's me umupo ka na Linda
My name is Nikki Isa ako sa mga nurse
Kailangan kong magtanong sa iyo ng ilang mga katanungan tungkol sa
Ano ang nagdala sa iyo dito ngayon
Medyo sumasakit ang tiyan mo at dumudugo
oo hindi naman talaga masakit
It 's like cramping up on me na parang may period ako
Akala ko baka buntis ako
kasi nag skip ako ng period okay
Gaano ka na katagal nagkaroon ng ganitong cramping
Nagsimula ito mga dalawang oras na ang nakalipas
Nakaupo ako at nanonood ng TV at kakabukas lang
medyo biglaan okay
sa sukat na 0 hanggang 10
na may 10 ang pinakamasamang sakit na maiisip mo
paano mo isusulat ang cramping na ito
mga 5 sige
at dumudugo ka
Nagsimula itong makakita sa umaga
at ngayon ay parang mabigat na panahon
may nalampasan ka bang clots
hindi
Um kailan ang iyong huling normal na regla
ang tagal na nating makita
Siguro pito o linggo na ang nakalipas nabuntis ka na ba
hindi okay
Any pagkahilo no
okay mabuti
ilang taon ka na 23
anumang problemang medikal na regular kang nagpapatingin sa doktor
hindi, malusog talaga ako
sige umiinom ka ng gamot
Walang anumang allergy sa anumang gamot
hindi sige
Kailangan ko lang kunin ang blood pressure mo
at ilagay ang bagay na ito sa iyong galit
Ang pananakit ng ibabang bahagi ng tiyan na may pagdurugo sa ari ay karaniwan
pangunahing reklamo sa mga kababaihan ng edad ng panganganak
ang sanhi ay maaaring mula sa isang ectopic na pagbubuntis
sa isang kusang pagpapalaglag
sa isang hindi regular na regla
upang magpasya sa talamak na antas
mahalagang tingnan ang pasyente
itong malusog na 23 taong gulang na babae
ay hindi nangangailangan ng agarang mga interbensyon sa pagliligtas ng buhay
kaya hindi niya natutugunan ang pamantayan para sa ESI level 1
ang tanong ay nagiging
nakakatugon ba siya sa pamantayan para sa ikalawang antas ng ESI
at ang sagot ay hindi gising siya
nakatuon sa alerto
Five over 10 ang sakit niya
at ang kanyang tiyan cramping ay pangkalahatan
pananakit ng ibabang bahagi ng tiyan ang kanyang balat ay mainit at tuyo
at hindi siya nakaranas ng pagkahilo
Walang indikasyon na mayroon siyang ectopic pregnancy
Kumportable ang triage nurse na stable na siya
maghintay sa waiting room
kaya lumipat sa mga mapagkukunan
ang pasyenteng ito ay kumonsumo ng maraming mapagkukunan
Kakailanganin niya ang mga lab at IV na may mga likido at ultrasound
at marahil IV gamot sa sakit
dalawa o higit pang mapagkukunan
So itatalaga siya sa ESI Level 3
matapos tingnan ng nurse ang vital signs ng pasyente
at mga tala na sila ay nasa loob ng normal na mga limitasyon
kung ang vital signs ng pasyente ay nahulog sa labas
ang tinatanggap na parameter para sa edad na ito
Sa kasong ito, ang rate ng puso ay higit sa 100
isang rate ng paghinga na higit sa 20
kaya niyang i-uptriage siya sa ESI Level 2
kung siya ay hypotensive o makabuluhang tachycartic
o nagkaroon ng kapansanan sa mental status o dumudugo
na nangangailangan ng pangangailangan para sa agarang
Mga interbensyon sa hemodynamic
tulad ng food resuscitation o dugo
gagawa siya ng pamantayan para sa ESI Level 1
Ito ay isang magandang oras upang pag-usapan ang tungkol sa pasyente
na nagpapakita ng pananakit ng tiyan
karamihan sa mga pasyente na may pananakit ng tiyan ay hindi bababa sa
Ang ESI level 3 ay kumonsumo ng maraming resource lab
IV na may mga likido IV na gamot at isang cat scan
ang matatandang pasyente sa matinding sakit
o abnormal na vital signs
matutugunan ang pamantayan sa antas 2 ng ESI
ang pangangailangan para sa hemodynamic interventions
ay gagawa ng pananakit ng tiyan
Antas 1 ng ESI
Nangangailangan ng agarang mga interbensyon sa pagliligtas ng buhay
okay kaya huminto tayo at pag-usapan iyon saglit
Mayroon ba kayong anumang mga katanungan tungkol sa sitwasyong ito
Mr Humbles pagkatapos ay medyo alisin na
anumang mga katanungan tungkol sa isang iyon
ano sa tingin mo medyo prangka
oo naisip ko na ito ay medyo tipikal
ang mga pasyente na nagpapakita ng R E
d at um
ang mga uri ng mga bagay na iyong tinatasa
ang mga uri ng karaniwang interbensyon
And her color mukhang maganda
medyo animated siya
Napangiti pa siya sa pakikipag-usap sa nurse
So at wala siyang unilateral pain
o anumang bagay na nagpapahiwatig ng anectopic
So I 'd feel comfort na kahit buntis siya
medyo stable na siya
Marami kaming pasyente na nagtatanong tungkol sa ectopic na iyon
Or maraming nurse ang nagtatanong tungkol diyan
gusto nilang gawin iyon
level 2 ang reklamong iyon dahil sa isang ectopic
But she really don 't I think sinabi mo
sige tama
I was gonna say masyado siyang maganda
I mean mababa ang pain level niya
She interacted well maganda ang kulay niya
at ang kanyang mga palatandaan ng file ay tiyak na angkop oo
Generalized na pananakit ng tiyan gaya ng sinabi mo
hindi naisalokal na pananakit ng tiyan
Mukhang nakuha mo na oo
Sumasang-ayon kami na ito ay isang antas 3
oh mabuti
okay dapat gumawa tayo ng isa pa
sigurado okay
para ma-on natin itong muli
Mr Humphrey ang pangalan ko ay Nikki
Isa ako sa mga nurse dito sa emergency department
Kailangan kitang tanungin a
ilang mga katanungan tungkol sa kung ano ang nagdala sa iyo dito ngayon okay
Naiintindihan ko na nahihirapan kang ipasa ang iyong tubig
Tama sinubukan ko at sinusubukan kong umihi
pero nagdribble lang ako ng konti pakiramdam ko busog na ako
parang kailangan kong pumunta at kaya ko
Sinabihan ako ng aking doktor na pumasok
kailan ka huling nakapasa sa iyong tubig
karaniwang mga 10 a m
may napansin ka bang nasusunog
konting dugo no
sige nilagnat chills nope
lahat tama
sukat ng 0 hanggang 10
na may 10 ang pinakamasamang sakit na maiisip mo
paano mo ire-rate ang discomfort na ito
siguro 4 okay
regular ka bang nagpapatingin sa doktor para sa anumang bagay
High blood pressure sakit sa puso
diabetes sa kanser
hindi, malusog ako tulad ng isang kabayo
sige regular ka bang umiinom ng anumang gamot
Aspen lang ang araw
anumang allergy sa anumang bagay no
okay mabuti
habang tinitingnan mo itong pasyente
malinaw na hindi niya natutugunan ang pamantayan para sa antas 1 ng ESI
Iniharap niya sa emergency department
sa kawalan ng kakayahang umihi
mga 4 at kalahating oras
Marahil dahil sa benign prosthetic hypertrophy
Mukha siyang komportable kaya niyang umupo sa upuan
at mahinahong ibigay ang kanyang kasaysayan sa triage nurse
at ni-rate niya ang kanyang antas ng kakulangan sa ginhawa ay apat sa 10
kaya hindi niya natutugunan ang pamantayan para sa ESI Level two
kung habang naghihintay ang kanyang kakulangan sa ginhawa ay tumaas nang malaki
Siya ay maaaring palaging uptriaged
Tandaan
ang pasyente sa matinding pagkabalisa dahil sa pagpapanatili ng ihi
ay pacing malamang tachycartic
hindi makaupo
at pasalita sa triage nurse
na siya ay miserable
kung mukhang miserable ang pasyenteng ito
Itatalaga sana siya sa ESI Level 2 dahil sa pagkabalisa
kaya lumipat tayo sa susunod na hakbang sa algorithm
Pagkatapos ay sinagot ng triage nurse ang tanong
ilang iba 't ibang mapagkukunan ang kukunin ng pasyenteng ito
ang isang pasyente na may pagpapanatili ng ihi ay mangangailangan ng a
catheter ng urethral
isang urinalysis at marahil isang kultura ng ihi
dalawang mapagkukunan isang pamamaraan kasama ang isang lab
Ang mga vital sign ng pasyente ay nasa loob ng normal na limitasyon
Kaya ang pasyenteng ito ay isang ESI level 3
So ano sa tingin mo pumayag ka
oo ako
level 3 sigurado
Akala ko napakalinaw ng hiwa
Ibig kong sabihin ito ay isang napaka-uncomplicated na pasyente
at medyo prangka
Not in a lot of distress eksakto
Nakaupo siya doon
Sa tingin ko, dapat itong tumagal ng isang segment
Ipakita na napakahusay ng tama
ngunit kakailanganin niya ng mga pamamaraan at lab
So magtatagal tayo
So malinaw yung resource piece na kapag sinabi mong labs
blood work din ba ang sinasabi mo
Well tiyak ang iyong pagsusuri
oo dahil maaari ka ring magkaroon ng impeksyon
minsan yan ay impeksyon sa ihi
Iyan ay isang magandang punto ngunit tandaan
Lab ay hindi mahalaga kung ito ay dugo
ihi o dumi isa pa rin itong mapagkukunan
Kaya ang kanyang mga mapagkukunan ay isang urethral catheter sa lab 2
isa siyang ESI level three
okay lumipat tayo sa susunod na kaso
okay na ngayon
Mayroon kaming 45 taong gulang na lalaki
Dinala sa triage ng kanyang kaibigan
na nagsasaad na nasugatan ng pasyente ang kanyang kaliwang balikat
habang naglalaro ng football pasyente ay may gross deformity
sa kanyang balikat
at ang kanyang neurovascular deficits sa kanyang kaliwang braso
hindi niya maigalaw ang braso niya
at nagrereklamo sa matinding sakit
20 over 10 at siya ay diaphoratic
So ano sa tingin mo ang nangyayari sa scenario na ito
Sa tingin ko siya ay isang antas 2 siya ay nasa matinding sakit o pagkabalisa
And I can 't really do anything with him in triage good
Malamang may ibang dahilan yan
pwede mo siyang gawing level 2
dahil ba sa neurovascular deficits niya
ganap na ngayon ay ang lahat ng dislocated balikat antas dalawang
Hindi naman siguro depende sa itsura nila
kung gaano kalubha ang kanilang sakit
So what if maganda naman ang itsura niya
ay hindi sa sobrang sakit
at nagkaroon ng magandang neurovascular status
Well kailangan lang niya ng X ray
So isang level 4
Malamang hindi pa rin siya mangangailangan ng IV
Mga gamot para ilipat ang balikat na iyon
at kakailanganin pa niya ng X ray
kaya sa pinakamababa
Ang mga na-dislocate na balikat ay hindi bababa sa ESI level 3
at tandaan ang conscious sedation bilang isang pamamaraan
binibilang bilang dalawang mapagkukunan
Dinala ni nanay ang kanyang 4 na taong gulang na anak na lalaki
na may pangunahing reklamo ng isang pulang braso
pasyente
Nakagat ng aso ng pamilya mga tatlong araw na ang nakakaraan
And the child 's kind of cranky
Ang kanyang kanang braso ay pula na may ilang edema sa isang malaking lugar
nakapaligid sa kagat ng aso ang kanyang temperatura ay 99
5 rate ng puso 1 20 paghinga ay 24
kaya anumang antas 1 o 2 na pamantayan ay natutugunan dito
hindi, sa tingin ko siya ay isang ESI level 3
okay paano ba naman
kailangan niya ng labs at IV antibiotics
at malamang may cellulitis siya
Paano naman ang vital signs niya
dapat mo ba siyang i-upgrade batay sa mga ito
malamang hindi
siya ay nasa loob ng normal na pamantayan ng vital sign
mahusay na ipinapakita ng kasong ito
gaano kahalaga ang palaging suriin ang mga paa 't kamay
at biswal na tasahin ang lugar ng dalawang reklamo
hangga 't maaari
kung siya ay nagkaroon ng pagbaba ng pulso o compartment syndrome
Maaaring siya ay isang ESI level 2 ngunit mahusay
ang pasyenteng ito ay ESI level three
Next case may dumating na 70 years old na lalaki sakay ng ambulansya
sa nursing home
ang nursing home ay nag-uulat ng hindi produktibong ubo
Since nabulunan siya sa lunch niya ngayon
ang kanyang baseline mano status ay hindi nagbabago
at karaniwan siyang nalilito
mainit at basa ang kanyang balat
ang kanyang vital signs ng mga sumusunod
temperatura 100.2 rate ng puso 94
presyon ng dugo 1
35 over 80 at ang kanyang ramir saturation ay 94%
ang kanyang respiratory rate ay dalawampu at hindi panganganak
So naririnig ko ba ang ESI level 1 para sa pasyenteng ito
Hindi ko alam
I don 't think kailangan niyang i-intubate ngayon
mabuti hindi rin ako
You know wala talaga siya sa acute respiratory distress
ngunit ano ang tungkol sa US natal status
kailangan ba niya ng ESI level 1 criteria para dito
parang hindi naman
okay bakit hindi
Well dahil hindi siya unresponsive
nalilito lang siya kaya siguro kailangan niya ng level 2 criteria
So ano ang iniisip ng iba sa inyo oo
Level 2 ako
Not really lagi siyang naguguluhan
So hindi na bago
paano naman ang matinding pagkabalisa o mataas na panganib
sa tingin mo ba ito ay isang mataas na panganib na sitwasyon
ibibigay mo ba sa pasyenteng ito ang iyong huling bukas na kama
Well, pumasok siya sakay ng ambulansya
And I really don 't want na nasa waiting room siya
hindi rin ako pero
lahat ng mga pasyente na dumating sa pamamagitan ng ambulansya
ay ikinategorya bilang ESI
Level 1 o dalawa lamang kung natutugunan nila ang pamantayan
kaya kung iisipin mo
ang pasyenteng ito ay hindi nakakatugon sa antas 1 o 2 na pamantayan
at ang kanyang mga vital sign ay nasa loob ng normal na limitasyon
hindi siya lumalabag sa anumang pamantayan ng vital sign
So nasa ESI Level 3 talaga siya
tiyak na mangangailangan siya ng dalawa o higit pang mapagkukunan
walang lab X ray
IV antibiotics malamang na mayroon siyang pneumonia
ngunit maaari mo pa ring mapadali ang paglalagay sa isang kama
ngunit ang kasong ito ay naglalarawan ng isang talagang mahalagang punto
kategorya ng placement at triage
minsan ay dalawang magkaibang bagay
may ilan
level 3 na mga pasyente na maaaring direktang pumunta sa isang silid
ngunit ang iba ay maaaring talagang maghintay para sa proseso ng pagsubok
Ngayon ay mayroon na kaming limang taong gulang
na dinadala ng kanyang ama
na nag-ulat na ang anak na babae ay sinusubukang tumulong
ilagay ang hapag kainan sa basag na salamin
kaya
may napansin kang 3 centimeter laceration sa kaliwang kamay niya
kontrolado ang pagdurugo
at ang bata ay walang medikal na kasaysayan
Hindi umiinom ng gamot at walang allergy
at normal ang vitals namin
So ano sa tingin mo ang nangyayari dito
ito ay madali lamang isang laceration
isang mapagkukunan ng pag-aayos ng laceration
okay mabuti
Paano kung ito ay isang 3 taong gulang
na sumisigaw ng madugong pagpatay
iniisip mo ba ang conscious sedation
talagang kaya kung iyon ang kaso
gaano karaming mga mapagkukunan ang ubusin ng pasyente
at paano nito mababago ang iyong kategorya ng triage
Well conscious sedation ay dalawang mapagkukunan
Plus gagamit sila ng IV meds
kaya na ang pasyente ay isang antas ng tatlong
talagang paano kung sapat na ang pandikit ng sugat
na magiging mahusay na ang sugat na pandikit ay binibilang bilang isang mapagkukunan
hindi ito ay hindi
kaya kung sapat na ang pandikit ng sugat
at hindi ito binibilang bilang isang mapagkukunan
ang pasyenteng ito ay magiging ESI level 5
Dumating ang EMS kasama ang isang 49 taong gulang na lalaki
na may kasaysayan ng cirrhosis at Hepatitis C
tumawag ang kanyang asawa sa 9 1
1 nang magsimula siyang magsuka ng matingkad na pulang dugo
sa pagdating siya ay maputlang diaphoratic
siya ay may presyon ng dugo na 92 higit sa 78
1: 30 ang tibok ng kanyang puso at 28 ang kanyang respiratory rate
So ano sa tingin mo ang kasong ito
nakakatugon ba siya sa ESI level 1 o 2 na pamantayan
Siguro medyo hypotensive siya
at tachycardic at ticipnik din siya
So iniisip mo ang ESI level 1 o 2
Well, sa tingin ko ay maaari siyang pumunta sa alinmang paraan
okay isipin mo ang history niya
para saan ba siya nasa panganib
Maaari siyang magdugo mula sa kanyang varices
okay pero ano agad
Life saving interventions ang kailangan niya
Kailangan niya ng ilang linya para sa likido at dugo
So I guess A1 siya
Right hypotensive siya
tachycartic to kypnic namumutla siya at nagsusuka ng dugo
kailangan niya ng agarang IV access
at posibleng negatibong dugo
at hindi bababa sa isang Floyd bolus
okay bumalik tayo at manood ng ilan pang video case dito
Grabe ang sakit ng ulo ko
Hindi ko kinaya ang sakit ng ulo ko kanina
ngunit hindi tulad ng isang ito
mukha ka talagang miserable
alam mo sa sukat na 0 hanggang 10
Kung 10 ang pinakamasamang sakit na maiisip mo
paano mo ito ire-rate ngayon
a 10 + Hindi ko matiis kung kailan ito nagsimula
ngayon halos isang oras na ang nakalipas
Pumunta ako sa banyo
Ginagalaw ko ang aking bituka at nagsimula ito kaagad pagkatapos nito
okay nagkakaroon ka ba ng anumang pagduduwal na pagsusuka
Nakaramdam ako ng sakit sa tiyan ko
hindi mo ba ako mabibigyan ng kahit ano para sa sakit
hindi ngayon
Magpapatingin ka sa doktor sa loob ng ilang minuto
kaya kailangan ko munang magtanong sa iyo ng ilang higit pang mga katanungan
at ayusin ang iyong presyon ng dugo
ilang taon ka na 35
okay at magkaroon ng anumang mga medikal na problema no
na uminom ng anumang gamot araw-araw sa anumang kadahilanan hindi
okay at may allergy ka ba sa mga gamot no
Sige
ito ay isang ESI level 2
ang pasyenteng ito ay may bagong simula ng matinding sakit ng ulo
tipikal na presentasyon iyon
para sa subarachnoid hemorrhage
ito ay isang mataas na panganib na sitwasyon
Ang pananakit ng ulo ay madalas na reklamo
at karapat-dapat sa isang maliit na karagdagang talakayan
mga pasyente
na nagpapakita ng kanilang karaniwang migraine headache
ay madalas na sinusuri bilang ESI Level 3
karaniwang nangangailangan sila ng IV na may likido
at IV gamot sa sakit gayunpaman
mga pasyente ng migraine na alam na nangangailangan lamang sila ng IM
Selective serotonin agonist at gamot laban sa migraine
ay mangangailangan lamang ng isang mapagkukunan at gamot sa IM
at samakatuwid ay mauuri bilang ESI Level 4
kahit isang pasyente na may karaniwang migraine
na nagpapakita sa matinding sakit na pagsusuka
isang triage kahit na ito ay isang tipikal na sakit ng ulo
Maaaring subukan bilang ESI Level 2 dahil sa matinding pananakit
upang buod sa sakit ng ulo
Mahalaga ang kasaysayan upang maalis ang isang mataas na panganib na sitwasyon
pagkatapos ay kailangan mo talagang suriin kung ano ang hitsura ng pasyente
at sa wakas
kung gaano karaming mga mapagkukunan ang maaari mong asahan ang kakailanganin
sa partikular na senaryo na ito
ang pasyente Matt ESI antas 2 pamantayan
okay kaya ang sakit ng ulo ay medyo magulo at kulay abo minsan
So ano naisip niyo yung scenario na yun
Well sa tingin ko ay bago iyon
buksan ang aking mga mata sa kung paano ko ginagamot ang sakit ng ulo
at lalo na ang mga taong may migraine
Dahil kadalasan alam mo
sakit lang sa ulo
So hindi mo talaga iniisip yung pagdurugo
o tulad ng isang posibleng tumor o isang bagay
ngunit sumasang-ayon ako sa antas na iyon
na dapat siya ang 2 dahil sa kanya
Sa tingin ko ang dahilan kung bakit iyon ay isang 2 ay dahilan
higit sa lahat dahil sa kanyang sakit at kanyang kawalang-tatag
sa ganoong paraan na tama
Sa tingin ko ang koneksyon sa paggalaw ng patinig
ay talagang mahalaga din
And she looks so awful din
oo kahit na ang ilang mga migraine ay ginagawa
ngunit ang koneksyon ng paggalaw ng kampana ay mahalaga
Sa tingin ko tiyak na ang kampana ay soberanya ang lahat ng tama
Tiyak na isang tip off na ito ay maaaring maging isang hiwalay
Greater good na ilagay siya sa gilid
anumang uri ng mga tanong na masakit sa ulo
No just the worst headache na naranasan ko sa buhay ko
Gusto mo ba ng katalinuhan para sa pahayag na iyon
kabayo ay nagkaroon ng isang magandang o buhay karaniwang
once na sabihin nila na
medyo mahirap na hindi sila gawing level 2 na pasyente
Kahit na sa isang taong migraine na madalas magkaroon ng migraine
ito ang kanilang pinakamasamang migraine
at mas masahol pa kaysa sa kanilang normal na kasalukuyang migraine
at hindi ito karaniwang migraine kaysa sa malamang na gagawin ko
Gusto ko rin at minsan sinasabi iyon
Gusto kasi nila ng mabilis na gamot sa sakit
Sa tingin ko
Well kailangan mo bang tanggapin ang mga ito sa kanilang salita
kapag sinusubukan mo sila
eksaktong sigurado okay
sige next case
Dumating ang pasyente sa pagsubok at sasabihin sa iyo
Inilabas ko ang aking apendiks noong nakaraang linggo
And my incision puro pula at bumukas
at mayroon akong dilaw na ito
Mga mahalay na bagay na lumalabas sa aking hiwa
ito ay isang 19 taong gulang na lalaki na walang medikal na kasaysayan
Hindi umiinom ng gamot
at sinasabi niya sa iyo na siya ay allergic sa penicillin
ang kanyang temperatura ay 101 8
Ang kanyang tibok ng puso ay 98 at ang kanyang paghinga ay 16 bilang P O
Two is fine so ano sa tingin mo sa kasong ito
kailangan ba niya ng anumang antas 1 o 2 na pamantayan
No I think level 3 siya
Kakailanganin niya ang lab work
at ilalagay din sa IV antibiotics
kaya walang gustong magbigay sa kanya ng iyong huling bukas na kama
Inuubos niya ang lahat ng dilaw na bagay na ito
So okay nagchecheck lang ako
So tama ka
mangangailangan siya ng hindi bababa sa dalawang mapagkukunan
mga pasyente na post op
kadalasan ay nagiging ESI man lang
level 3 kaya pag-usapan natin ang vital science
nilalabag ba niya ang alinman sa mga parameter na iyon
parang hindi naman
okay sige at suriin ang iyong mga sheet gamit ang algorithm
Laging magandang panatilihin ang mga ito sa triage
Pagkatapos mong maging komportable sa ESI
hindi mo na talaga kakailanganing gamitin ang mga ito
ngunit ito ay palaging mabuti na sila ay nasa labas
Laging may mga taong bago sa pagsubok
Kaya sa kasong ito ang kanyang mga vital sign ay walang limitasyon
para mapanatili pa rin natin siya bilang isang level 3 na pasyente na mahusay
ganap na okay
Kaya 't magpatuloy tayo sa susunod na kaso
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