ESI Sample Cases 1

Summary

This 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

• 🔍 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.
• 👦 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.
• 🤕 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.
• 🧓 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.
• 🚑 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.
• 🏥 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.
• 🤒 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.
• 🤰 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.
• 👨‍⚕️ 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.
• 🩺 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.
• 🩹 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

00:00

🏥 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.

05:00

🚑 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.

10:01

🤰 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.

15:05

👨‍🦳 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.

20:12

🏈 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.

25:15

🩺 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.

30:18

🤕 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.

Keywords

💡Emergency Severity Index (ESI)

The Emergency Severity Index (ESI) is a triage system used in emergency departments to quickly assess and prioritize patients based on the severity of their condition and the resources they might need. In the video, ESI levels are discussed to determine the urgency of care for various patients, such as an eight-year-old with an ankle injury or a 42-year-old with shortness of breath.

💡Triage

Triage is the process of determining the priority of patients' treatments based on the severity of their condition. In the video, triage is used to assess patients like a child with a sprained ankle or an adult with respiratory distress, helping to allocate appropriate medical resources and attention.

💡Ankle Sprain

An ankle sprain refers to an injury to the ligaments of the ankle, often caused by a twist or turn that stretches or tears the ligaments. In the script, an eight-year-old's sprained ankle is discussed as a case study, highlighting the need for assessment and potential X-ray to determine the extent of the injury.

💡Ottawa Ankle Rules

The Ottawa Ankle Rules are a set of criteria used to determine whether an X-ray is necessary for patients with ankle injuries. In the video, these rules are mentioned in the context of deciding whether an adult patient needs an X-ray after an ankle injury.

💡Respiratory Distress

Respiratory distress is a serious condition characterized by difficulty in breathing, often indicated by rapid or labored breathing. The video discusses a 42-year-old female experiencing respiratory distress, emphasizing the need for immediate medical attention and potential intubation.

💡Intubation

Intubation is a medical procedure where a tube is inserted into a patient's trachea to facilitate breathing, often necessary in cases of respiratory failure or severe respiratory distress. The script mentions intubation as a potential treatment for a patient with acute respiratory distress.

💡Morbidity

Morbidity refers to the state of being diseased or the incidence of a disease in a population. In the video, a 42-year-old morbidly obese female is presented as a case, highlighting how obesity can be a factor in the severity of respiratory distress.

💡Vital Signs

Vital signs are a group of measurements taken to assess a person's state of health, including heart rate, respiratory rate, blood pressure, and body temperature. The video script uses vital signs to assess patients' conditions, such as the 42-year-old female with respiratory distress or the 28-year-old male with a back lump.

💡Urinary Retention

Urinary retention is the inability to pass urine, despite the urge to do so. In the script, a patient with urinary retention is discussed, illustrating how this condition can be managed in the emergency department, often requiring a urethral catheter and lab tests.

💡Neurovascular Deficits

Neurovascular deficits refer to damage or dysfunction in the nerves and blood vessels. The video mentions a patient with a dislocated shoulder and neurovascular deficits, indicating the need for immediate attention and potential procedures to restore function.

💡Incision

An incision is a cut made into the body, typically during surgery. The script discusses a patient with a post-operative incision that has become infected, requiring lab work and IV antibiotics, demonstrating the importance of post-operative care and monitoring.

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