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