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<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Home</a> > <a href="/qual/" class="crumb_link">Quality Assessment</a> > <a href="/qual/measurix.htm" class="crumb_link">Measuring Healthcare Quality</a> > <a href="." class="crumb_link">Emergency Severity Index, Version 4</a> > Figure 3-1a</span></p>
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<tr>
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<td height="30px"><span class="title"><a name="h1" id="h1"></a>Emergency Severity Index, Version 4: Implementation Handbook</span>
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<tr>
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<td><div id="centerContent">
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<h3>Figure 3-1a. ESI Triage Algorithm</h3>
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<table border="0" cellpadding="4" cellspacing="1" width="80%">
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<tr valign="top">
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<td width="50%" align="center"><img src="esifig3-1a.gif" alt="Flow chart demonstrating the algorithm. Box A is labeled 'requires immediate life-saving intervention?' with an arrow labeled 'Yes' pointing to a 1 in a circle and an arrow labeled 'No' pointing to Box B. Box B is labeled 'high risk situation? or confused/lethargic/disoriented? or severe pain/distress?' with an arrow labeled 'Yes' pointing to a 2 in a circle and an arrow labeled 'No' pointing to Box C. Box C is labeled 'how many different resources are needed?' with an arrow labeled 'none' pointing to a 5 in a circle, an arrow labeled 'one' pointing to a 4 in a circle, and an arrow labeled 'many' pointing to Box D. Box D is labeled 'danger zone vitals?' with the following vital sign formulae: HR/RR/SaO2<92%: <3 m/>180/>50; 3 m-3y/>160/>40; 3-8 y/>140/>30; >8y/>100/>20'. An arrow labeled 'Consider' points from Box D to a 2 in a circle and an arrow labeled 'No' points to a 3 in a circle." /></td>
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<td width="50%"><strong>A. Immediate life-saving intervention required:</strong> airway, emergency medications, or other hemodynamic interventions (IV, supplemental O2, monitor, ECG or labs DO NOT count); and/or any of the following clinical conditions: intubated, apneic,
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pulseless, severe respiratory distress, SPO<sub>2</sub><90, acute mental status changes, or
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unresponsive.<br /><br />
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<strong>Unresponsiveness</strong> is defined as a patient that is either:
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<ol>
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<li>Nonverbal and not following commands (acutely).</li>
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<li>Requires noxious stimulus (P or U on AVPU) scale.</li>
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</ol>
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<p><strong>B. High risk situation</strong> is a patient you would put in your last open bed.</p>
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<p><strong>Severe pain/distress</strong> is determined by clinical observation and/or patient rating of greater than or equal to 7 on 0-10 pain scale.</p>
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<p><strong>C. Resources:</strong> Count the number of different types of resources, not the individual tests or x-rays (examples: CBC, electrolytes and coags equals one resource; CBC
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plus chest x-ray equals two resources).</p>
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<table border="1" cellpadding="0" cellspacing="0" width="100%">
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<tr valign="top">
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<th width="50%">Resources</th>
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<th width="50%">Not Resources</th></tr>
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<tr valign="top">
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<td width="50%">
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<ul>
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<li>Labs (blood, urine).</li>
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<li>ECG, X-rays.</li>
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<li>CT-MRI-ultrasound- angiography.</li>
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</ul>
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</td>
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<td width="50%">
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<ul>
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<li>History & physical (including pelvic).</li>
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<li>Point-of-care testing.</li>
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</ul>
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</td></tr>
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<tr valign="top">
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<td width="50%"><ul>
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<li>IV fluids (hydration).</li>
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</ul></td>
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<td width="50%">
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<ul>
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<li>Saline or heplock.</li>
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</ul>
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</td></tr>
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<tr valign="top">
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<td width="50%">
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<ul>
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<li>IV or IM or nebulized medications.</li>
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</ul></td>
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<td width="50%">
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<ul>
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<li>PO medications.</li>
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<li>Tetanus immunization.</li>
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<li>Prescription refills.</li>
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</ul>
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</td></tr>
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<tr valign="top">
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<td width="50%"><ul>
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<li>Specialty consultation.</li>
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</ul></td>
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<td width="50%">
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<ul>
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<li>Phone call to PCP.</li>
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</ul>
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</td></tr>
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<tr valign="top">
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<td width="50%">
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<ul>
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<li>IV or IM or nebulized medications.</li>
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</ul></td>
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<td width="50%">
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<ul>
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<li>Simple wound care (dressings, recheck).</li>
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<li>Crutches, splints, slings.</li>
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</ul>
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</td></tr>
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</table>
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<p><strong>D. Danger Zone Vital Signs.</strong> Consider uptriage to ESI 2 if any vital sign criterion is exceeded.</p>
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<strong>Pediatric Fever Considerations:</strong>
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<ol>
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<li>1 to 28 days of age: assign at least ESI 2 if temp >38.0 C (100.4F)</li>
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<li>1-3 months of age: consider assigning ESI 2 if temp >38.0 C (100.4F)</li>
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<li>3 months to 3 yrs of age: consider assigning ESI 3 if: temp >39.0 C (102.2 F), or incomplete immunizations, or no obvious source of fever.</li>
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</ol>
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<p class="size2">©ESI Triage Research Team, 2004 (Refer to teaching materials for further clarification)</p>
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</td></tr>
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</table>
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<p class="size2">©ESI Triage Research Team, 2004. Reproduced with permission.</p>
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<p class="size2"><a href="esi3.htm#Fig3-1">Return to Document</a></p>
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<p> </p>
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<div class="footnote">
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<p> The information on this page is archived and provided for reference purposes only.</p></div>
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