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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> > > Table 4-1</span></p>
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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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</td>
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<tr>
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<td><div id="centerContent">
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<h3>Table 4-1. Examples of High-risk Situations</h3>
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<table border="1" cellpadding="8" cellspacing="0" width="90%">
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<tr valign="top">
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<th scope="col" width="25%">System</th>
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<th scope="col" width="35%">Examples/diagnosis</th>
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<th scope="col" width="40%">Signs/symptoms</th> </tr>
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<tr valign="top">
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<td scope="row">Abdomen</td>
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<td>Abdominal pain in the elderly. <br />
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Gastrointestinal bleeding.
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</td>
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<td>Severe pain, stable vital signs.<br />
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Tachycardia, vomiting blood or bright
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red blood per rectum.</td>
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</tr>
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<tr valign="top">
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<td scope="row">Cardiac</td>
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<td>Chest pain.<br />
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Acute arterial occlusion.<br />
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History of angioplasty with chest pain.<br />
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Pericardial effusion.<br />
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Infective endocardititis. </td>
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<td>Constant or intermittent, stable vital signs.<br />
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Absence of distal pulse.<br />
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Stable vital signs.<br />
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Chest pain and shortness of breath.<br />
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History of drug abuse.</td>
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</tr>
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<tr valign="top">
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<td scope="row">General</td>
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<td>Immunocompromised patients.<br />
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Oncology patients.<br />
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Transplant (post or on waiting list).</td>
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<td>May or may not have fever. </td>
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</tr>
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<tr valign="top">
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<td scope="row">Genitourinary</td>
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<td>Testicular torsion.<br />
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Acute renal failure.</td>
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<td>Sudden onset of testicular pain.<br />
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Unable to be dialyzed.</td>
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</tr>
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<tr valign="top">
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<td scope="row">Gynecological</td>
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<td>Ectopic pregnancy.<br />
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Spontaneous abortion. </td>
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<td>+ pregnant, severe lower quadrant pain.<br />
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Bleeding and tachycardia with stable
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blood pressure. </td>
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</tr>
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<tr valign="top">
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<td scope="row">Mental Health</td>
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<td>Combative, hostile, hysterical.<br />
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Suicidal attempt/complaint.<br />
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ETOH with trauma.<br />
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Sexual assault—any. </td>
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<td> </td>
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</tr>
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<tr valign="top">
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<td scope="row">Neurologic</td>
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<td>Rule out meningitis.<br />
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History of multiple cerebrovascular
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accidents.<br />
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Acute ischemic stroke. </td>
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<td>Headache, fever, lethargy.<br />
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Motor or speech deficits.<br />
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Motor or speech deficits. </td>
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</tr>
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<tr valign="top">
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<td scope="row">Pediatric</td>
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<td>Vomiting, diarrhea, unable to eat.<br />
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Asthma attack.</td>
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<td>Sunken fontanel, poor skin turgor, lethargy.<br />
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Nasal flaring or use of intercostals.</td>
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</tr>
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<tr valign="top">
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<td scope="row">Respiratory</td>
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<td>Acute epiglottitis.<br />
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Severe asthma.<br />
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Pleural effusions.<br />
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Spontaneous pneumothorax. </td>
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<td>Drooling.<br />
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Severe shortness of breath.<br /> Severe shortness of breath.<br />
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Sudden onset of shortness of breath. </td>
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</tr><tr valign="top">
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<td scope="row">Trauma</td>
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<td>Motor vehicle crash with transient loss of consciousness.<br />
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Stab wound to the groin. </td>
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<td>History of head trauma.<br /> <br />
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Bleeding controlled, obvious stab wound. </td>
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</tr>
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</table>
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<p class="size2"><a href="esi4.htm#Tab4-1">Return to Document</a></p>
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<p> </p>
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<p> The information on this page is archived and provided for reference purposes only.</p></div>
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