Emergency Severity Index

Rosebud Lake to be used for emergency water distribution

Triage. « kristaplasch

Today I worked in triage.  I never really realized how much they actually do in triage before the patents actually get to come back to a room.  The people check into registration then I call them into the room.  I ask them what is going on, put their diagnosis in the computer, check vital signs, assess pain, put in the physician notification, check for medication allergies, and then finally assign them a ESI.  So breaking these things up, putting in their diagnosis.  Some cases are easy, if their bone is possible broken, you just type in arm pain/break, or abdominal pain is AP.  But some people are crazy, okay, so most people are crazy.  Unlike back in the actual ER where the beds are and stuff you might have 10 patients a day.  In triage you meet every single patient and their family members or whoever brought them.  And obviously if your loved one is sick, or not feeling well, they take it out on the person in the front. Me.  Next taking vital signs is easy, assessing pain is just asking if, and where, and how severe the pain is.  Notifying the physician just means putting time of triage arrival in.  Medication allergies is also just about asking them their allergies and putting that in the computer.  ESI is scary. It stands for emergency severity index.  We had a four-hour training on it like the fourth day of the internship.  So, what you do is listen to the whole story and figure out how emergent this person needs to be seen.  A level one is marked red on the screens, it means this person will not live unless they are brought back immediately.  These patients have been in a car accident, overdosed, or come in with full cardiac arrest.  These patients are usually a one on one with a nurse meaning they have no other patients until they are stable.  I have seen two  ESI ones since I have been there.  One was from a brain bleed and had to be intubated on the scene, and the other was a car accident.  An ESI of two means they need help immediately or within minutes.  These are abuse patients, suicidal patients, any patient in room 4 and 5 I guess, because those are the behavioral health safe rooms, chest pain patients, and sometimes shortness of breath patients.  Most of the patients we see down in the ER are level three.  These are the abdominal pains, and a whole mess of other things.  What makes the difference of a level 3 to a level 4 is ER versus UC (urgent care).  Since at this hospital I work is called the EUCC, and obviously an urgent care visit is less expensive than ER.  I would do the whole triage part by myself, and then have Janet help me with the ESI some of the time.  The nice thing of working Triage during the night is that from midnight to 6am everyone is an ER patient no matter their ESI number.  Then there are level fives which are patients that could wait a few days to get in with their normal doctors but just kind of come in.  So that was probably really confusing, but obviously the longer you do it the easier it gets.  Working triage was the first 7 hours of my day, and I literally got like 10 minutes to not do anything in those 7 hours because we were so booked the wait for a bed was like a good 2 hours.  The last 5 hours I spent with patients.  I helped with a trauma.  Where the lady was beyond plastered and she was in a car wreck, the patient was the passenger, and her husband was the driver who was now in jail.  She was singing and yelling at us, her neck might have been injured so she had a collar on.  But, she would not sit still.  She was so drunk she could not even tell what she was doing to herself tying to bend and trying to get out of the bed to find her husband.  She did not understand that he was in jail.  I had a girl with pain all over her body and she had been to Gunderson a lot before, so you always question if they are just narcotic abusers.  I don’t think she was, but I guess I will never know.  I had a patient with plantar fasciitis.  There was nothing we could do for him so I kind of felt bad, but the doctor got him some stretches he could do to help with the pain.  He was also going to have to go and see a foot specialist.  Janet also took over on two chest pains.  I got to help with one of them, because I was busy with my patient.  But this lady was just super nice.  She asked if I was a student.  I told her yes, and she said I could poke her as many times as needed.  I would just like to say though, she is having the worst pain of her life, she is having a hard time breathing, but she knows doing is the best experience.  It meant so much that she would let me poke her until I got the IV.  It never showed that it was a MI, but still she was going to be admitted for further testing.  Janet was still finishing up again, but she let me go.  All three of these nights I have gotten off late, but the experience has been worth it.  I have also noticed, not that anyone has been mean, but when nurses looked aged it is great for them.  With wrinkles comes experience, and when a patient sees that it makes them feel more comfortable.  I totally can see why they do that, and now I guess I can look forward to being 40.  Not that any patients have said anything rude or anything, but I do look young, especially for working in the ER, but I love it.  O and I just remember this might be too much information but I am going to marry someone in the army.  I had two young gentlemen that just had gotten back from overseas, and when I triaged them they both had southern accents, and they both said yes maam, to everything I asked them.  They were so polite.  I had also helped move them to the back and he was just so thankful for everything,  Also Saturday and Sunday were the busiest I have ever seen it.  No break for me!

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