 Welcome to nursing school explained today's topic is triaging which occurs in the emergency department but sometimes also on the medical floors or the ICU and triaging is a word in French that means to sort and so when we do triage we try to prioritize the patients by their acuity or by their how stable they are so we always want to make sure that we treat the patient who is the most unstable first and in the emergency department patients are triaged by what's called an ESI category which stands for the emergency severity index and the index goes from level one to five where level one is the most acute and then level five is the most stable patient and I've kind of color coded them here from red being warning unstable into the kind of yellow orange category and then they're getting milder into the green level here and when we talk about the emergency severity index we usually assess the patient by their ABCs and vital signs as well as how soon do they need to be seen what are the expected resources that we need to dedicate to care for this patient as well as some examples so emergency severity index number one would be an unstable patient who either has unstable airway breathing or circulation or unstable bio science they need to be seen right away and the expected resources will be many an example here is a cardiac arrest so besides the nurse the physician or the provider nurse practitioner of PA who might be caring for this patient you might have one nurse two nurses you probably will have a respiratory therapist there most likely you'll have some sort of a tech that can do compressions you might also have a lab tech that responds to get the blood drawn and sent to the lab as soon as possible you might have an x-ray technician standing by so there are many resources from really many departments that are needed and the interventions will be continuous and frequent and then reassessments will occur continuously as well so this is a high level of patient that's going to need a lot of resources designated to them and besides cardiac arrest the other example here is an overdose with decreased respiratory rate so maybe that might be an overdose and an opioid that cannot be reversed with just a simple dose of Narcan but they might need to intubate it so we'll need those additional resources the respiratory therapists the lab to rule out other things that might be going on with this patient that's depressing their respiratory rate or somebody in severe respiratory distress this could be maybe an elderly patient who comes from the nursing home who now has a pneumonia and they might be turning septic or with these unstable vital signs or maybe this is a COVID patient who has been at home and now they're in a severe respiratory distress and they're coming in with unstable vital signs need to be seen right away and need continuous and many interventions now emergency severity index two the vital signs and ABCs will be threatened so they will be somewhat stable this might be somebody with the blood pressure in the 80s where they are still maybe meditating but not completely alert or maybe they have a threatened injury to their chest they should be seen within 10 minutes or fairly quickly again they'll have high level of resources that are needed and need continuous interventions as well because they are at risk for turning unstable quickly here and examples of an ESI category two would be a patient with chest pain because when they first arrive we don't know is the chest pain because of ischemia or maybe even an MI or is this a costocondrated kind of a pain or maybe they have a pneumonia or some other underlying lung issue and what this could be a multiple trauma victim who doesn't have an immediate need or stabilization of their ABCs and vital signs but this is somebody who might have had a car accident with blood force trauma to the chest where we have to suspect that there might be some underlying injuries to the lungs or maybe to the rib cage, rib fractures, pneumothorax, hemothorax that could turn unstable here pretty quickly. Now an ESI category three is a patient with stable vital signs but they should be seen within about one hour and they would need medium to high resources in multiple studies so an example would be a patient with abdominal pain because this could be a gastroenteritis, a stomach flu or it could be an acute appendicitis, it could be a small bowel obstruction, it could be a pancreatitis where the patient could get really ill and then actually move up the severity index here fairly quickly so we don't know but multiple studies are needed and those usually include blood work and any kind of other diagnostic studies mostly radiology related or a hip fracture maybe an elderly patient felt they broke their hip but we don't know if there are any other underlying issues maybe they are on any in on some anticoagulants and put them at higher risk for bleeding so there should be a level three where they're still stable but again we have to keep a closer eye on them because maybe during our evaluation we'll find something that will move them up this category index here. ESI category four as a patient begin the stable vital signs and they don't have to be seen right away a delay is okay the resources are low and there might be just simple interventions needed this might be somebody with the closed extremity fracture who might just need a simple x-ray then maybe a split place well it may be a UTI and a patient who's going in an evaluation a review analysis and then go home with a prescription for an antibiotic and ESI category five are the most stable patients so again vital signs will be stable they can be seen with a delay and again low resources are needed and they might need an exam only there might not even be any diagnostics studies that we need such as blood work urine sample x-ray and so forth and then examples here cough and cold or flu like illness we're not expecting them to even maybe need an IV access for fluids or a simple prescription refill so in summary here the emergency severity index is very helpful in being able to sort the patients and allocate the number of resources you have available in the emergency department to the patient and dedicate them to this maybe critical patient and then still make sure that we still can care for all these patients in these other categories and keep in mind there's that old saying in the ER if you if they don't rush you in to be seen that's a good thing in the ER because that means that you're probably a category three four or five and and most likely you're going to be okay but if they rush you in and you are category one or two then you are more significantly ill and that's you know really nobody wants to be there be significantly ill so thank you for watching this video here on nursing school explain please also watch my other video where I go into the primary and secondary surveys more details about the abc def ghi all the way to i and of the alphabet where we really categorize or assess the patient in a very methodical fashion to figure out about more details about their abc's please also subscribe here on youtube and follow me on instagram to stay on top of the latest video releases as well as study tips and and click start questions thanks for watching