"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 normal.

ESI 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.

EMS presents to the ED with an 18-year-old female with 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 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.

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 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.

A 4-year-old female transported to the ED following a fall off the jungle gym at a preschool. A fall from 4 feet.  A witness reports that the child hit her head and was unconscious for a couple of minutes.  On arrival, you notice the child is crying ad asking for her mother.  Her left arm is splinted.  Vital signs: HR 162, RR 28.

ESI level 2: High-risk situation.  This 4-year-old had a witnessed fall with the loss of consciousness and presents to the ED with a change in the level of consciousness.  She needs to be rapidly evaluated and closely monitored.

EMS arrives with an 87-year-old male who fell and hit his head.  He is awake, alert, and oriented and remembers the fall.  He has a past medical history of atrial fibrillation and is on multiple medications, including Warfarin.  His vital signs are within normal limits.

ESI level 2: High risk. Patients taking Warfarin who fall are at high risk of internal bleeding.  Although the patient's vital signs are within normal limits and he shows no signs of a head injury, he needs prompt evaluation and a head CT.

"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.

"I have this infection in my cuticle," reports a healthy 26-year-old female.  "It started hurting 2 days ago, and today I noticed the puss."  The patient has a small paronychia on her right second finger.  No known drug allergies. T 98.8, RR 14, HR 62, 108/70.

ESI level 3: Two or more resources. This young woman needs an incision and drainage of her paronychia. She will require no other resources.

A young male walks into triage and tells you that he has been shot.  He rolls up the left leg of his shorts, you notice two wounds.  He tells you that he heard three shots.  He is alert and responding appropriately to questions.  Initial vital signs: T 98.2, HR 78, RR 16, BP 118/80

ESI level 2: High-risk situation.  This patient has two obvious wounds, but until he is thoroughly examined in the trauma room, you can't rule out the possibility that he has another gunshot wound.  The wounds on his thigh look non-life-threatening, but a bullet could have nicked a blood vessel or other structure; therefore, he meets ESI level-2 criteria.  His vital signs are within normal limits, so he does not meet ESI level-1 criteria.

"I got my belly button pierced a month ago and now it hurts so bad," reports a 19-year-old healthy college student who is accompanied by her roommate.  They are chatting about plans for the evening.  The area is red, tender, and swollen, and pus is oozing from around the site. Vital signs: T 100.0, HR 74, RR 18, BP 102/70, SpO2 100%,  Pain 8/10

ESI Level 3: two or more resources.  Based on history, this patient may have cellulitis from a naval piercing.  At a minimum, she will require labs and IV antibiotics

A 16-year-old male wearing a swimsuit walks into the ED.  He explains that he dove into a pool, and his face struck the bottom.  You notice an abrasion on his forehead and nose as he tells you that he needs to see a doctor because of tingling in both hands. 

ESI level 2: High Risk.  Because of the mechanism of injury and his complaints of tingling in both hands, this patient should be assigned ESI level 2.  He has a cervical spine injury until proven otherwise.  He is not an ESI level 1 in that he does not require immediate lifesaving interventions to prevent death,  At triage, he needs to be appropriately immobilized.