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Emergency Severity Index Pt.2: Practice Cases – 07 Cellulitis

October 18, 2019

[Music] Facilitator 2 (FA2): Okay, next case. M om brings in her
four year old son with a chief complaint of a red arm.
The patient was bitten by the family dog about three days ago and the child is
kind of cranky. His right arm is red with some edema to a large area surrounding
the dog bite. His temperature (T) is 99.5, heart rate (HR) is 120, respirations (RR) are 24. So, any
Level 1 or 2 criteria being met here? Registered Nurse 3 (RN3): No, I think he’s an ESI Level 3. FA2: Okay. How come? RN3: He needs labs and IV antibiotics
and he probably has cellulitis. FA2: What about his vital signs?
Should you upgrade him based on these? RN3: Probably not – he is
within the normal vital sign criteria. FA2: Great. This case
demonstrates how important it is to always check extremities and visually
assess the area of chief complaint whenever possible. If he had a decreased pulse or
compartment syndrome, he may even be an ESI Level 2. But good,
this patient is ESI Level 3.

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