Emergency Severity Index (ESI) Implementation Handbook, 2012 Edition

Respiratory arrest
Cardiopulmonary arrest
Major head trauma with hypoventilation
Active seizures
Unresponsiveness
Peticheal rash in a patient with altered mental status (regardless of vital signs)

Respiratory failure:

• Hypoventilation.
• Cyanosis.
• Decreased muscle tone.
• Decreased mental status.
• Bradycardia (late finding, concerning for impending cardiopulmonary arrest).

Shock/sepsis with signs of hypoperfusion:

• Tachycardia.
• Tachypnea.
• Alteration in pulses: diminished or bounding.
• Alteration in capillary refill time >3-4 seconds.
• Alteration in skin appearance: cool/mottled or flushed appearance.
• Widened pulse pressure.
• Hypotension (often a late finding in the prepubescent patient).

Anaphylactic reaction (onset in minutes to hours):

• Respiratory compromise (dyspnea, wheeze, stridor, hypoxemia).
• Reduced systolic blood pressure.
• Hypoperfusion (eg, syncope, incontinence, hypotonia).
• Skin and/or mucosal involvement (hives, itch-flush, swollen lips, tongue or uvula).
• Persistent gastrointestinal symptoms.