Any patient that is considered an ESI Level I or II.

Vital signs:

Temperature:

· Any adult with a temperature > 104

· Any patient over 60 with a temperature > 101

Pulse:

· Any adult patient with a pulse > 130

· Any patient over 50 with an unexplained tachycardia

Blood Pressure:

· Any patient with a MAP < 70

· Any patient with a SBP < 100

Pediatrics

· Any patient < 30 days

· Any patient with temperature > 100.0 that is less than 90 days

· Pediatric head injuries < 8 years

· Pediatric abdominal pain and vomiting < 12 years

Febrile patients:

· Any febrile patient with comorbid conditions, including:

o Age > 60

o Diabetes

o Respiratory conditions such as Asthma, COPD.

· Potential immunocompromise, including steroid therapy, immunologic medications, HIV/AIDS, chemotherapy

· Implanted medical devices, such as PermCath, central lines, or PICC lines

Chest Pain:

ALL EKGs MUST BE SIGNED BY PHYSICIAN OR SENIOR APC

· Any person > 40 with chest pain

· Any person of any age with chest pain and risk factors.

Respiratory:

· Any person > 60 complaining of dyspnea.

· Any person with respiratory rate outside of the normal range for age.

· Any person with accessory muscle use, retractions, or pursed lip breathing

· Any person requiring oxygen

· Any person with saturations < 92%

· Any person with comorbidities

Neurological:

· Any person that’s a possible Stroke Alert

· Any person with a new neurological deficit.

· Any person with alteration of their baseline mental status

Psychological:

· Any person that is acutely agitated that cannot be verbally deescalated.

· Any person that is expressing suicidal/homicidal ideation

· Any person presenting with auditory/visual hallucinations

Abdominal:

· Any person > 60 with abdominal pain

Laboratory:

· Any person with an unexplained leukocytosis

· Any person with a lactic acidosis

· Any person with an anion gap

· Any person with an acute abnormality of renal or liver function