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Do Steroids Improve Clinically Relevant Outcomes in Patients with Septic Shock? February 01, 2023
Sepsis is a dysregulated host response to infection that may progress to septic shock, a state of global hypoperfusion that often requires fluid resuscitation and vasopressors to support adequate oxygen delivery. Septic shock results in both macro- and microcirculatory failure, which ultimately pro …

Clinical Practice Statements, Other Issues
What Evaluations Are Needed in the Emergency Department Patients after a TASER Device Activation? October 07, 2019
Reviewed and approved by the AAEM Board of Directors. (10/7/2019) Recommendations: The routine performance of EKGs, prolonged ED observation or hospitalization for ongoing cardiac monitoring is not indicated after CEW exposure in an otherwise asymptomatic awake and alert patient with a s …

Clinical Practice Statements, Other Issues
Should Antiemetics be Given Prophylactically with Intravenous Opioids While Treating Acute Pain in the Emergency Department? June 07, 2019
Parenteral opioids are the most common analgesics used in the emergency department (ED) for relief of acute pain. Gastrointestinal side effects such as nausea and vomiting are common following opioid analgesia in long-term therapy for malignant and chronic pain and are considered a limiting factor …

Clinical Practice Statements, Other Issues
What Is the Role of Intravenous and Intraoral Contrast in CT Evaluation of Acute Appendicitis? June 07, 2019
Reviewed and approved by the AAEM Board of Directors. (6/7/2019) IntroductionPatients presenting to the emergency department (ED) with abdominal pain and concern for appendicitis typically require diagnostic imaging to confirm the diagnosis. Computer tomography (CT), magnetic resonance imaging ( …

Clinical Practice Statements, Other Issues
The Use of qSOFA in the Emergency Department April 08, 2019
Introduction:The concept of sepsis has recently been redefined by an International Task Force. The task force recommended the use of the qSOFA score instead of SIRS criteria to identify patients at high risk of mortality from sepsis outside of the ICU, including in Emergency Departments. However, t …

Clinical Practice Statements, Other Issues
What is the Role of Thrombolysis in Intermediate Risk Pulmonary Embolism? with references November 28, 2018
Reviewed and approved by the AAEM Board of Directors (11/28/2018) IntroductionPulmonary embolism (PE) remains a leading cause of cardiovascular mortality1 resulting in an estimated 150,000 deaths annually2 in the United States. With a 3-month mortality rate of 9-15%,3,4 PE presents an important …

Clinical Practice Statements, Other Issues
Is Lactate Measurement in the Emergency Department Valuable as a Predictor of Poor Outcomes in Adult Patients with Sepsis? November 28, 2018
Reviewed and approved by the AAEM Board of Directors (11/28/2018) Introduction Current emergency department (ED) management of sepsis includes serial measurements of serum lactate. Since the initial publication of the Surviving Sepsis Campaign Guidelines and the landmark study by Rivers and coll …

Clinical Practice Statements, Other Issues
During the Emergency Department Evaluation of a Well Appearing Neonate with Fever, Should Empiric Acyclovir be Initiated? July 10, 2017
Reviewed and approved by the AAEM Board of Directors (7/10/2017) IntroductionDuring the assessment of a febrile neonate, defined as less than 28 days of age, initiation of a full septic work-up including blood, urine and cerebrospinal fluid (CSF) analysis followed by administration of broad spec …

Clinical Practice Statements, Other Issues
What is the Role of Reversal Agents in the Management of ED Patients with Dabigatran-Associated Hemorrhage? June 30, 2017
Reviewed and approved by the AAEM Board of Directors (6/7/2017) IntroductionDabigatran was approved by the Food and Drug Administration (FDA) in 2010 and was the first nonwarfarin oral anticoagulant (NOAC) to be introduced to the U.S. market. Dabigatran is a direct thrombin inhibitor that inhibi …

Clinical Practice Statements, Other Issues
Can an Age-Adjusted D-Dimer be Used to Safely Rule Out Pulmonary Embolism in Emergency Department Patients? March 20, 2017
Reviewed and approved by the AAEM Board of Directors (3/20/2017) Introduction: Pulmonary embolism (PE) is a serious, potentially fatal condition, but is difficult to safely rule out using only clinical features. Studies have demonstrated that a combination of risk-stratification and D-dimer test …

Clinical Practice Statements, Other Issues
Ultrasound for the Diagnosis and Management of Ureterolithiasis in the Emergency Department March 17, 2017
Reviewed and approved by the AAEM Board of Directors (3/17/2017) IntroductionThe work-up of uncomplicated suspected ureterolithiasis has been shown to be expeditious when ultrasound is the diagnostic modality of choice. Classically, a non-contrast cat scan (CT) of the abdomen and pelvis has been …

Clinical Practice Statements, Other Issues
What is the Preferred Resuscitation Fluid for Patients with Sepsis and Septic Shock? March 17, 2017
Reviewed and approved by the AAEM Board of Directors (3/17/2017). Answer: Crystalloid solutions remain the resuscitative fluid of choice for patients with sepsis and septi shock. Balanced crystalloid solutions may improve patient-centered outcomes and should be considered as an alternative to 0. …

Clinical Practice Statements, Other Issues
tPA and Ischemic Stroke: Focused Update of 2010 Clinical Practice Advisory from the AmericanAcademy of Emergency Medicine March 17, 2017
Reviewed and approved by the AAEM Board of Directors (3/17/2017) Executive Summary:No new studies published between 2010 and 2016 meaningfully reduced uncertainty regarding our understanding of the benefits and harms of tPA for acute ischemic stroke. Discussions regarding benefit and harm should …

Clinical Practice Statements, Other Issues
Does Early Goal-Directed Therapy Decrease Mortality Compared with Standard Care in Patients with Septic Shock? February 17, 2016
Reviewed and approved by the AAEM Board of Directors (2/17/2016) Answer: No. However, standard care has significantly improved since the publication of the original EGDT trial. Early recognition of sepsis, prompt administration of appropriate antimicrobial therapy, urgent source control, intrave …

Clinical Practice Statements, Other Issues
What is the Emergency Department Management of Patients with Angioedema Secondary to an ACE-inhibitor? April 11, 2011
Update to 2006 guideline reviewed and approved by the AAEM Board of Directors 4/11/2011. Angiotensin-converting-enzyme (ACE) inhibitors are one of the most commonly prescribed antihypertensive medications worldwide. A known adverse effect of ACE-inhibitors is angioedema, characterized by the abr …

Clinical Practice Statements, Other Issues
Does Early Goal Directed Therapy Decrease Mortality in Patients with Septic Shock? February 14, 2010
Reviewed and approved by the AAEM Board of Directors 2/14/2010 Define the Issue and State the Question A. Topic Area: Sepsis B. General Issue: Early goal directed therapy C. Specific Question: Does early goal directed therapy decrease mortality in patients with septic shock? D. Execut …

Clinical Practice Statements, Other Issues
Does the Urine Dipstick and/or the Urine Microanalysis Correlate with a Culture Positive UTI in Febrile Children? February 14, 2010
Reviewed and approved by the AAEM Board of Directors 2/14/2010. Define the Issue and State the Question A. Topic Area: _______Pediatric fever_____________ B. General Issue: __Urinary tract infection ___________ C. Specific Question: _Does the urine dipstick and or the urine microana …

Clinical Practice Statements, Other Issues
Do Steroids Administered in the Emergency Room Improve Mortality or Shock Reversal in Patients with Septic Shock? February 14, 2010
Reviewed and approved by the AAEM Board of Directors 2/14/2010. Define the Issue and State the Question A. Topic Area: Sepsis B. General Issue: Steroid administration in septic shock C. Clinical Question: Do steroids administered in the emergency room improve mortality or shock reversa …

Clinical Practice Statements, Other Issues
During the Emergency Department Evaluation of a Well Appearing Neonate (<30 days of age) with a Fever, Should Empiric Acyclovir be Initiated? January 11, 2010
Reviewed and approved by the AAEM Board of Directors 1/11/2010. Define the Issue and State the Question A. Topic Area: PEDIATRIC FEVER: NEONATAL HERPES INFECTION B. General Issue: NEONATAL HERPES INFECTION C. Specific Question: DURING THE EMERGENCY DEPARTMENT EVALUATION OF A WELL A …

Clinical Practice Statements, Other Issues
The Measurement of Time to Antibiotics for Admitted Patients with Community-Acquired Pneumonia (CAP) in the ED March 09, 2009
Reviewed and approved by the AAEM Board of Directors 3/1/2009. Define the Issue and State the Question A. Topic Area: The measurement of time to antibiotics for admitted patients with community-acquired pneumonia (CAP) in the ED. B. General Issue: Unintended consequences of the implementati …

Clinical Practice Statements, Other Issues