Clinical Practice Statements

Contrary to popular beliefs, health outcomes are driven only to a small degree by healthcare, and driven far more by what are called the “social determinants of health” (SDOH). Emergency physicians (EPs) are perfectly situated to provide both local and national leadership to recognize and address such social factors. There are many ways in which […]

Ketamine is a medication that can be utilized in the emergency department and prehospital setting for the sedation of the severely agitated patient. After an incident involving the misuse of prehospital ketamine received attention in the lay press, the safety and appropriateness of the prehospital use ketamine was brought into question. This clinical practice statement […]

Emergency Department (ED) overcrowding and resulting delayed patient care is a rapidly growing worldwide problem leading to increased mortality and morbidity. (39,40,41) ED triage presents the first opportunity to promptly identify high-risk patients and efficiently allocate ED resources. Current ED triage systems have suboptimal ability to differentiate critically ill patients due to subtle signs or […]

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 progresses to multi-organ dysfunction and potentially death.(1,2) Depending on the patient population, mortality […]

Statement reviewed and approved by AAEM Board of Directors. (4/23/2022) Executive SummaryEmergency departments (ED) and emergency medical services (EMS) are motivated to increase survival following sudden out of hospital cardiac arrest (OHCA).1 Extracorporeal cardiopulmonary resuscitation (ECPR) has been promoted as an option but substantial uncertainty exists regarding how to select patients.2 Recently, a single-center randomized […]

Statement reviewed and approved by the AAEM Board of Directors. (4/23/2022) Every day, we manage many complicated patients in the fast-paced environment of the Emergency Department (ED). This work includes making phone calls, answering questions (from physicians, students, patients, and families), charting, and reviewing clinical data. The 2020 Position statement from the Academy of Academic […]

Statement reviewed and approved by AAEM Board of Directors. (11/10/2021)Summary Recommendation: References and Literature Grading (PDF)

Statement reviewed and approved by AAEM Board of Directors. (9/16/2021) What is Palliative Care?The Center to Advance Palliative Care has provided the following definition: Early involvement is associated with greater benefits, including improved quality and reduced cost of care. An increasing number of professional society guidelines recommend early palliative involvement, eg., American College of Emergency […]

Statement reviewed and approved by AAEM Board of Directors. (9/14/2020)Updated 4/26/2021 and 8/16/2021. Recommendations: Executive Summary Reference and Literature Grading (PDF)

Statement reviewed and approved by AAEM Board of Directors. (4/8/2021) Summary Recommendation:There is substantial clinical uncertainty regarding the management of head injured patients taking DOACs for delayed intracranial hemorrhage (ICH) as there are no high-quality studies evaluating this question. DOACs have been generally shown to have a reduced rate of mortality, hemorrhagic stroke, and intracranial […]

Statement reviewed and approved by AAEM Board of Directors. (11/12/2020) Recommendations: Reference and Literature Grading (PDF)

IntroductionManagement of emergency department (ED) patients with severe sepsis and septic shock focuses on early identification, hemodynamic resuscitation, and appropriate antibiotic administration.[1] The 2012 Surviving Sepsis Campaign guidelines for the management of patients with severe sepsis and septic shock recommend that antibiotics be administered within the first hour of recognition of severe sepsis or septic […]

Reviewed and approved by the AAEM Board of Directors. (June 5, 2020) Recommendations:1) Triage nurse-ordered testing reduces Emergency Department length of stay, though the overalldecrease in time is small. The decision to utilize triage nurse-ordered testing should weigh thepotential time saved versus the risk of extraneous testing.2) Limited data suggests that triage nurse-ordered testing is […]

Reviewed and approved by the AAEM Board of Directors. (4/19/2020) Recommendations: Introduction:In 2011, the Clinical Practice Committee (CPC) of the American Academy of EmergencyMedicine (AAEM) published a statement on Telemetry Bed Usage for Patients with Low RiskChest Pain. The high-level conclusions of this statement were: Reference and Literature Grading (PDF)

Reviewed and approved by the AAEM Board of Directors. (10/7/2019) Recommendations: Introduction: Use of Conducted Energy Weapons (CEW) such as the TASER includes delivery of a series of brief electrical pulses, which result in painful muscular contractions. The pulses may be delivered via three possible mechanisms. The delivery may be via a pair of metal […]

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 in effective pain therapy.1 Despite the lack of clear and […]

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 (MRI), and ultrasound (US) are the imaging modalities that can be used to diagnosis appendicitis. For non-pregnant […]

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, there are concerns from ED clinicians using qSOFA in […]

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 problem. Until recently, there has been little change in the treatment options […]

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 colleagues in 2001, numerous lactate measurement strategies have been introduced, including lactate clearance and […]

Submit the paper in initial format as written by the author(s) to Dr. Gary Vilke, our JEM "expediter.” He can send it to the appropriate editor for expedited review. (no sharing of authorship with this route and it is presumably not as involved as getting it published as an outsider sending it to JEM for […]

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 spectrum antibiotics is standard. Consideration of testing and treatment for possible […]

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 inhibits both free and fibrin-bound thrombin. Current indications include prevention and […]

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 testing can essentially rule-out PE. The prevalence of PE increases with age, but D-dimer […]

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 used to determine the size and location of a suspected ureteral stone […]