Clinical Practice Statements

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 occur for patients and risk prediction scores may facilitate or expedite the conversation. […]

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 0.9% normal saline (when available) in patients with sepsis. The use of albumin does […]

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, intravenous fluid, and maintenance of adequate mean arterial pressure are critical interventions in the care of […]

IntroductionSub-dissociative dose ketamine (low-dose ketamine) is useful and safe to use alone or in combination with opioid analgesics for the treatment of acute pain in the Emergency Department (ED) and in pre-hospital settings. Its use is associated with higher rates of minor but well tolerated adverse side effects. In order to identify manuscripts for review […]

Executive SummaryAppropriate patients may be eligible for mechanical thrombectomy whether or not they have previously received intravenous t-PA, and whether or not they presented to a center capable of this specialized technique. Based on several recent randomized controlled trials, mechanical treatment reduces long-term disability in properly selected patients with acute ischemic stroke due to large […]

IntroductionThe successful use of intravenous fat emulsion (IFE) for the adverse effects associated with local anesthetics has led to its consideration as an effective antidote for multiple xenobiotics/substances (1, 2, 3, 4, 5, 6) . Similar to most toxicology research, the evidence is completely reliant on animal experiments and human case reports. In addition to […]

Position StatementCurrent evidence suggests that patients with acute cholecystitis who are under 70 years of age and without risk factors should undergo early cholecystectomy during their initial hospital stay, preferably within 24-48 hours after onset of symptoms. DiscussionAcute cholecystitis (AC) is an acute inflammation of the gallbladder. In the US, gallstones are present in over […]

IntroductionInfluenza is an acute respiratory virus that is responsible for both epidemic and pandemic outbreaks of disease. There are three types of Influenza (A, B, and C) that are further subtyped based on surface proteins. Currently, A (H1/N1) and A (H3/N2) are the subtypes circulating in humans (1). The annual global prevalence of seasonal influenza […]

Executive summaryComputed tomography angiography (CTA) of the brain is a reasonable test to consider when evaluating select patients for subarachnoid hemorrhage after a negative non-contrast computed tomography of the brain. The benefits and risks of CTA of the brain need to be considered by the treating physician. DiscussionAcute onset headache is a common presenting complaint […]

Policy StatementIt is the position of the American Academy of Emergency Medicine that ultrasound should be integrated into the core curriculum of undergraduate medical education. BackgroundMedical diagnostic ultrasound has been used by various specialties since the 1950s. Contemporary point of care ultrasound (POCUS) was first researched and utilized byemergency physicians in the mid 1980s. Emergency […]

Executive summaryPain is one of the most common chief complaints among emergency department patients with a reported rate of over 50%.(1) There is great variability among emergency clinicians in the management of pain, especially with respect to the use of opioid medications.(2) Importantly, morbidity and mortality have increased as the frequency of opioid use for […]

It is the position of the American Academy of Emergency Medicine that when appropriate expertise is available ultrasonography (US) should be strongly considered as the initial imaging modality when evaluating the pediatric patient with suspected acute appendicitis who requires imaging. Background A growing body of research supports the use of ultrasonography as the initial imaging […]

Clinical Policy StatementUtilization of ultrasound (US) as the initial imaging screening tool for appendicitis in adults can reduce the need for computer tomography (CT) and exposure to ionizing radiation. SummaryAcute appendicitis continues to be the most frequent cause of acute abdominal emergency in the United States. However, the diagnosis of appendicitis is challenging. As a […]

Droperidol (Inapsine®) is a butyrophenone used in emergency medicine practice for control of psychosis/agitation (1), as an antiemetic (2), for vertigo (3), as an adjunct analgesic (especially in opioid-tolerant patients) and as a treatment for benign headache (4). Initially produced in 1961, it has numerous sites of biochemical activity, mostnotably as a dopamine receptor antagonist […]

Clinical Policy StatementIt is the position of the American Academy of Emergency Medicine that emergency physicians must be permitted by hospital bylaws and credentialing procedures to utilize propofol (and other sedating agents) for the induction of procedural sedation, without an anesthesiologist present. SummaryA large body of research supports the assertion that propofol and other sedating […]

Critically ill emergency department (ED) patients that require admission to the intensive care unit (ICU) often utilize significant personnel, time, and equipment when compared to patients who do not require ICU level care. In many EDs, critical resources can quickly be depleted. This has the potential to adversely affect the care provided to these critically […]

On December 11, 2009, the Centers for Medicare and Medicaid Services (CMS) published revised Hospital Anesthesia Services Interpretive Guidelines. These guidelines apply to the Conditions of Participation of hospitals in Medicare. The American Academy of Emergency Medicine (AAEM) Board of Directors is particularly concerned with the provision stating, All services along the continuum of anesthesia […]

SummaryAccurate, timely interpretations of radiologic studies by board-certified radiologists are necessary to provide the best patient care and promote patient safety. This can only be accomplished if attending radiologists are interpreting studies while clinical care is being provided. Emergency physicians should insist on timely attending radiologist interpretations of radiological studies, even during off-hours. BackgroundIn order […]

Every year, more than 8 million Americans present to the emergency department (ED) with chest pain, making it the 2nd most common complaint in the ED [1]. Although <5% of low-risk chest pain patients are found to have an acute myocardial infarction (MI) [2], many are admitted to the hospital for further evaluation. Telemetry monitoring […]

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 abrupt onset of non-pitting, non-pruritic swelling that involves the reticular dermis, subcutaneous, and submucosal layers. Lesions are […]

It is the position of the American Academy of Emergency Medicine that emergency physicians should not obtain informed consent for any procedure they will not personally perform or supervise. DiscussionWith respect to patients who present to the Emergency Department with STEMI, the American Heart Association recommends a door-to-balloon time of 90 minutes or less. In […]

The American Academy of Emergency Medicine is aware that some emergency physicians (EPs) are being compelled to provide dual simultaneous coverage for both the ED and the inpatient hospitalist services. This dual-coverage requires EPs to leave the emergency department (ED) to manage routine and non-urgent medical problems of hospitalized patients. Emergency physicians should not provide […]

Use of Conducted Energy Weapons (CEW) such as the TASER includes delivery of a series of brief electrical pulses, which result in pain and muscular contractions. The pulses may be delivered via a pair of sharp metal probes fired from the device, commonly referred to as “probe mode”, or by direct contact with the front […]

Parenteral opioids are the most common analgesics used in the Emergency Department for relief of acute pain. Gastrointestinal side effects such as nausea andvomiting 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 clear and supporting evidence, it has […]

With the advent of more sophisticated CT scanners, imaging without contrast (unenhanced) is increasingly utilized in the evaluation of adults with suspectedacute appendicitis. Oral contrast presents a significant delay to imaging. Intravenous contrast presents the small, but real risks of allergic reaction andcontrast nephropathy. There is sufficient literature to support the use of unenhanced CT […]