Other Issues

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 […]

Emergency departments utilizing a “provider in triage” model should: Ensure that providers have an opportunity to perform an appropriate history and physical prior to ordering diagnostic testing; Conduct appropriate reviews to verify that over-testing is not occurring from triage based providers; Provide advance practice providers with supervision and support by board certified emergency physicians. Approved […]

The introduction of the electronic medical records system into the practice of medicine has brought great benefits and presented great challenges to the doctor patient relationship.                                 Multiple studies have shown both benefits and detriments with EMRs. Benefits include a reduction in medication errors, which is the number one cause of adverse events,1 and fast […]

AAEM opposes the oversight and management of emergency medicine residency programs by contract management groups with lay ownership. AAEM is concerned that this arrangement raises significant conflicts of interests between a residency program's educational mission and the contract management group's fiduciary duty to its shareholders.   Approved: 9/7/17  

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 […]

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 (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 (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 […]

AAEM believes that evidence for testing psychiatric patients as part of medical clearance process clearly states that the testing should be clinically based, similar to other patients in the ED, and, individually based upon the particular patient presentation.  Consistent with the literature on the topic, AAEM opposes routine laboratory testing of psychiatric patients in the […]

The number of psychiatric patients who present to emergency departments (EDs) has increased in the last few years; many of these patients will need to be admitted to an inpatient bed. The care of psychiatric patients in the ED is commonly delayed by limited involvement of psychiatric specialty personnel and lack of psychiatric resources in […]

AAEM encourages prescriber and pharmacist access to prescription drug monitoring programs (PDMPs), which can be a useful tool to identify possible prescription drug abuse. AAEM supports the interstate data sharing between state PDMPs and calls for standardization between states and the eventual creation of a federal PDMP. PDMPs should report prescriptions in real-time and be […]

It is the position of the American Academy of Emergency Medicine that, when properly applied to an individual patient for whom the clinician already has a low clinical suspicion for PE, based on a gestalt impression, the Pulmonary Embolism Rule-Out Criteria (PERC) meets the standard of care for EM. When a patient is PERC negative […]

The American Academy of Emergency Medicine (AAEM) opposes joint ventures between a hospital or hospital system and a corporate emergency medicine contract management group (CMG) whereby a portion of the emergency physician professional fee is distributed to the hospital or hospital system and the CMG in excess of fair market value for services performed.  Such an arrangement […]

Emergency departments and emergency physician’s primary directive is to care for ill and traumatized patients presenting in an unscheduled fashion. This is constructed without regard for ability to pay and with a high expectation for accurate and timely evaluation and management to exclude and treat emergent and urgent life and limb-threatening conditions. Increasingly limited resources […]

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 […]

The American Academy of Emergency Medicine, recognizing recent international reports of governmental interference with emergency care and at the request of our emergency physician colleagues in some of the affected countries, condemns any activities by governmental or non-governmental agencies that interfere with the normal operation of emergency services. Accordingly, the American Academy of Emergency Medicine […]

Reviewed and approved by the AAEM Board of Directors 2/14/2010.

Reviewed and approved by the AAEM Board of Directors 2/14/2010.

Reviewed and approved by the AAEM Board of Directors 2/14/2010 Answer: Yes. Though adoption of EGDT has been slow and multiple barriers exist, it appears that EGDT improves mortality in adult patients with septic shock. Further study is needed, however, to quantify the exact effect size of each individual component and the protocol in its […]