ACEP clinical policies - Revision history

Danbot: Strip excess bold

2026-03-22T09:38:06Z

Strip excess bold

Elcatracho: /* See Also */

2021-01-19T00:56:30Z

Elcatracho: /* Syncope (2007) Clinical Policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med. 2007;49:431-444 */

2021-01-19T00:50:33Z

Syncope (2007) Clinical Policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with syncope. Ann Emerg Med. 2007;49:431-444

← Older revision		Revision as of 00:50, 19 January 2021
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	***History or presence of heart failure, CAD< or structural heart disease		***History or presence of heart failure, CAD< or structural heart disease
	*'''Level C:'''		*'''Level C:'''
	**Lab testing and advanced investigative testing such as echo or cranial CT need not be routinely performed unless guided by specific findings in the History and PE.		**Lab testing and advanced investigative testing such as echo or cranial CT need not be routinely performed unless guided by specific findings in the History and PE.

			==[[Transient ischemic attack\|Suspected transient ischemic attack (2016)]]==
			*'''Level B:'''
			**In adult patients with suspected TIA, do not rely on current existing risk stratification instruments (eg, age, blood pressure, clinical features, duration of TIA and presence of diabetes [ABCD2] score) to identify TIA patients who can be safely discharged from the ED.
			**In adult patients with suspected TIA without high-risk conditions, a rapid ED-based diagnostic protocol may be used to evaluate patients at short-term risk for stroke. High-risk conditions include abnormal initial head CT result (if obtained), suspected embolic source (presence of atrial fibrillation, cardiomyopathy, or valvulopathy), known carotid stenosis, previous large stroke, and crescendo TIA.
			*'''Level C:'''
			**(1) The safety of delaying neuroimaging from the initial ED workup is unknown. If noncontrast brain MRI is not readily available, it is reasonable for physicians to obtain a noncontrast head CT as part of the initial TIA workup to identify TIA mimics (eg, intracranial hemorrhage, mass lesion). However, noncontrast head CT should not be used to identify patients at high short-term risk for stroke. (2) When feasible, physicians should obtain MRI with diffusion-weighted imaging (DWI) to identify patients at high short-term risk for stroke. (3) When feasible, physicians should obtain cervical vascular imaging (eg, carotid ultrasonography, CTA, or MRA) to identify patients at high short-term risk for stroke.
			**In adult patients with suspected TIA, carotid ultrasonography may be used to exclude severe carotid stenosis because it has accuracy similar to that of MRA or CTA.

	==See Also==		==See Also==

Ostermayer: Text replacement - " PE " to " PE "

2017-01-27T17:30:17Z

Text replacement - " PE " to " PE "

← Older revision		Revision as of 17:30, 27 January 2017
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	*''Exclusion:'' Children or for patients whom episode of syncope is thought to be secondary to another disease process		*''Exclusion:'' Children or for patients whom episode of syncope is thought to be secondary to another disease process
	*'''Level A:'''		*'''Level A:'''
	**History and PE consistent with heart failure help identify patients at high risk for an adverse outcome.		**History and [[PE]] consistent with heart failure help identify patients at high risk for an adverse outcome.
	**Standard 12-lead ECG		**Standard 12-lead ECG
	*'''Level B:'''		*'''Level B:'''

Zipdoc at 07:50, 31 December 2016

2016-12-31T07:50:34Z

← Older revision		Revision as of 07:50, 31 December 2016
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	**Refer for outpatient follow up.		**Refer for outpatient follow up.

	==tPA for [[Thrombolysis in Acute Ischemic Stroke (tPA)\|Acute Ischemic Stroke]] (~~2012~~)<ref> Clinical Policy: Use of intravenous ~~tPA~~ for the management of acute ischemic stroke in the emergency department. Ann Emerg Med. ~~2013~~;61:~~225~~-~~243~~.[~~http~~://www.acep.org/Clinical---Practice-Management/Clinical-Policy--Use-of-Intravenous-~~tPA~~-for-the-Management-of-Acute-Ischemic-Stroke-in-the-Emergency-Department/ PDF]</ref>==		==tPA for [[Thrombolysis in Acute Ischemic Stroke (tPA)\|Acute Ischemic Stroke]] (2015)<ref> Clinical Policy: Use of intravenous tissue plasminogen activator for the management of acute ischemic stroke in the emergency department. Ann Emerg Med. 2015;66:322-333.[https://www.acep.org/Clinical---Practice-Management/Clinical-Policy--Use-of-Intravenous-Tissue-Plasminogen-Activator-for-the-Management-of-Acute-Ischemic-2-Stroke-in-the-Emergency-Department---NEW/ PDF]</ref>==
	*''Inclusion:'' Adult patients presenting to ED with acute ischemic stroke		*''Inclusion:'' Adult patients presenting to ED with acute ischemic stroke
	*''Exclusion:'' Children < 18 years		*''Exclusion:'' Children < 18 years
	*'''Level A:'''		*'''Level A:'''
	**~~Offer IV tPA to acute ischemic stroke patients who meet NINDS inclusion/exclusion criteria and can be treated within 3 hours after symptom onset~~.		**None.
	*'''Level B:'''		*'''Level B:'''
	**~~To consider~~ IV tPA to acute ischemic stroke patients who meet ~~ECASS III~~ inclusion/exclusion criteria and can be treated ~~between~~ 3 to 4.5 hours ~~after~~ symptom onset.		**Offer IV tPA to acute ischemic stroke patients who meet NINDS inclusion/exclusion criteria and can be treated within 3 hours after symptom onset. Consider increased risk of symptomatic intracranial hemorrhage in decision to administer tPA. (May consider administration in carefully selected patients presenting within 3-4.5 hours of symptom onset.)

	==Prescribing [[Opioids]] (2012)<ref>Clinical policy: Critical issues in the prescribing of opioids for adult patients in the emergency department. Ann Emerg Med. 2012;60:499-525.[http://www.acep.org/Clinical---Practice-Management/Clinical-Policy--Critical-Issues-in-the-Prescribing-of-Opioids-for-Adult-Patients-in-the-Emergency-Department/ PDF]</ref>==		==Prescribing [[Opioids]] (2012)<ref>Clinical policy: Critical issues in the prescribing of opioids for adult patients in the emergency department. Ann Emerg Med. 2012;60:499-525.[http://www.acep.org/Clinical---Practice-Management/Clinical-Policy--Critical-Issues-in-the-Prescribing-of-Opioids-for-Adult-Patients-in-the-Emergency-Department/ PDF]</ref>==

Mholtz at 05:44, 31 December 2016

2016-12-31T05:44:37Z

← Older revision		Revision as of 05:44, 31 December 2016
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	==~~Guidelines for ACEP Clinical Policy~~==		==Background==


			==Recommendation Levels==
	*'''Level A:''' Generally accepted principles for patient management that reflect high degree of clinical certainty.		*'''Level A:''' Generally accepted principles for patient management that reflect high degree of clinical certainty.
	*'''Level B:''' Recommendations for patient management that may identify a particular strategy or range of management strategies that reflect moderate clinical certainty.		*'''Level B:''' Recommendations for patient management that may identify a particular strategy or range of management strategies that reflect moderate clinical certainty.
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	**Lab testing and advanced investigative testing such as echo or cranial CT need not be routinely performed unless guided by specific findings in the History and PE.		**Lab testing and advanced investigative testing such as echo or cranial CT need not be routinely performed unless guided by specific findings in the History and PE.

	==~~Sources~~==		==See Also==


			==References==
	<references/>		<references/>

	[[Category:Misc/General]]		[[Category:Misc/General]]

Neil.m.young: Text replacement - "Cr " to "creatinine "

2016-08-11T09:50:45Z

Text replacement - "Cr " to "creatinine "

← Older revision		Revision as of 09:50, 11 August 2016
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	*'''Level C:'''		*'''Level C:'''
	**Routine screening for acute target organ injury (Cr, UA, ECG) not required		**Routine screening for acute target organ injury (Cr, UA, ECG) not required
	**In select patient population ( poor follow up), screening Cr may identify kidney injury that affects disposition.		**In select patient population ( poor follow up), screening creatinine may identify kidney injury that affects disposition.
	**Routine ED medical intervention not required.		**Routine ED medical intervention not required.
	**May treat elevated BP in ED +/or initiate therapy for long term control in select patients.		**May treat elevated BP in ED +/or initiate therapy for long term control in select patients.

Neil.m.young: Text replacement - "* " to "*"

2016-08-03T14:29:26Z

Text replacement - "* " to "*"

← Older revision		Revision as of 14:29, 3 August 2016
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	**If opioids indicated, prescription for lowest practical dose for limited duration <1 week), and should consider risk for misuse, abuse, or diversion.		**If opioids indicated, prescription for lowest practical dose for limited duration <1 week), and should consider risk for misuse, abuse, or diversion.
	**Avoid prescribing outpatient opioids for a patient with an acute exacerbation of chronic non-cancer pain.		**Avoid prescribing outpatient opioids for a patient with an acute exacerbation of chronic non-cancer pain.
	** Honor existing patient-physician pain contracts/treatment agreements and consider past prescription patterns.		**Honor existing patient-physician pain contracts/treatment agreements and consider past prescription patterns.

	==[[Head CT in Trauma\|Neuroimaging and decision making in TBI]] (2008)<ref> Clinical policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 2008;52:714-748.</ref>==		==[[Head CT in Trauma\|Neuroimaging and decision making in TBI]] (2008)<ref> Clinical policy: Neuroimaging and decisionmaking in adult mild traumatic brain injury in the acute setting. Ann Emerg Med. 2008;52:714-748.</ref>==

Rossdonaldson1: Text replacement - " phenytoin" to " phenytoin"

2016-08-03T09:47:19Z

Text replacement - " phenytoin" to " phenytoin"

← Older revision		Revision as of 09:47, 3 August 2016
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	**Administer additional antiepileptic medication in refractory status epilepticus who have failed treatment with BZDs		**Administer additional antiepileptic medication in refractory status epilepticus who have failed treatment with BZDs
	*'''Level B:'''		*'''Level B:'''
	**Administer IV phenytoin, fosphenytoin, or valproate in refractory status epilepticus who have failed BZD		**Administer IV [[phenytoin]], fosphenytoin, or valproate in refractory status epilepticus who have failed BZD
	*'''Level C:'''		*'''Level C:'''
	**EP need not initiate antiepileptic medication in ED for 1st time provoked seizure. Identify and treat precipitating medical conditions.		**EP need not initiate antiepileptic medication in ED for 1st time provoked seizure. Identify and treat precipitating medical conditions.

Rossdonaldson1: Text replacement - "pulm " to "pulmonary "

2016-07-31T08:38:35Z

Text replacement - "pulm " to "pulmonary "

← Older revision		Revision as of 08:38, 31 July 2016
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	*''Inclusion:''		*''Inclusion:''
	*Patients of all age with emergent/urgent condition that require pain +/or anxiety management to accomplish interventional or diagnostic procedure		*Patients of all age with emergent/urgent condition that require pain +/or anxiety management to accomplish interventional or diagnostic procedure
	*High-risk patients (~~cardiopulm~~ d/o, multiple/head trauma, CNS depressant) w understanding that these patients are at increased risk of complications from procedural sedation and analgesia.		*High-risk patients (cardiopulmonary d/o, multiple/head trauma, CNS depressant) w understanding that these patients are at increased risk of complications from procedural sedation and analgesia.
	*''Exclusion:''		*''Exclusion:''
	**Inhalational anesthetics		**Inhalational anesthetics

← Older revision		Revision as of 00:56, 19 January 2021
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	==See Also==		==See Also==

			==External Links==
			[https://www.acep.org/patient-care/clinical-policies/ ACEP Clinical Policies]

	==References==		==References==