Flipped Classroom Session: 3/9/2016 @LakelandHealthEMResidency
TASK: Create “on the spot” Summaries of ACEP clinical policies
WHY: Get quick overview of ACEP clinical policies to understand current practices of care in our EM Community.
- For first time generalized convulsive seizure who has returned to baseline.
- Provoked seizure – no antiepileptic med; identify and treat cause of seizure.
- Unprovoked seizure (without evidence of brain disease or injury) – no antiepileptic med.
- May initiate antiepileptics or defer care to other providers for first unprovoked seizure with history of brain disease or injury.
- Patients with first time unprovoked seizure may not require admission.
- In patients with generalized convulsive status epileptics who continue to seize after administration of optimal dosing of benzos further options include IV phenytoin, fosphenytoin, valproate. keppra, propofol, phenobarbital.
- Pre-procedural fasting is not required when sedation is needed in emergent situations.
- Capnography – May be useful in the early detection of apnea and hypoventilation
- Multiple induction agents are considered safe to include: Ketamine, Propofol, Etomidate
Thoracic Aortic Dissection
- Do not rely on D-dimer alone to exclude the diagnosis of aortic dissection.
- Emergency physicians may use CTA to exclude thoracic aortic dissection because it has accuracy similar to that of TEE and MRA.
- In patients with asymptomatic markedly elevated blood pressure, routine ED medical intervention is not required.
- In select patient populations (eg, poor follow-up), emergency physicians may treat markedly elevated blood pressure in the ED and/or initiate therapy for long-term control.
- Patients with asymptomatic markedly elevated blood pressure should be referred for outpatient follow-up.