EBM

EBM/Flipped Classroom ACEP clinical policy summary

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.

SOURCE: http://www.acep.org/Clinical—Practice-Management/ACEP-Current-Clinical-Policies

Seizures

  1. For first time generalized convulsive seizure who has returned to baseline.
  2. Provoked seizure – no antiepileptic med; identify and treat cause of seizure.
  3. Unprovoked seizure (without evidence of brain disease or injury) – no antiepileptic med.
  4. May initiate antiepileptics or defer care to other providers for first unprovoked seizure with history of brain disease or injury.
  5. Patients with first time unprovoked seizure may not require admission.
  6. 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.

Sedation

  1. Pre-procedural fasting is not required when sedation is needed in emergent situations.
  2. Capnography – May be useful in the early detection of apnea and hypoventilation
  3. Multiple induction agents are considered safe to include: Ketamine, Propofol, Etomidate

Thoracic Aortic Dissection

  1. Do not rely on D-dimer alone to exclude the diagnosis of aortic dissection.
  2. Emergency physicians may use CTA to exclude thoracic aortic dissection because it has accuracy similar to that of TEE and MRA.

Hypertension 

  1. In patients with asymptomatic markedly elevated blood pressure, routine ED medical intervention is not required.
  2. 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.
  3. Patients with asymptomatic markedly elevated blood pressure should be referred for outpatient follow-up.

http://www.lakelandhealth.org/gmemain/residencyprograms/emergency-medicine-residency

 

 

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