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EM Pharmacotherapy Guidelines and Position Statements: Resource for ED Rotations

Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP |

EM Pharmacotherapy GuidelinesSeveral years ago I created a resource for my ED rotation that I share with pharmacy students, pharmacy residents, and EM physician residents. It contains most of the guidelines and position statements on EM drug therapy that I utilize most often and is updated as new iterations are published. We’d like to share this tool with you to be used/modified to meet your rotation needs.

Last updated: February 22, 2018

Acute Coronary Syndromes

  • Non-ST-elevation acute coronary syndromes1 [2014, American Heart Association/American College of Cardiology]
  • ST-elevation myocardial infarction2 [2013, AHA/ACC]

Advanced Cardiac Life Support

  • Adult advanced cardiovascular life support3 [2015, AHA – Part 7]
  • Post-cardiac arrest care4 [2015, AHA – Part 8]
  • Pediatric advanced life support5 [2015, AHA – Part 12]

Anaphylaxis

  • Anaphylaxis6 [2011, World Allergy Organization]
  • Anaphylaxis update7 [2015 update, WAO]

Atrial Fibrillation

  • Atrial fibrillation8 [2014, AHA/ACC/Heart Rhythm Society]

Bleeding

  • Anticoagulant therapy: Antithrombotic Therapy for VTE Disease, 10th ed9 [2016, American College of Chest Physicians]
  • Gastroesophageal varices and variceal hemorrhage in cirrhosis10 [2007, American College of Gastroenterology]
  • Nonvariceal upper gastrointestinal bleeding11 [2010]
  • Management of bleeding in patients on oral anticoagulants12 [2017, ACC]

Hyperglycemic Crises

  • Hyperglycemic crises in adults13 [2009]

Infectious Diseases (IDSA Practice Guidelines)

Cardiovascular

  • Infective Endocarditis in adults14 [2015, AHA]

Central Nervous System

  • Bacterial meningitis15 [2004, Infectious Diseases Society of America]
  • Healthcare-associated ventriculitis and meningitis16 [2017, IDSA]
  • Encephalitis17 [2008, IDSA]

Gastrointestinal

  • Clostridium difficile infection in adults and children18 [2018, IDSA/Society for Healthcare Epidemiology of America (SHEA)]
  • Infectious diarrhea19 [2017, IDSA]

Genitourinary

  • Asymptomatic bacteriuria in adults20 [2005, IDSA – update in progress]
  • Catheter-associated urinary tract infection in adults21 [2009, IDSA]
  • Acute uncomplicated cystitis and pyelonephritis in women22 [2010, IDSA/European Society for Microbiology and Infectious Diseases]

Intra-Abdominal

  • Intra-abdominal infection in adults and children23 [2010, IDSA/Surgical Infection Society – update in progress]

Respiratory

  • Community-acquired pneumonia in adults24 [2007, IDSA/American Thoracic Society – update in progress]
  • Hospital-acquired and ventilator-associated pneumonia25 [2016, IDSA/ATS]
  • Acute bacterial rhinosinusitis in children and adults26 [2012, IDSA]
  • Group A Streptococcal pharyngitis27 [2012, IDSA]
  • Community-acquired pneumonia in infants and children older than 3 months of age28 [2011, IDSA/Pediatric Infectious Diseases Society]

Skeletal (Bones & Joints)

  • Vertebral osteomyelitis in adults.29 [2015, IDSA]

Skin & Soft Tissue

  • Diabetic foot infections30 [2012, IDSA]
  • Skin and soft tissue infections31 [2014, IDSA]
  • Methicillin-resistant Staphylococcus Aureus infections in adults and children32 [2011, IDSA]
  • Monitoring of vancomycin in adults33 [2009, IDSA/American Society of Health-System Pharmacists/Society of Infectious Diseases Pharmacists – update in progress]
  • Antimicrobial prophylaxis in surgery34 [2013, IDSA/ASHP/SHEA/SIS]

Neurology/Neurosurgery

  • Acute ischemic stroke35 [2018, AHA/American Stroke Association]
  • Spontaneous intracerebral hemorrhage36 [2015, AHA/ASA]
  • Reversal of antithrombotics in intracranial hemorrhage37 [2016, Neurocritical Care Society/Society of Critical Care Medicine]
  • Status epilepticus38 [2012, NCS]
  • Convulsive status epilepticus in children and adults39 [2016, American Epilepsy Society]
  • Acute migraine in adults40 [2016, American Headache Society]

Pain, Agitation, and Delirium

  • Pain, agitation, and delirium in adult patients in the ICU41 [2013, American College of Critical Care Medicine]

Sepsis

  • Sepsis and septic shock42 [2016, Suriving Sepsis Campaign]

Sexually-Transmitted Infections and Post-Exposure Prophylaxis

  • Sexually transmitted diseases43 [2015, Centers for Disease Control and Prevention]
  • Occupational postexposure prophylaxis44 [2013, U.S. Public Health Service]
  • Nonoccupational postexposure prophylaxis [2016, CDC – Accessed on June 7, 2017]

Toxicology

  • Calcium channel blocker poisoning in adults45 [2017]
  • Intravenous lipid emulsion therapy in poisoning46 [2016, Lipid Emulsion Workgroup]

Other

1.
Amsterdam E, Wenger N, Brindis R, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;130(25):2354-2394. [PubMed]
2.
American C, Society for, O’Gara P, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78-140. [PubMed]
3.
Link M, Berkow L, Kudenchuk P, et al. Part 7: Adult Advanced Cardiovascular Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S444-64. [PubMed]
4.
Callaway C, Donnino M, Fink E, et al. Part 8: Post-Cardiac Arrest Care: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S465-82. [PubMed]
5.
de C, Berg M, Chameides L, et al. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015;132(18 Suppl 2):S526-42. [PubMed]
6.
Simons F, Ardusso L, Bilò M, et al. World allergy organization guidelines for the assessment and management of anaphylaxis. World Allergy Organ J. 2011;4(2):13-37. [PubMed]
7.
Simons F, Ebisawa M, Sanchez-Borges M, et al. 2015 update of the evidence base: World Allergy Organization anaphylaxis guidelines. World Allergy Organ J. 2015;8(1):32. [PubMed]
8.
January C, Wann L, Alpert J, et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2014;64(21):e1-76. [PubMed]
9.
Kearon C, Akl E, Ornelas J, et al. Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016;149(2):315-352. [PubMed]
10.
Garcia-Tsao G, Sanyal A, Grace N, Carey W, Practice G, Practice P. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46(3):922-938. [PubMed]
11.
Barkun A, Bardou M, Kuipers E, et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101-113. [PubMed]
12.
Tomaselli G, Mahaffey K, Cuker A, et al. 2017 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Task Force on Expert Consensus Decision Pathways. J Am Coll Cardiol. 2017;70(24):3042-3067. [PubMed]
13.
Kitabchi A, Umpierrez G, Miles J, Fisher J. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32(7):1335-1343. [PubMed]
14.
Baddour L, Wilson W, Bayer A, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation. 2015;132(15):1435-1486. [PubMed]
15.
Tunkel A, Hartman B, Kaplan S, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004;39(9):1267-1284. [PubMed]
16.
Tunkel A, Hasbun R, Bhimraj A, et al. 2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clin Infect Dis. February 2017. [PubMed]
17.
Tunkel A, Glaser C, Bloch K, et al. The management of encephalitis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2008;47(3):303-327. [PubMed]
18.
McDonald L, Gerding D, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. February 2018. [PubMed]
19.
Shane A, Mody R, Crump J, et al. 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious Diarrhea. Clin Infect Dis. 2017;65(12):1963-1973. [PubMed]
20.
Nicolle L, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40(5):643-654. [PubMed]
21.
Hooton T, Bradley S, Cardenas D, et al. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(5):625-663. [PubMed]
22.
Gupta K, Hooton T, Naber K, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-20. [PubMed]
23.
Solomkin J, Mazuski J, Bradley J, et al. Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(2):133-164. [PubMed]
24.
Mandell L, Wunderink R, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44 Suppl 2:S27-72. [PubMed]
25.
Kalil A, Metersky M, Klompas M, et al. Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia: 2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect Dis. 2016;63(5):e61-e111. [PubMed]
26.
Chow A, Benninger M, Brook I, et al. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112. [PubMed]
27.
Shulman S, Bisno A, Clegg H, et al. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):1279-1282. [PubMed]
28.
Bradley J, Byington C, Shah S, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25-76. [PubMed]
29.
Berbari E, Kanj S, Kowalski T, et al. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis. 2015;61(6):e26-46. [PubMed]
30.
Lipsky B, Berendt A, Cornia P, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132-73. [PubMed]
31.
Stevens D, Bisno A, Chambers H, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-52. [PubMed]
32.
Liu C, Bayer A, Cosgrove S, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011;52(3):e18-55. [PubMed]
33.
Rybak M, Lomaestro B, Rotschafer J, et al. Therapeutic monitoring of vancomycin in adult patients: a consensus review of the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Am J Health Syst Pharm. 2009;66(1):82-98. [PubMed]
34.
Bratzler D, Dellinger E, Olsen K, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. [PubMed]
35.
Powers W, Rabinstein A, Ackerson T, et al. 2018 Guidelines for the Early Management of Patients With Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. January 2018. [PubMed]
36.
Hemphill J, Greenberg S, Anderson C, et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2015;46(7):2032-2060. [PubMed]
37.
Frontera J, Lewin J, Rabinstein A, et al. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocrit Care. 2016;24(1):6-46. [PubMed]
38.
Brophy G, Bell R, Claassen J, et al. Guidelines for the evaluation and management of status epilepticus. Neurocrit Care. 2012;17(1):3-23. [PubMed]
39.
Glauser T, Shinnar S, Gloss D, et al. Evidence-Based Guideline: Treatment of Convulsive Status Epilepticus in Children and Adults: Report of the Guideline Committee of the American Epilepsy Society. Epilepsy Curr. 2016;16(1):48-61. [PubMed]
40.
Orr S, Friedman B, Christie S, et al. Management of Adults With Acute Migraine in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache. 2016;56(6):911-940. [PubMed]
41.
Barr J, Fraser G, Puntillo K, et al. Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Crit Care Med. 2013;41(1):263-306. [PubMed]
42.
Rhodes A, Evans L, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017;45(3):486-552. [PubMed]
43.
Workowski K, Bolan G, Centers for. Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep. 2015;64(RR-03):1-137. [PubMed]
44.
Kuhar D, Henderson D, Struble K, et al. Updated US Public Health Service guidelines for the management of occupational exposures to human immunodeficiency virus and recommendations for postexposure prophylaxis. Infect Control Hosp Epidemiol. 2013;34(9):875-892. [PubMed]
45.
St-Onge M, Anseeuw K, Cantrell F, et al. Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults. Crit Care Med. 2017;45(3):e306-e315. [PubMed]
46.
Gosselin S, Hoegberg L, Hoffman R, et al. Evidence-based recommendations on the use of intravenous lipid emulsion therapy in poisoning<sup/>. Clin Toxicol (Phila). 2016;54(10):899-923. [PubMed]

Author information

Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP

Bryan D. Hayes, PharmD, DABAT, FAACT, FASHP

Leadership Team, ALiEM
Creator and Lead Editor, Capsules and EM Pharm Pearls Series
Attending Pharmacist, EM and Toxicology, MGH
Associate Professor of EM, Division of Medical Toxicology, Harvard Medical School

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