This clinical policy focuses on critical issues concerning the management of patients
presenting to the emergency department (ED) with acetaminophen overdose. The subcommittee
reviewed the medical literature relevant to the questions posed. The critical questions
are:
- 1.What are the indications for N-acetylcysteine (NAC) in the acetaminophen overdose patient with a known time of acute ingestion who can be risk stratified by the Rumack-Matthew nomogram?
- 2.What are the indications for NAC in the acetaminophen overdose patient who cannot be risk stratified by the Rumack-Matthew nomogram?
Recommendations are provided on the basis of the strength of evidence of the literature.
Level A recommendations represent patient management principles that reflect a high degree of clinical certainty;
Level B recommendations represent patient management principles that reflect moderate clinical certainty;
and Level C recommendations represent other patient management strategies that are based on preliminary, inconclusive,
or conflicting evidence, or based on committee consensus. This guideline is intended
for physicians working in EDs.
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Article info
Footnotes
Reprinted from Wolf SJ, Heard K, Sloan EP, Jagoda AS. American College of Emergency Physicians Clinical Policies Subcommittee. Clinical policy: critical issues in the management of patients presenting to the emergency department with acetaminophen overdose. Ann Emerg Med. 2007;50:292-313. Reprinted with permission from the American College of Emergency Physicians.
Policy statements and clinical policies are the official policies of the American College of Emergency Physicians and, as such, are not subject to the same peer review process as articles appearing in the print journal. Policy statements and clinical policies of ACEP do not necessarily reflect the policies and beliefs of Annals of Emergency Medicine and its editors.
Members of the American College of Emergency Physicians Clinical Policies Committee (Oversight Committee):
- Andy S. Jagoda, MD (Chair 2003-2006, Co-Chair 2006-2007)
- Wyatt W. Decker, MD (Co-Chair 2006-2007)
- Deborah B. Diercks, MD
- Jonathan A. Edlow, MD
- Francis M. Fesmire, MD
- Steven A. Godwin, MD
- Sigrid A. Hahn, MD
- John M. Howell, MD
- J. Stephen Huff, MD
- Thomas W. Lukens, MD, PhD
- Donna L. Mason, RN, MS, CEN (ENA Representative 2004-2006)
- Michael Moon, RN, CNS, MSN, CEN (ENA Representative 2004)
- Anthony M. Napoli, MD (EMRA Representative 2004-2006)
- Devorah Nazarian, MD
- Jim Richmann, RN, BS, MA(c), CEN (ENA Representative 2006-2007)
- Scott M. Silvers, MD
- Edward P. Sloan, MD, MPH
- Molly E. W. Thiessen, MD (EMRA Representative 2006-2007)
- Robert L. Wears, MD, MS (Methodologist)
- Stephen J. Wolf, MD
- Cherri D. Hobgood, MD (Board Liaison 2004-2006)
- David C. Seaberg, MD, CPE (Board Liaison 2006-2007)
- Rhonda R. Whitson, RHIA, Staff Liaison, Clinical Policies Committee and Subcommittees
Approved by the ACEP Board of Directors, June 13, 2007
Supported by the Emergency Nurses Association, July 22, 2007
Identification
Copyright
© 2007 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.
