Evidence Based-Medicine Guidelines

The following is a collection of best practice guidelines currently in use by the Surgical Critical Care and Acute Care Surgery teams at Orlando Regional Medical Center (ORMC). They are based upon the most recent medical literature and are reviewed and updated on a regular basis. Guidelines that are either or have been within the past 180 days are marked accordingly. Please note that certain aspects of these guidelines, such as antibiotic sensitivities and recommendations, are specific to the adult ICU's at ORMC and may not be applicable to other patient populations. These guidelines may be downloaded and adapted for use in your own intensive care unit. Please contact the Webmaster if you have questions or suggestions regarding these guidelines.

Are you rotating on the ORMC Surgical Critical Care team? If so, watch this brief video describing your involvement with the Evidence-Based Medicine Guideline Committee


The Evidence-Based Medicine Guidelines Committee is pleased to share these guidelines for clinical use in your intensive care unit. If you choose to do so, the Committee requests that the time and effort involved in developing these guidelines be appropriately recognized. All guidelines contained on this site are copyrighted by SurgicalCriticalCare.net unless otherwise indicated.

Guidelines should be referenced in the following manner: Rojas K, Birrer K, Cheatham M, Smith C. Seizure Prophylaxis following Traumatic Brain Injury. http://www.surgicalcriticalcare.net/Guidelines/Seizure prophylaxis in TBI 2017.pdf. Updated July 26, 2017. Accessed November 13, 2017.



Cardiovascular

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Atrial Fibrillation in the Surgical Patient
12-13-2017
8553
Axillary Artery and Vein Cannulation
07-30-2015
9970
Blunt Cardiac Trauma
09-29-2016
4462
Free Flap Management
02-21-2020
4378
Hypertension Management
11-26-2015
9502
Noninvasive Hemodynamic Monitoring
09-29-2016
4327
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
2975
Vasopressors and Inotropes in Shock
09-12-2019
31967


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
4075
Hyperglycemia Control in the Critically Ill
12-07-2011
6295
Thyroid Management in the ICU
06-18-2019
2492


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
16746
Fluid Resuscitation
11-03-2017
9839
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
5669
Rhabdomyolysis: Prevention and Treatment
08-12-2018
9127


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
5222
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
6895
Blunt Splenic Injury
09-30-2015
4655
Cirrhotic Management
02-25-2016
3340
Clostridium difficile Infection
06-29-2015
4142
Diverticulitis
09-30-2015
3445
Enteral Feeding Guidelines
04-10-2017
10037
Intra-abdominal Pressure Monitoring
03-23-2015
3455
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
12208
Percutaneous Endoscopic Gastrostomy
06-04-2014
2592
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
7674
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
5615
Small Bowel Obstruction
06-04-2014
3139
Stress Ulcer Prophylaxis
11-03-2017
5423


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
3804
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
7091
Disseminated Intravascular Coagulation
04-10-2017
2626
DVT Prophylaxis in Solid Organ Injury
12-05-2013
3002
Erythropoietin Use in the Critically Ill
02-06-2008
4810
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
3118
Heparin Induced Thrombocytopenia
09-14-2019
3978
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
3008
Massive Transfusion Protocol for Hemorrhagic Shock
05-27-2020
29089
Non-Vitamin K Anticoagulation Reversal
08-12-2018
4147
Thromboelastography (TEG) in Trauma
12-04-2014
5292
Ultrasound Guided Peripheral IV Insertion
05-27-2020
34
Venous Thromboprophylaxis in Obesity
02-25-2016
13223
Warfarin Dosing
09-01-2009
3562
Warfarin Reversal
11-30-2017
4746


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2865
Antibiotic Prophylaxis in Surgery
11-30-2013
11794
Candida Infections in Surgical Patients
04-10-2017
4689
Continuous Antibiotic Infusions
05-16-2007
2580
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
5505
Facial Fracture Antibiotics
04-29-2020
2291
Presumptive Chest Tube Antibiotics
03-07-2013
3007


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
8205
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
23754
Blunt Cerebrovascular Injury
09-30-2015
3979
Brain Death Determination / Apnea Test Procedure
09-10-2019
6612
Cervical Spine Clearance
12-13-2017
3701
Delirium Management in the ICU
08-12-2018
6269
Hypertonic Saline Solution Instructions
05-07-2008
3503
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6771
Pain Management in Surgery
09-30-2015
3488
Sedation and Agitation Management in the ICU
10-25-2009
3582
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
30369
Severe Traumatic Brain Injury Management
09-11-2019
9729
Syncope Evaluation in the Trauma Patient
09-29-2016
2769
Therapeutic Hypothermia
02-25-2016
3110


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
3133
Chest Tube Management
09-29-2016
4375
Diaphragm Pacing
07-18-2019
1738
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
2356
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2692
Independent Lung Ventilation
12-04-2014
2473
Multi-modality Rib Fracture Management
03-05-2020
5107
Peri-Procedural Tracheostomy Complications
01-04-2013
2398
Post-Extubation Stridor
08-01-2017
5661
Post-Tracheostomy Hemorrhage
07-30-2015
3798
Rescue Ventilation
08-22-2018
3076
Retained Hemothorax
04-28-2016
7847
Surgical Fixation of Rib Fractures
02-07-2013
9645
Timing of Tracheostomy
04-29-2020
4828
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
3918
Ventilator-Associated Pneumonia
02-25-2016
3187


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
2217
Burn Resuscitation
11-26-2019
6207
Ketamine for Analgesia
12-27-2019
4933
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
6830
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
3008
Snakebite/crotalid Antivenoms
09-28-2018
3717


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
3619
Central Venous Catheterization
12-04-2009
6509
Fever Assessment
06-27-2019
6934
Gabapentin in Post-operative Pain Management
09-29-2016
5283
Ketamine for Analgesia
12-13-2017
6093
Laparoscopy in Trauma
02-25-2016
2836
Mangled Extremity
04-28-2016
4523
Muscle Relaxants in Multimodal Pain Management
01-26-2017
5189
Necrotizing Soft Tissues Infections
09-28-2018
4427
Negative Pressure Wound Therapy
02-06-2014
2462
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
7428



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