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
7256
Axillary Artery and Vein Cannulation
07-30-2015
8617
Blunt Cardiac Trauma
09-29-2016
3743
Free Flap Management
03-05-2018
2880
Hypertension Management
11-26-2015
8181
Noninvasive Hemodynamic Monitoring
09-29-2016
3692
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
2289
Vasopressors and Inotropes in Shock
09-12-2019
27600


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
3327
Hyperglycemia Control in the Critically Ill
12-07-2011
5196
Thyroid Management in the ICU
06-18-2019
1404


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
13942
Fluid Resuscitation
11-03-2017
6482
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
4314
Rhabdomyolysis: Prevention and Treatment
08-12-2018
7166


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
4412
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
5383
Blunt Splenic Injury
09-30-2015
4056
Cirrhotic Management
02-25-2016
2682
Clostridium difficile Infection
06-29-2015
3508
Diverticulitis
09-30-2015
2729
Enteral Feeding Guidelines
04-10-2017
7593
Intra-abdominal Pressure Monitoring
03-23-2015
2778
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
9761
Percutaneous Endoscopic Gastrostomy
06-04-2014
2070
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
3817
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
4711
Small Bowel Obstruction
06-04-2014
2560
Stress Ulcer Prophylaxis
11-03-2017
4526


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
3000
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
6157
Disseminated Intravascular Coagulation
04-10-2017
2089
DVT Prophylaxis in Solid Organ Injury
12-05-2013
2489
Erythropoietin Use in the Critically Ill
02-06-2008
4211
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
2636
Heparin Induced Thrombocytopenia
09-14-2019
2755
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
2522
Massive Transfusion Protocol for Hemorrhagic Shock
11-03-2017
25022
Non-Vitamin K Anticoagulation Reversal
08-12-2018
3612
Thromboelastography (TEG) in Trauma
12-04-2014
4404
Venous Thromboprophylaxis in Obesity
02-25-2016
11365
Warfarin Dosing
09-01-2009
3123
Warfarin Reversal
11-30-2017
4092


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2446
Antibiotic Prophylaxis in Surgery
11-30-2013
10741
Candida Infections in Surgical Patients
04-10-2017
4232
Continuous Antibiotic Infusions
05-16-2007
2156
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
4910
Facial Fracture Antibiotics
06-27-2019
1163
Presumptive Chest Tube Antibiotics
03-07-2013
2555


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
7350
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
23060
Blunt Cerebrovascular Injury
09-30-2015
3500
Brain Death Determination / Apnea Test Procedure
09-10-2019
5232
Cervical Spine Clearance
12-13-2017
3164
Delirium Management in the ICU
08-12-2018
4955
Hypertonic Saline Solution Instructions
05-07-2008
2989
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6292
Pain Management in Surgery
09-30-2015
2979
Sedation and Agitation Management in the ICU
10-25-2009
3017
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
26859
Severe Traumatic Brain Injury Management
09-11-2019
7730
Syncope Evaluation in the Trauma Patient
09-29-2016
2271
Therapeutic Hypothermia
02-25-2016
2593


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
2634
Chest Tube Management
09-29-2016
3623
Diaphragm Pacing
07-18-2019
896
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
1758
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2274
Independent Lung Ventilation
12-04-2014
2073
Multi-modality Rib Fracture Management
12-01-2010
3932
Paracostal Infusion of Bupivacaine for Management of Rib Fracture Pain
04-21-2010
4066
Peri-Procedural Tracheostomy Complications
01-04-2013
2005
Post-Extubation Stridor
08-01-2017
5190
Post-Tracheostomy Hemorrhage
07-30-2015
3125
Rescue Ventilation
08-22-2018
2293
Retained Hemothorax
04-28-2016
6739
Surgical Fixation of Rib Fractures
02-07-2013
9082
Timing of Tracheostomy
09-30-2015
4062
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
3162
Ventilator-Associated Pneumonia
02-25-2016
2644


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
1299
Burn Resuscitation
06-18-2019
3996
Ketamine Sedation for Adult Burn Dressing Changes
12-07-2013
3635
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
4161
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
2578
Snakebite/crotalid Antivenoms
09-28-2018
3192


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
2980
Central Venous Catheterization
12-04-2009
5819
Fever Assessment
06-27-2019
5487
Gabapentin in Post-operative Pain Management
09-29-2016
4785
Ketamine for Analgesia
12-13-2017
4488
Laparoscopy in Trauma
02-25-2016
2331
Mangled Extremity
04-28-2016
3736
Muscle Relaxants in Multimodal Pain Management
01-26-2017
4295
Necrotizing Soft Tissues Infections
09-28-2018
3438
Negative Pressure Wound Therapy
02-06-2014
2052
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
6098



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