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
8820
Axillary Artery and Vein Cannulation
07-30-2015
10325
Blunt Cardiac Trauma
09-29-2016
4607
Free Flap Management
02-21-2020
4969
Hypertension Management
11-26-2015
9792
Noninvasive Hemodynamic Monitoring
09-29-2016
4444
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
3082
Vasopressors and Inotropes in Shock
09-12-2019
33130


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
4198
Hyperglycemia Control in the Critically Ill
12-07-2011
6492
Thyroid Management in the ICU
06-18-2019
2640


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
17364
Fluid Resuscitation
11-03-2017
10447
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
5986
Rhabdomyolysis: Prevention and Treatment
08-12-2018
9621


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
5378
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
7437
Blunt Splenic Injury
09-30-2015
4756
Cirrhotic Management
02-25-2016
3442
Clostridium difficile Infection
06-29-2015
4246
Diverticulitis
09-30-2015
3533
Enteral Feeding Guidelines
04-10-2017
10562
Intra-abdominal Pressure Monitoring
03-23-2015
3543
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
12874
Percutaneous Endoscopic Gastrostomy
06-11-2020
2834
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
7871
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
5809
Small Bowel Obstruction
06-04-2014
3238
Stress Ulcer Prophylaxis
11-03-2017
5636


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
3891
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
7237
Disseminated Intravascular Coagulation
04-10-2017
2699
DVT Prophylaxis in Solid Organ Injury
12-05-2013
3097
Erythropoietin Use in the Critically Ill
02-06-2008
4916
Heparin Induced Thrombocytopenia
09-14-2019
4187
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
3093
Massive Transfusion Protocol for Hemorrhagic Shock
05-27-2020
30534
Non-Vitamin K Anticoagulation Reversal
08-12-2018
4247
Thromboelastography (TEG) in Trauma
12-04-2014
5463
Ultrasound Guided Peripheral IV Insertion
05-27-2020
359
Venous Thromboprophylaxis in Obesity
02-25-2016
13505
Warfarin Dosing
09-01-2009
3640
Warfarin Reversal
11-30-2017
4872


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2949
Antibiotic Prophylaxis in Surgery
11-30-2013
11964
Candida Infections in Surgical Patients
04-10-2017
4774
Continuous Antibiotic Infusions
05-16-2007
2653
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
5610
Facial Fracture Antibiotics
04-29-2020
2883
Presumptive Chest Tube Antibiotics
03-07-2013
3077


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
8378
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
23891
Blunt Cerebrovascular Injury
09-30-2015
4066
Brain Death Determination / Apnea Test Procedure
09-10-2019
6787
Cervical Spine Clearance
12-13-2017
3793
Delirium Management in the ICU
08-12-2018
6610
Hypertonic Saline Bolus & Infusion Instructions
05-27-2020
3852
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6840
Pain Management in Surgery
09-30-2015
3561
Sedation and Agitation Management in the ICU
10-25-2009
3687
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
31347
Severe Traumatic Brain Injury Management
09-11-2019
10169
Syncope Evaluation in the Trauma Patient
09-29-2016
2856
Therapeutic Hypothermia
02-25-2016
3201


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
3229
Chest Tube Management
09-29-2016
4545
Diaphragm Pacing
07-18-2019
1811
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
2462
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2756
Independent Lung Ventilation
12-04-2014
2549
Multi-modality Rib Fracture Management
03-05-2020
5593
Peri-Procedural Tracheostomy Complications
01-04-2013
2462
Post-Extubation Stridor
08-01-2017
5743
Post-Tracheostomy Hemorrhage
07-30-2015
3918
Rescue Ventilation
08-22-2018
3191
Retained Hemothorax
04-28-2016
8125
Surgical Fixation of Rib Fractures
02-07-2013
9715
Timing of Tracheostomy
04-29-2020
5210
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
4075
Ventilator-Associated Pneumonia
02-25-2016
3263


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
2454
Burn Resuscitation
11-26-2019
6672
Ketamine for Analgesia
12-27-2019
5207
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
7239
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
3090
Snakebite/crotalid Antivenoms
09-28-2018
3858


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
3726
Central Venous Catheterization
12-04-2009
6634
Fever Assessment
06-27-2019
7175
Gabapentin in Post-operative Pain Management
09-29-2016
5377
Ketamine for Analgesia
12-13-2017
6613
Laparoscopy in Trauma
02-25-2016
2923
Mangled Extremity
04-28-2016
4679
Muscle Relaxants in Multimodal Pain Management
01-26-2017
5428
Necrotizing Soft Tissues Infections
09-28-2018
4654
Negative Pressure Wound Therapy
02-06-2014
2533
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
7674



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