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
6655
Axillary Artery and Vein Cannulation
07-30-2015
7991
Blunt Cardiac Trauma
09-29-2016
3398
Free Flap Management
03-05-2018
2311
Hypertension Management
11-26-2015
7461
Noninvasive Hemodynamic Monitoring
09-29-2016
3359
Resuscitative Balloon Occlusion of the Aorta (REBOA)
08-12-2018
1898
Vasopressors and Inotropes in Shock
04-20-2011
26058


Endocrine

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Critical Illness-Related Corticosteroid Insufficiency
03-03-2015
2955
Hyperglycemia Control in the Critically Ill
12-07-2011
4734
Thyroid Management in the ICU
06-18-2019
547


Fluids/Electrolytes/Nutrition

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Electrolyte Replacement
08-12-2018
12299
Fluid Resuscitation
11-03-2017
5892
Nasogastric/Nasoenteric Tube Placement in Traumatic Craniofacial Fractures
01-26-2017
3709
Rhabdomyolysis: Prevention and Treatment
08-12-2018
5544


Gastrointestinal

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Cholecystitis
01-08-2015
3961
Acute Gastrointestinal Hemorrhage: Pharmacologic Management
12-13-2017
4847
Blunt Splenic Injury
09-30-2015
3756
Cirrhotic Management
02-25-2016
2407
Clostridium difficile Infection
06-29-2015
3199
Diverticulitis
09-30-2015
2433
Enteral Feeding Guidelines
04-10-2017
6748
Intra-abdominal Pressure Monitoring
03-23-2015
2477
Octreotide in the Prevention and Treatment of Gastrointestinal and Pancreatic Fistulas
11-03-2017
8352
Percutaneous Endoscopic Gastrostomy
06-04-2014
1841
Post-Splenectomy Vaccine Prophylaxis
01-27-2019
3422
Premature Gastrostomy / Jejunostomy Removal
10-21-2009
4296
Small Bowel Obstruction
06-04-2014
2261
Stress Ulcer Prophylaxis
11-03-2017
4140


Hematologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Blood Conservation and Transfusion Avoidance Strategies in the Surgical Patient
06-27-2019
2259
Deep Venous Thrombosis Prophylaxis in the Critically Ill
01-30-2014
5701
Disseminated Intravascular Coagulation
04-10-2017
1841
DVT Prophylaxis in Solid Organ Injury
12-05-2013
2217
Erythropoietin Use in the Critically Ill
02-06-2008
3872
Factor VIIa (Recombinant) (Novoseven®) in Trauma
09-03-2008
2401
Heparin Induced Thrombocytopenia
09-05-2013
2186
Inferior Vena Caval Filter Use in Patients at High Risk for Pulmonary Embolism
10-28-2009
2274
Massive Transfusion Protocol for Hemorrhagic Shock
11-03-2017
22896
Non-Vitamin K Anticoagulation Reversal
08-12-2018
3326
Thromboelastography (TEG) in Trauma
12-04-2014
3914
Venous Thromboprophylaxis in Obesity
02-25-2016
10426
Warfarin Dosing
09-01-2009
2860
Warfarin Reversal
11-30-2017
3757


Infectious Disease

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Aerosolized Antibiotic Therapy in the ICU
03-30-2016
2237
Antibiotic Prophylaxis in Surgery
11-30-2013
9614
Candida Infections in Surgical Patients
04-10-2017
3990
Continuous Antibiotic Infusions
05-16-2007
1914
Empiric Antibiotic Use in Critically Ill Patients
05-09-2007
4585
Facial Fracture Antibiotics
06-27-2019
375
Presumptive Chest Tube Antibiotics
03-07-2013
2327


Neurologic

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Acute Spinal Cord Injury Guideline
09-11-2018
6872
Antiplatelet Agent Reversal in Adults With Traumatic Intracranial Hemorrhage
04-10-2017
22674
Blunt Cerebrovascular Injury
09-30-2015
3254
Brain Death Determination / Apnea Test Procedure
09-30-2015
4454
Cervical Spine Clearance
12-13-2017
2885
Delirium Management in the ICU
08-12-2018
4297
Hypertonic Saline Solution Instructions
05-07-2008
2704
Methylprednisolone (Solumedrol) in Acute Spinal Cord Injury
08-02-2014
6015
Pain Management in Surgery
09-30-2015
2745
Sedation and Agitation Management in the ICU
10-25-2009
2731
Seizure Prophylaxis in Traumatic Brain Injury
08-01-2017
25932
Severe Traumatic Brain Injury Management
06-27-2019
6497
Syncope Evaluation in the Trauma Patient
09-29-2016
2026
Therapeutic Hypothermia
02-25-2016
2337


Respiratory

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Air Travel Following Traumatic Pneumothorax
03-20-2015
2383
Chest Tube Management
09-29-2016
3288
Diaphragm Pacing
07-18-2019
224
Extubating the Trauma Patient with an Open Abdomen
06-24-2018
1437
High frequency oscillatory ventilation in the surgical patient
03-04-2009
2036
Independent Lung Ventilation
12-04-2014
1872
Multi-modality Rib Fracture Management
12-01-2010
3620
Paracostal Infusion of Bupivacaine for Management of Rib Fracture Pain
04-21-2010
3765
Peri-Procedural Tracheostomy Complications
01-04-2013
1798
Post-Extubation Stridor
08-01-2017
4937
Post-Tracheostomy Hemorrhage
07-30-2015
2850
Rescue Ventilation
08-22-2018
1931
Retained Hemothorax
04-28-2016
6043
Surgical Fixation of Rib Fractures
02-07-2013
8804
Timing of Tracheostomy
09-30-2015
3756
Tissue Plasminogen Activator in Traumatic Hemothorax
04-01-2018
2802
Ventilator-Associated Pneumonia
02-25-2016
2394


Skin

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Burn Inhalation injury
06-18-2019
504
Burn Resuscitation
06-18-2019
3050
Ketamine Sedation for Adult Burn Dressing Changes
12-07-2013
3410
Perioperative Hypothermia Prevention in Burn Patients
04-01-2018
3048
Remifentanil Infusion for Adult Burn Dressing Changes
10-29-2009
2361
Snakebite/crotalid Antivenoms
09-28-2018
2926


Miscellaneous

EBM Guideline
Revision Date
Times Accessed (since 10/1/16)
Alcohol Withdrawal
07-30-2015
2661
Central Venous Catheterization
12-04-2009
5484
Fever Assessment
06-27-2019
4436
Gabapentin in Post-operative Pain Management
09-29-2016
4512
Ketamine for Analgesia
12-13-2017
3711
Laparoscopy in Trauma
02-25-2016
2123
Mangled Extremity
04-28-2016
3383
Muscle Relaxants in Multimodal Pain Management
01-26-2017
3816
Necrotizing Soft Tissues Infections
09-28-2018
2970
Negative Pressure Wound Therapy
02-06-2014
1840
Neuromuscular Blocking Agents in the Adult ICU
08-02-2018
5531



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